Most recent papers:

• Reducing geriatric outpatient waiting times: Impact of an advanced health practitioner.
  Robyn L Saxon, Marion A Gray, Florin I Oprescu.
  Australasian Journal on Ageing. October 17, 2017
  Objective To investigate the impact on patient waiting times of a role substitution model introducing an advanced allied health practitioner as the first point of contact within a geriatric outpatient context. Methods A pre‐ to postintervention design was used to determine impact over a five‐year period (2008–2012). All patients referred to the geriatric specialist outpatient department were included (n = 1514). Data relating to waiting times were analysed using one‐way ANOVA and post hoc Tukey tests to determine effects on patient waiting times. Results Waiting times were reduced from an average of 82 to as low as 35 days, in a context of increasing referral rates. Medical specialist capacity was increased through improvements to available outpatient times and reduced appointment lengths. Patients seen within their designated triage category timeframe increased from 47 to 86%. Conclusion Health professional substitution in geriatrics can be an effective intervention for reducing patient waiting times and improving access to care.

  October 17, 2017   doi: 10.1111/ajag.12459   open full text
• Dementia assessment services: What are the perceptions of older people?
  Ruth Walker, Julie Ratcliffe, Amy White, Renuka Visvanathan.
  Australasian Journal on Ageing. October 10, 2017
  Objective To determine how older people with dementia and their family caregivers experience dementia assessment services and preferences for future configuration of diagnostic services. Methods Qualitative, semistructured in‐depth interviews were conducted with nine individuals with dementia. In seven instances, the caregiver also took part in the interview, and on two occasions, the interview was with the person with dementia only. Results An important contact during assessment of dementia was the general practitioner, in particular working in a way or timeframe which provides clarity and comfort to the person with dementia and their family members. A problematic factor in clear diagnosis was when probable dementia was suspected during hospitalisation for another complaint. Participants expressed a wide range of views in terms of preferred settings for diagnostic services. Conclusion These findings highlight some key considerations, which should be included in future research leading to decisions about the design of dementia client services.

  October 10, 2017   doi: 10.1111/ajag.12455   open full text
• Identification of the trajectory of functional decline for advance care planning in a nursing home population.
  Suanne Lawrence, Andrew Robinson, Kathy Eagar.
  Australasian Journal on Ageing. September 18, 2017
  Objective To identify diagnostic groups and the form of the trajectory of functional decline that has the potential to enhance advance care planning (ACP) in a nursing home (NH) population. Methods Retrospective, longitudinal study with dependent variable (function) derived from the Resident Classification Scale (RCS), 1997–2008. Trajectory modelling used linear and curvilinear terms. Results The organ failure or other residents have a linear average functional decline. The organ failure residents had an average decline of 6.5 points per year and average function score at death of 68.6, CI [62.4, 74.8]. The cancer and frailty residents had significant curvilinear terms. The frailty residents had a slower rate of decline at 9.54 points per year and were most care dependent at death, with an average function score of 77.1, CI [73.8, 80.9]. Conclusion Functional change is a measurable variable for a predictive tool to enhance ACP for NH residents based on their diagnosis.

  September 18, 2017   doi: 10.1111/ajag.12454   open full text
• Predictors on admission of functional decline among older patients hospitalised for acute care: A prospective observational study.
  David Basic, Danielle Ní Chróinín, David Conforti, Chris Shanley.
  Australasian Journal on Ageing. August 30, 2017
  Objective We sought to investigate the incidence of, and factors associated with, in‐hospital functional decline among older acute hospital patients. Methods We conducted a prospective observational study of consecutive patients admitted under geriatric medicine over 5 years. The primary outcome measure was functional decline between admission and discharge, representing deterioration in any of the following: Modified Barthel Index (MBI), independence in Timed Up and Go test or walking, and/or need for walking aid. Results Overall, 56% (950/1693) patients (mean age 81.9 years) exhibited in‐hospital functional decline. Premorbid MBI (odds ratio (OR) 1.05 per unit increase, P < 0.001), adverse drug reaction (OR 1.50, P = 0.001) and in‐hospital consultation as the referral source (OR 1.57, P = 0.001) were independently associated with functional decline, adjusting for age, dementia and nursing home residence. Conclusion These factors may aid identification of vulnerable patients who might particularly benefit from targeted multidisciplinary intervention. Further studies validating this, and exploring the impact of focussed management, are needed.

  August 30, 2017   doi: 10.1111/ajag.12458   open full text
• Body weight status and health‐care expenditure among university retirees in Beijing, China.
  Ning Jiang, Hongjun Yu, Ruopeng An.
  Australasian Journal on Ageing. August 11, 2017
  Objective This study examined the impact of overweight and obesity on health‐care expenditure among university retirees in Beijing, China. Methods Annual health surveys of retirees were conducted at Tsinghua University during 2011–2016. Individual random‐effect regressions were performed to estimate incremental health‐care expenditures attributable to overweight/obesity, adjusting for various individual characteristics. Results Compared to their normal‐weight counterparts, obesity was associated with an increase in annual out‐of‐pocket expenditure on outpatient care by 27%, inpatient care 19% and medication 15%, and an increase in annual total out‐of‐pocket health‐care expenditure by 33%. Overweight was associated with an increase in annual out‐of‐pocket expenditure on inpatient care by 13%, and an increase in annual total out‐of‐pocket health‐care expenditure by 13%. The impact of obesity on health‐care expenditure was statistically significant among men but not women. Conclusion Overweight, and obesity in particular, was associated with substantial increases in out‐of‐pocket health‐care expenditures among Chinese older adults.

  August 11, 2017   doi: 10.1111/ajag.12453   open full text
• Quality indicators in the care of older persons in the emergency department: A systematic review of the literature.
  Ellen Burkett, Melinda G Martin‐Khan, Leonard C Gray.
  Australasian Journal on Ageing. July 31, 2017
  Objective A systematic review of the literature was undertaken to assess the methodological quality of existing quality indicators (QIs) for the emergency department (ED) care of older persons. Methods MEDLINE, CINAHL, EMBASE and grey literature were searched. Articles were included if they addressed ED care of persons aged ≥65 years and defined a QI amenable to influence by ED providers. The methodological quality of QIs was assessed using relevant items from the Appraisal of Indicators through Research and Evaluation and the QUALIFY tools. Results Sixty‐one articles were included in the review, with identification of 50 QIs meeting predefined inclusion criteria. Thirty‐six of fifty ED QIs for older persons were process indicators. The appraisal instruments’ total ratings ranged from 39 to 67%, with only 18 QIs scoring 50% or more for all five domains. Conclusion There is a need for a balanced, methodologically robust set of QIs for care of older persons in the ED.

  July 31, 2017   doi: 10.1111/ajag.12451   open full text
• Relationships in consumer‐directed care: An integrative literature review.
  Tracee Cash, Wendy Moyle, Siobhan O'Dwyer.
  Australasian Journal on Ageing. July 06, 2017
  Objective To undertake an integrative review of the literature on relationships between community aged care recipients, family carers and care providers under consumer‐directed care (CDC). Methods Seven databases were systematically searched. Peer‐reviewed and grey literature on CDC between 1998 and 2014 were assessed using an integrative literature review (ILR) framework. Search terms included CDC, self‐directed care, direct payments, community aged care, community dwelling and older adults. Full‐text copies were assessed against the inclusion criteria. Results Fifteen studies met the inclusion criteria. This ILR found no research with a specific focus on caregiving relationships for older adults. The literature did however identify relational issues such as support, planning and provider attitude as fundamental to the success of CDC. Conclusion Relationships within the caregiving triad have important implications for the way CDC is enacted, particularly when the care recipient has dementia, suggesting this population as a priority for future research.

  July 06, 2017   doi: 10.1111/ajag.12444   open full text
• Availability of services in registered retirement villages in Queensland, Australia: A content analysis.
  Xin Hu, Bo Xia, Laurie Buys, Martin Skitmore.
  Australasian Journal on Ageing. July 06, 2017
  Objective The study investigates and compares the services available in different types of registered retirement villages in Queensland (QLD). Methods A content analysis based on official websites of 175 registered villages in QLD, Australia, is presented. Results This study identifies 82 services, with activity organisation, emergency response, hairdressing and transportation being most frequently available to residents. The number of services available is associated with the village size and financial type, with residents living in large private villages having access to significantly more services. Conclusion The research findings reveal the state of the art of current industry practice. They provide useful implications for stakeholders. For instance, residents who prefer to get access to various services should focus more on large private villages. Developers can check their service delivery environment to confirm its balance with residents’ competencies. The government can propose innovative initiatives to promote the delivery of appropriate services in villages.

  July 06, 2017   doi: 10.1111/ajag.12445   open full text
• Delirium in a residential care facility: An exploratory study of staff knowledge.
  Amy Buettel, Michelle Cleary, Marguerite Bramble.
  Australasian Journal on Ageing. July 05, 2017
  Objective To explore staff knowledge of delirium by eliciting meaning through descriptions of their experiences within a residential aged care facility (RACF). Methods Six staff from one RACF in Australia participated in this qualitative study. Semi‐structured individual interviews were conducted and analysed using Colaizzi's analytical framework. Results The analysis revealed four themes: (i) absence of the word delirium; (ii) care based on intuition and automated actions; (iii) reliance on teamwork; and (iv) confusing delirium, depression and dementia. Conclusion Delirium was absent from clinical discourse in the RACF. Although participants concluded that delirium was common, lack of knowledge led to under‐assessment. Findings emphasise the need for staff education, informed assessment and clinical guidelines to better support staff care for residents.

  July 05, 2017   doi: 10.1111/ajag.12452   open full text
• ‘Although we're isolated, we're not really isolated’: The value of information and communication technology for older people in rural Australia.
  Turi Berg, Rachel Winterton, Maree Petersen, Jeni Warburton.
  Australasian Journal on Ageing. June 22, 2017
  Objective Drawing from a larger study that identified the supports and services that facilitate wellness among older people from rural communities, this study examined the specific contribution made by information and communication technology (ICT). Methods Qualitative interviews were undertaken with 60 older adults from six Australian rural areas. A preliminary thematic analysis was conducted, followed by a higher‐order inductive analysis. Results Information and communication technology use was discussed in terms of individual enrichment, and in terms of enabling connections between the individual and their social networks, community and wider service environments. Conclusion Information and communication technologies may facilitate wellness for rural older people by compensating for geographical and social isolation. In the changing world of health and aged care service delivery, ICTs will be more important than ever for rural older people in building their capacity to access the services, socialisation and support that they need, regardless of location.

  June 22, 2017   doi: 10.1111/ajag.12449   open full text
• Talking to healthcare providers about sex in later life: Findings from a qualitative study with older Australian men and women.
  Bianca Fileborn, Anthony Lyons, Wendy Heywood, Sharron Hinchliff, Sue Malta, Briony Dow, Graham Brown, Catherine Barrett, Victor Minichiello.
  Australasian Journal on Ageing. June 22, 2017
  Objective Healthcare providers (HCPs) can play an important role in supporting the sexual health of older adults; however, we know little about the experiences of older people in talking to HCPs about sex. This article examines older adults' experiences and perceptions of talking to HCPs about sex. Methods Semi‐structured interviews were conducted with 30 men and 23 women aged 60 and older recruited from a national, online survey of older Australians. Data were analysed using a thematic approach. Results Most participants did not discuss sex with their HCP, and their HCP did not raise it. For those who did discuss sex with a HCP, negative and stigmatising responses were common. Positive responses could facilitate access to sexual health care. Conclusion Older people benefit when HCPs are proactive and ask about sexual health. Education in how to talk about sex with older people would also be beneficial for HCPs.

  June 22, 2017   doi: 10.1111/ajag.12450   open full text
• Comparison of fall‐related traumatic brain injury in residential aged care and community‐dwelling older people: A population‐based study.
  Lara A Harvey, Rebecca Mitchell, Henry Brodaty, Brian Draper, Jacqueline CT Close.
  Australasian Journal on Ageing. June 21, 2017
  Objective To compare trends, causes, and outcomes of fall‐related traumatic brain injury (TBI) between community‐dwelling (CD) individuals and residential aged care facility (RACF) residents. Methods Hospitalisation and RACF administrative data for 6635 individuals aged ≥65 years admitted to all NSW hospitals for fall‐related TBI from 2008–2009 to 2012–2013 were linked. Results Of the 6944 hospitalisations, 20.8% were for RACF residents. Age‐standardised hospitalisation rates were almost fourfold higher for RACF residents than CD individuals (standardised rate ratio 3.7; 95% CI 3.4–4.1); but increased at a similar annual rate of 9.2% (95% CI 0.3–19.0) and 7.2% (95% CI 5.6–8.9), respectively. Compared to CD individuals: a higher proportion of falls in RACF residents were furniture‐related (21.4% vs 9.9%); resulted in haemorrhage (82.5% vs 73.7%); and death (23.1% vs 14.9%). Overall, 7.7% of hospitalisations for CD individuals resulted in new permanent RACF placement. Conclusion Residential aged care facility residents have higher hospitalisation rates and poorer health outcomes than their CD counterparts.

  June 21, 2017   doi: 10.1111/ajag.12422   open full text
• Role of art centres for Aboriginal Australians living with dementia in remote communities.
  Melissa Lindeman, Paulene Mackell, Xiaoping Lin, Annie Farthing, Heather Jensen, Maree Meredith, Betty Haralambous.
  Australasian Journal on Ageing. June 21, 2017
  Objective To explore the role art centres in remote communities play for Aboriginal and Torres Strait Islander Australians living with dementia. Methods A comprehensive literature search was undertaken, with no restrictions on articles regarding year of publication. Results Art programmes have been found to be of benefit to both people living with dementia and their carers, particularly when programmes are administered in environments that are culturally revered. Findings indicate remote art centres play a key role in maintaining traditions, culture and practices unique to Aboriginal and Torres Strait Islanders, but there is a gap in knowledge regarding how they cater for the needs of people with dementia. Conclusion Addressing this gap will be helpful in remote areas where prevalence of dementia is up to five times that of non‐Aboriginal people, and there are limited health and support services. Further research is required to explore strengths and gaps of current practices.

  June 21, 2017   doi: 10.1111/ajag.12443   open full text
• Well‐being of older Aboriginal Australians: The importance of ‘keeping spirit strong’.
  Kate Smith, Lianne Gilchrist.
  Australasian Journal on Ageing. June 21, 2017
  There is no abstract available for this paper.

  June 21, 2017   doi: 10.1111/ajag.12421   open full text
• Arts and cultural activity: A vital part of the health and care system.
  Paul L Cann.
  Australasian Journal on Ageing. June 21, 2017
  This article discusses how the arts and cultural activities are a vital part of a health and care system and have potential to fulfil the theme of active ageing. The changing nature of care provision in response to demographic change, fiscal pressure and increasingly consumerist attitudes on the part of care users, is considered. Selected examples of how participation in arts and cultural activities increases not only well‐being but also health outcomes are then outlined. The article highlights the potential of ‘cultural commissioning’ and within that ‘arts on prescription’ – public funding of arts‐related activities for people with care needs – and advocates investment in arts and cultural activities to better meet the demands of health, social care and aged care. Concluding remarks are made, and a way forward is suggested.

  June 21, 2017   doi: 10.1111/ajag.12438   open full text
• Meaningful use of computers has a potential therapeutic and preventative role in dementia care: A systematic review.
  Jimmy Liapis, Katherine E Harding.
  Australasian Journal on Ageing. June 15, 2017
  Objective Personal computers provide an increasingly accessible resource for leisure, social engagement and activities of daily living. This systematic review aimed to explore preventative or therapeutic benefits of such technology in people at risk of, or living with, dementia. Methods A systematic search of health databases combined key concepts of dementia and computer use. Inclusion criteria were applied, studies appraised for quality and results synthesised descriptively. Results Nine studies met inclusion criteria: Four population‐based studies and five small observational/intervention studies. Findings show an association between computer use in older age and decreased risk of dementia and provide preliminary evidence that computer‐based activity interventions are feasible and enjoyable for people with dementia. Conclusion Early findings are promising, but more rigorous studies are required to examine the nature of the relationship between computer use and dementia risk, and the potential of computer activities to improve outcomes for people experiencing cognitive decline.

  June 15, 2017   doi: 10.1111/ajag.12446   open full text
• Examining coping style and the relationship between stress and subjective well‐being in Australia's ‘sandwich generation’.
  Jade E Gillett, Dimity A Crisp.
  Australasian Journal on Ageing. June 02, 2017
  Objective The sandwich generation represents adults, often in midlife, who care for both children and ageing parents/relatives. While the stress they experience has received some attention, little research has investigated the subjective well‐being (SWB) of this population. This study examined the relationship between perceived stress and SWB and the moderating effect of coping style. Methods Ninety‐three participants (80 women), aged 23–63 years, completed an online survey measuring perceived stress, coping strategies, life satisfaction and positive and negative affect. Results Stress was negatively associated with SWB. While emotion‐ and problem‐focused coping were directly associated with SWB outcomes, the only moderating effect found was for avoidance‐focused coping (AFC). Specifically, AFC was associated with higher positive affect for those reporting lower stress. Conclusion This study highlights the need to recognise the distinct circumstances that exist for the sandwich generation. Limitations and suggestions for future research are discussed.

  June 02, 2017   doi: 10.1111/ajag.12439   open full text
• Malnutrition risk of older people across district health board community, hospital and residential care settings in New Zealand.
  Carol Wham, Emily Fraser, Julia Buhs‐Catterall, Rebecca Watkin, Cheryl Gammon, Jacqui Allen.
  Australasian Journal on Ageing. May 25, 2017
  Objective To determine the prevalence of malnutrition risk in older people across three settings. Methods Older people living in the community or newly admitted to hospital or residential care were assessed for malnutrition risk using the validated Mini‐Nutritional Assessment – Short Form and dysphagia risk using the Eating Assessment Tool‐10. Demographic, physical and health data were collected. Results Of 167 participants, 23% were malnourished and 35% were at high risk of malnutrition. Those recently admitted to residential care versus a hospital or living in the community had a higher prevalence of malnourishment (47% vs 23% and 2%) (P < 0.001). Risk of dysphagia differed with settings (P < 0.001) with highest risk in residential care. Hospitalised and residential care participants were significantly more likely to have ≥4 comorbidities, take ≥5 medications and have below normal cognition compared to community participants. Conclusion Choice of nutrition intervention is setting dependent.

  May 25, 2017   doi: 10.1111/ajag.12410   open full text
• Projections of the number of Australians with disability aged 65 and over eligible for the National Disability Insurance Scheme: 2017–2026.
  Nicholas Biddle, Heather Crawford.
  Australasian Journal on Ageing. May 25, 2017
  Objective To develop projections of the size of the Australian population aged 65 years and over eligible for disability support through the National Disability Insurance Scheme (NDIS) for the decade following its introduction, to support planning and costing of the scheme. Methods We estimate disability and mortality transition probabilities and develop projections of the NDIS‐eligible, ageing population from 2017 to 2026. Results An estimated 8000 men and 10 200 women aged 65 years and over will be eligible for support through the NDIS in 2017 (the scheme's first full year), increasing to 48 800 men and 56 900 women in 2026. Conclusions Growth in the NDIS‐eligible, ageing population has implications for relative budget allocations between the NDIS and the aged‐care system, and projections of the size of this population are useful for calculating the overall cost of the NDIS.

  May 25, 2017   doi: 10.1111/ajag.12415   open full text
• Functional neuroimaging offers insights into delirium pathophysiology: A systematic review.
  Lucy Haggstrom, Robert Welschinger, Gideon A Caplan.
  Australasian Journal on Ageing. May 18, 2017
  Objective This systematic review describes the current functional neuroimaging literature in delirium, discusses pathophysiological implications of these results and highlights areas for further study. Methods In accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, an extensive search of medical databases was undertaken, identifying eighteen studies of variable quality and design suitable for inclusion. Results Functional neuroimaging has highlighted significant abnormalities during delirium, with disturbances in cerebral haemodynamics and functional connectivity potentially playing a key role in delirium pathophysiology. Conclusions Although employing functional neuroimaging in delirium remains difficult, these findings demonstrate the potential of functional imaging to increase our understanding of the underlying mechanisms of delirium, to lead to more efficient interventions and targeted therapies and to reduce the burden of this underdiagnosed syndrome.

  May 18, 2017   doi: 10.1111/ajag.12417   open full text
• Differences in emergency ambulance demand between older adults living in residential aged care facilities and those living in the community in Melbourne, Australia.
  Kate Cantwell, Amee Morgans, Karen Smith, Michael Livingston, Paul Dietze.
  Australasian Journal on Ageing. May 07, 2017
  Objective To describe the clinical presentation and temporal variation in ambulance service cases involving patients aged 65 years or older (older adults) from residential aged care facilities and those who are community dwelling (CD). Methods This study used four years of electronic case records from Ambulance Victoria in Melbourne, Australia. Trigonometric regression was used to analyse demand patterns. Results Residential aged care facility cases included proportionally more falls and infection‐related problems and fewer circulatory‐related incidents than CD cases. Community dwelling demand patterns differed between weekdays and weekends and peaked late morning. Residential aged care facility cases peaked late morning, with a secondary peak early evening, but with no significant difference between days. Conclusions Older adult ambulance demand has distinct temporal patterns that differ by place of residence and are associated with different clinical presentations. These results provide a basis for informing ambulance planning and the identification of alternate health services.

  May 07, 2017   doi: 10.1111/ajag.12413   open full text
• Job satisfaction and intention to stay within community and residential aged care employees.
  Katrina Radford, Ellen Meissner.
  Australasian Journal on Ageing. April 27, 2017
  Objective This study investigated the different facets of job satisfaction that influence community care and residential care employees’ intention to stay in the aged care workforce. Methods A survey of four organisations in Australia was undertaken. t‐Tests were conducted to analyse differences between groups. Regression analyses were performed to examine the factors influencing intentions to stay in the workforce. Results Community care workers were more satisfied with various facets of job satisfaction including work on their present job, supervision, people in their present job and the job in general. There was a difference between how the various facets of job satisfaction influenced intentions to stay for residential care compared to community care workers. Conclusions Both workers were satisfied with their work conditions and work to different extents. There is an opportunity for residential care to look to the practices within the community care sector to improve employees’ intentions to stay.

  April 27, 2017   doi: 10.1111/ajag.12416   open full text
• Medical students’ perceptions of the importance of exercise and their perceived competence in prescribing exercise to older people.
  Agathe Daria Jadczak, Khai Loon Tam, Solomon Yu, Renuka Visvanathan.
  Australasian Journal on Ageing. April 22, 2017
  Objective To determine the effects of a 4.5‐week geriatric medicine course on fifth year medical students’ perception of the importance of and their competence in prescribing exercise to older people. Methods The modified Exercise and Physical Activity Competence Questionnaire was administered to 81 students before and after the course. Scores ranged from 0 to 6. One open‐ended question about perceived barriers to exercise prescription was asked. Results Students’ perceptions of the importance of designing an exercise prescription (P = 0.038), determining the training heart rate (P = 0.021), determining the body mass index (P > 0.001), referring an older person to an exercise program (P > 0.001) and identifying age‐related limitations (P = 0.029) improved significantly after the course. Students’ self‐perceived competence improved significantly across all items (P > 0.001). Barriers to exercise prescription included lack of: knowledge (57%), patient compliance (39%) and time (33%). Conclusion A geriatric medicine course contributes to improved senior medical students’ perceptions of importance of and their competence in prescribing exercise to older people.

  April 22, 2017   doi: 10.1111/ajag.12412   open full text
• Disease burden, comorbidity and geriatric syndromes in the Australian aged care population.
  Jodie Belinda Hillen, Agnes Vitry, Gillian E Caughey.
  Australasian Journal on Ageing. April 11, 2017
  Objective To describe the burden of disease in the Australian residential aged care population. Methods Cross‐sectional analysis of Aged Care Funding Instrument data. Results Dementia (48%), depression (22.5%) and arthritis (14.2%) were the most prevalent chronic diseases in this population. Unclassified conditions such as falls, pain and urinary incontinence were also significant burdens in this population (17.1%). Circulatory, musculoskeletal and unclassified conditions were the most prevalent comorbidities across all common medical groups. Dementia and depression were the most common comorbid mental health conditions across all medical groups. Conclusion The challenges for evaluating clinical care in Australian residential aged care are many. Delivering good clinical care should be a priority for aged care providers given the high burden of chronic disease and comorbidity. An informative starting point could be to target management of the most prevalent and burdensome conditions and comorbidities.

  April 11, 2017   doi: 10.1111/ajag.12411   open full text
• Improving the sexual lives of older Australians: Perspectives from a qualitative study.
  Bianca Fileborn, Anthony Lyons, Sharron Hinchliff, Graham Brown, Wendy Heywood, Briony Dow, Sue Malta, Victor Minichiello.
  Australasian Journal on Ageing. April 03, 2017
  Objective To examine older Australian's perspectives on how their sexual lives can best be supported and/or improved. Methods Fifty‐three, semi‐structured interviews were conducted with Australian men (n = 30) and women (n = 23) aged 60 and over. Results Participants identified a range of key issues and areas where their sexual lives could be further supported or improved upon, including normalising the occurrence of sex and sexual desire in later life; increasing and improving on the quality of, cultural representations of older adults; introducing policy, educational and practice‐based changes in age care facilities to support the consensual sexual expression of residents; and ensuring that sexual health campaigns and education are inclusive of older people. Conclusion Our findings present clear implications for further developing sexuality education and public health campaigns, training and education of health‐care professionals, and generating social and cultural change pertaining to the acceptability of the diversity of sexual expression in later life.

  April 03, 2017   doi: 10.1111/ajag.12405   open full text
• Screening for malnutrition in hospitalised older people: Comparison of the Mini Nutritional Assessment with its short‐form versions.
  Elsa Dent, Ian Chapman, Cynthia Piantadosi, Renuka Visvanathan.
  Australasian Journal on Ageing. March 27, 2017
  Objective To determine how well the Mini Nutritional Assessment (MNA) Short Form (MNA‐SF) performed as a nutritional screening tool when calf circumference replaced body mass index (BMI) as the included anthropometric measurement. Methods A total of 100 patients ≥70 years were recruited from a Geriatric Evaluation and Management Unit. Results Mean age of patients was 85.2 (6.1) years. By the full MNA, 40% of patients were malnourished. The MNA correlated highly with both of its short‐form versions (r = 0.87 and r = 0.90 for the BMI and calf circumference versions, respectively). Both MNA‐SF versions also showed high accuracy in identifying malnutrition (auROC values >0.89). Conclusions The MNA‐SF is a rapid and accurate way to screen for malnutrition in hospitalised older adults. Substitution of BMI measurement with the time‐efficient calf circumference measurement maintained MNA‐SF accuracy. It is recommended that calf circumference measurement be used for nutritional screening by MNA‐SF in a hospital setting.

  March 27, 2017   doi: 10.1111/ajag.12402   open full text
• Behavioural and neuropsychiatric disturbance in three clinical subtypes of frontotemporal dementia: A Clinical Research Center for Dementia of South Korea‐FTD Study.
  Moon Ho Park, Eun‐Joo Kim, Kyung Won Park, Jae Cheol Kwon, Bon D. Ku, Seol‐Heui Han, SangYun Kim, Dong Won Yang, Duk L. Na, Seong Hye Choi.
  Australasian Journal on Ageing. March 22, 2017
  Objectives To characterise the behavioural and neuropsychiatric disturbances of patients with three clinical subtypes of frontotemporal dementia (FTD): behavioural variant FTD (bvFTD), semantic dementia (SD) and progressive non‐fluent aphasia (PNFA). Methods Consecutive series of 66 patients with bvFTD, 58 patients with SD and 21 patients with PNFA were compared using the Frontal Behavioural Inventory (FBI) and the Neuropsychiatric Inventory (NPI). Results Patients with bvFTD had more behavioural and neuropsychiatric disturbances than patients with PNFA based on the total scores of FBI and NPI. When comparing subtotal and item scores of FBI and NPI, there were some significant differences among three clinical subtypes of FTD. Conclusion There are some distinct patterns of behavioural and neuropsychiatric disturbance among three clinical subtypes of FTD.

  March 22, 2017   doi: 10.1111/ajag.12374   open full text
• Tales from the ACFI: Dementia in residential aged care.
  Jenni Joenperä.
  Australasian Journal on Ageing. March 22, 2017
  Objective Provide an overview of how care needs in permanent residential aged care differ by dementia status. Methods On entry into permanent residential aged care, people's care needs are assessed on the Aged Care Funding Instrument (ACFI). ACFI also captures health conditions that are considered to affect the cost of people's care, such as dementia. Data were compared between 2009 and 2015. Results Assessed care needs have increased regardless of dementia status. However, compared with people without dementia, people with dementia were more likely to be rated ‘high’ in each of the three care need domains. In addition, people with dementia were more likely to require some assistance in specific areas that underlie these broad domains, such as nutrition, continence and cognition. Conclusion Dementia is associated with increased complexity in assessed care needs in permanent residential aged care.

  March 22, 2017   doi: 10.1111/ajag.12383   open full text
• Transitions to and from long‐term care facilities and length of completed stay: Reuse of population‐based survey data.
  Joanna B Broad, Thomas Lumley, Toni Ashton, Peter B Davis, Michal Boyd, Martin J Connolly.
  Australasian Journal on Ageing. March 20, 2017
  Objective This article estimates length of completed stay and resident transitions for RAC residents over 12 months in Auckland. Methods Data from a census‐type survey of nursing home residents (n = 6816) were linked with national mortality data. Transitions described include entry to residential aged care (RAC), movement between RAC facilities and deaths. Results When reweighted for missing data and adjusted for length bias, an estimated 9676 residents (95% CI 8368–10 985) used care over a 12‐month period. Half of new residents entered RAC via an acute hospital. Median survival was 2.0 years; 17% died within 3 months, and 23% survived over 5 years. Conclusion Cross‐sectional survey data, when appropriately adjusted for length‐biased sampling, enable estimates of period prevalence and transition probabilities that are useful for simulation studies. Given population ageing and the costs of ongoing care, these results can inform policy and planning for long‐term care needs of older people.

  March 20, 2017   doi: 10.1111/ajag.12378   open full text
• Vitamin D, bones and muscle: myth versus reality.
  Gustavo Duque, Robin M. Daly, Kerrie Sanders, Douglas P. Kiel.
  Australasian Journal on Ageing. March 14, 2017
  Objectives Evidence regarding the efficacy and dosing of vitamin D on fall and fracture prevention, with or without calcium, is characterised by uncertainty. Methods A panel of experts was organised at the First Australasian Conference on Sarcopenia and Frailty in Melbourne, Australia, in November 2016 to provide an interpretation of the current evidence and to give their opinions regarding the supplementation of vitamin D in three hypothetical cases. Results and Conclusion The authors conclude that (i) target serum 25(OH)D concentration should be 50 to 60 nmol/L year round, with a conservative upper limit <100 nmol/L; (ii) change in serum concentrations at any given dose is highly variable among individuals; (iii) dosing interval may need to be <2 months to have a continuous benefit; (iv) a loading dose can raise levels to target quickly, but there is no evidence yet that this has any positive effect on falls or fracture outcomes; and (v) a maintenance dose of 1000 IU/day, or given as an equivalent dose weekly or monthly, is sufficient for most individuals.

  March 14, 2017   doi: 10.1111/ajag.12408   open full text
• Work after age 65: A prospective study of Australian men and women.
  Tazeen Majeed, Peta M Forder, Meredith Tavener, Kha Vo, Julie Byles.
  Australasian Journal on Ageing. March 08, 2017
  Objective This study describes hours in paid work for Australian men and women aged over 65, focusing on associations between work and education. Methods Data were analysed separately for men and women, from baseline and first follow‐up surveys of the 45 and Up Study. Generalised estimating equation models were used to identify associations between work, education and other factors over time. Results The odds of doing paid work increased with higher education level and decreased with time, age, poorer physical function and having health conditions (high blood pressure, diabetes, stroke and breast cancer). Un‐partnered women were more likely to work in later life than partnered women. Conclusion This study quantifies the importance of education and health factors in determining continued participation of Australian men and women in paid work in later life. These factors need to be considered for policies aiming to increase workforce participation beyond 65 years of age.

  March 08, 2017   doi: 10.1111/ajag.12382   open full text
• Integrative review of older adult loneliness and social isolation in Aotearoa/New Zealand.
  Valerie A Wright‐St Clair, Stephen Neville, Vanessa Forsyth, Lindsey White, Sara Napier.
  Australasian Journal on Ageing. March 04, 2017
  Objective To conduct an integrative review of empirical studies of loneliness for older people in Aotearoa/New Zealand. Loneliness is a risk factor for older people's poor physical and cognitive health, serious illness and mortality. A national survey showed loneliness rates vary by gender and ethnicity. Methods A systematic search of health and social science databases was conducted. Of 21 scrutinised articles, nine were eligible for inclusion and subjected to independent quality appraisal. One qualitative and eight quantitative research articles were selected. Results Reported levels and rates of loneliness vary across age cohorts. Loneliness was significantly related to social isolation, living alone, depression, suicidal ideation, being female, being Māori and having a visual impairment. Qualitatively, older Korean immigrants experienced loneliness and social isolation, along with language and cultural differences. Conclusion Amongst older New Zealanders loneliness is commonly experienced by particular ethnic groups, highlighting a priority for targetted health and social services.

  March 04, 2017   doi: 10.1111/ajag.12379   open full text
• Health status, health behaviours and anxiety symptoms of older male caregivers: Findings from the Concord Health and Ageing in Men Project.
  Chen‐Chun Shu, Robert G Cumming, Hal L Kendig, Fiona M Blyth, Louise M Waite, David G Le Couteur, David J Handelsman, Vasi Naganathan.
  Australasian Journal on Ageing. February 16, 2017
  Objective To explore differences between older male caregivers and non‐caregivers on health status, health behaviours and well‐being, including symptoms of anxiety. Methods Data were collected through self‐completed questionnaires and face‐to‐face interviews with 1705 community living men aged ≥70 in the Concord Health and Ageing in Men Project. Results Eleven per cent of older men were caregivers, of whom 81.7% were looking after their wives or partners. Older male caregivers did not have worse physical health or more depressive symptoms than non‐caregivers, but being a caregiver was associated with increased likelihood of reporting anxiety symptoms (OR: 2.32, 95% CI: 1.39–3.87). Caregivers had similar levels and frequencies of leisure activities but did more housework activities than non‐caregivers. Conclusion Higher anxiety levels were the main adverse health condition in older male caregivers. Strategies to assist minimising anxiety for caregivers should be a target of interventions.

  February 16, 2017   doi: 10.1111/ajag.12376   open full text
• Caregiving‐related needs of family caregivers of older Singaporeans.
  Shweta Ajay, Truls Østbye, Rahul Malhotra.
  Australasian Journal on Ageing. February 13, 2017
  Objective To describe the extent and correlates of caregiving‐related needs among family caregivers of Singaporeans aged 75+ with ≥1 activity of daily living limitations (care‐recipients). Methods National survey data of 1181 care‐recipient/caregiver dyads were used. Caregiver's report (yes/no) of 16 needs was assessed. Care‐recipient and caregiver correlates of each need were determined through logistic regression analysis. Results Caregiving‐related needs were expressed by 42.3% caregivers. The most commonly reported need was keeping care‐recipient safe at home (24.5%). Needs concerned with caring for care‐recipients were more frequent than those concerned with the caregiver's own needs. The most frequent correlate was care‐recipient's extent of mood impairment (associated with 13 needs). Conclusion Caregivers should not neglect themselves when engaging in care provision. Families and service providers should explore whether reported lack of needs reflects limited awareness and/or under‐reporting.

  February 13, 2017   doi: 10.1111/ajag.12370   open full text
• Life satisfaction of older Turks living in Australia.
  Hülya Öztop, Bahar Kınacı.
  Australasian Journal on Ageing. February 03, 2017
  Objective This study examined the influence of socio‐economic and demographic variables, the frequency of travel to Turkey and years of living in Sydney on the life satisfaction of older Turkish people. Methods This study was conducted with 110 participants of 60 years of age or older, at the New South Wales Turkish Welfare Association in Sydney, Australia. The surveys were administered face‐to‐face at a date and time these participants went to the Association. The dependent variable of the study was the Life Satisfaction Scale. The study data were analysed using hierarchical regression analysis, and the three sets of regression models were run for each sex. Results The research found that in addition to sociodemographic factors, frequency of travel to Turkey, particularly for older women, and their years of living in Sydney had negative effects on life satisfaction. The study results indicate that the frequency of both the male and female participants’ visits to Turkey had a strong negative influence on their life satisfaction. Life satisfaction decreased as the frequency of the participants’ visits to Turkey and years of living in Sydney increased. Conclusion These findings support the current literature that shows the effects of the frequency of travel to Turkey and years of living in Sydney, which were considered to influence relationships with social networks, on life satisfaction, and indicates the necessity for a more detailed examination of social network relationships.

  February 03, 2017   doi: 10.1111/ajag.12373   open full text
• Ageing doctors.
  Steven Lillis, Eleanor Milligan.
  Australasian Journal on Ageing. January 25, 2017
  Doctors are neither more nor less susceptible than the general population to the effects of ageing. The relevance of deterioration with age depends on the nature of the work undertaken. Reduced muscle strength and visual and auditory deterioration can compromise clinical ability. Accumulation of chronic disease further reduces capacity. Cognitive decline is of particular importance, as good medical care requires considerable cognitive function. Patient safety is paramount, yet older doctors are an important part of the medical workforce and their value should be recognised. Changes in patient case mix, work place support systems and individual adjustments can assist safe practice. Deterioration in health should be acknowledged and requires proactive management. Current methods of ensuring competence are inadequate for supporting ageing doctors. A new initiative is recommended comprising collaboration between regulators, colleges and employing institutions to support the ageing doctor in providing safe and effective practice.

  January 25, 2017   doi: 10.1111/ajag.12371   open full text
• The effectiveness of environment assessment tools to guide refurbishment of Australian residential aged care facilities: A systematic review.
  Samantha Neylon, Caroline Bulsara, Anne‐Marie Hill.
  Australasian Journal on Ageing. January 24, 2017
  Objective To determine applicability of environment assessment tools in guiding minor refurbishments of Australian residential aged care facilities. Method Studies conducted in residential aged care settings using assessment tools which address the physical environment were eligible for inclusion in a systematic review. Given these studies are limited, tools which have not yet been utilised in research settings were also included. Tools were analysed using a critical appraisal screen. Results Forty‐three publications met the inclusion criteria. Ten environment assessment tools were identified, of which four addressed all seven minor refurbishment domains of lighting, colour and contrast, sound, flooring, furniture, signage and way finding. Only one had undergone reliability and validity testing. Conclusion There are four tools which may be suitable to use for minor refurbishment of Australian residential aged care facilities. Data on their reliability, validity and quality are limited.

  January 24, 2017   doi: 10.1111/ajag.12367   open full text
• Older patients' consultations in an apprenticeship model‐based general practice training program: A cross‐sectional study.
  Andrew Bonney, Simon Morgan, Amanda Tapley, Kim Henderson, Elizabeth Holliday, Andrew Davey, Mieke Driel, Neil Spike, Cathy Regan, Jean Ball, Parker Magin.
  Australasian Journal on Ageing. November 22, 2016
  Objective To investigate older patients' encounters with general practice registrars (GPRs) to inform training and clinical practice. Methods Cross‐sectional analysis of data from GPR consultations across five regional training providers in Australia. Data were analysed using simple and multiple logistic regression models. Results Our analysis included details of 118 831 consultations, 20 555 (17.6%, 95% CI 17.4–17.8) with patients aged ≥65 years. Older patient encounters had an increased likelihood of including chronic disease (OR 1.77, 95% CI 1.70, 1.86) and more problems (OR 1.24, 95% CI 1.20, 1.27). However, in‐consultation information or advice was less likely to be sought (OR 0.92, 95% CI 0.88, 0.97), and consultations were briefer (OR 0.99, 95% CI 0.99, 1.00). Conclusion Our results suggest relatively limited GPR exposure to older patients coupled with less complex consultations than expected. Solutions will need to be carefully constructed not only to increase caseloads, but also to address training and supervision concerns.

  November 22, 2016   doi: 10.1111/ajag.12364   open full text
• Resuscitation orders in acute hospitals: A point prevalence study.
  Amber Mills, Anne Walker, Michele Levinson, Alison M Hutchinson, Gemma Stephenson, Anthea Gellie, George Heriot, Harvey Newnham, Megan Robertson.
  Australasian Journal on Ageing. October 19, 2016
  Objective To determine the prevalence of resuscitation orders and Advance Care Plans, and the relationship with Medical Emergency Team (MET) calls. Methods A point prevalence review of patient records at five Victorian hospital services. Results One thousand nine hundred and thirty‐four patient records were reviewed, and 230 resuscitation orders and 15 Advance Care Plans found. Significantly, more resuscitation orders were found at public hospitals. Patients admitted to private hospitals were older, with shorter admissions. A further 24 orders were written following MET calls for 97 patients. Only 16% of patients aged 80+ years had a resuscitation order written within 24 hours of admission. Conclusion Fewer resuscitation orders were written at admission for older adults than might be expected if goals of care and resuscitation outcome are considered. MET continue to have a prominent role in end‐of‐life care. Consideration and documentation about treatment plans are needed early in an admission to avoid burdensome and futile resuscitation events.

  October 19, 2016   doi: 10.1111/ajag.12354   open full text
• Scoping review of medical assessment units and older people with complex health needs.
  Carole Rushton, Julia Crilly, Adeniyi Adeleye, Laurie Grealish, Mandy Beylacq, Mark Forbes.
  Australasian Journal on Ageing. September 23, 2016
  Objectives To explore current knowledge of medical assessment units (MAUs) with specific reference to older people with complex needs and to stimulate new topics and questions for future policy, research and practice. Methods A scoping review was conducted using an integrated‐latent thematic approach. Results This review provides a unique perspective on MAUs and older people which is framed using four themes: efficiency, effectiveness, equity and time. Eighteen articles were reviewed. Most (14) articles reported on efficiency and effectiveness while none reported explicitly on equity. Time was identified as a fourth, latent theme within the literature. Conclusion Findings from this review indicate that future policy, research and practice relating to MAUs should focus on older people with complex needs, patient‐centred metrics and those MAU characteristics most likely to deliver positive health outcomes to this particular cohort of patients.

  September 23, 2016   doi: 10.1111/ajag.12353   open full text
• Higher Charlson Comorbidity Index scores do not influence Functional Independence Measure score gains in older rehabilitation patients.
  Sarah Bernard, Charles Inderjeeth, Warren Raymond.
  Australasian Journal on Ageing. September 12, 2016
  Aim To assess the effect of age‐adjusted Charlson Comorbidity Index (CCI) score on Functional Independence Measure (FIM) score gain in older rehabilitation patients. Methods This prospective cohort study observed 306 older rehabilitation patients admitted to a secondary hospital between February and April 2015. Groups were compared using CCI score cut‐offs of ≤4, 5–6 and ≥ 7. Results Complete FIM data were available for 280 patients. The mean age‐adjusted CCI score was 5.59 ± 1.96. An age‐adjusted CCI score ≤4 correlated with higher FIM scores at admission P = 0.015, and discharge P = 0.002, but not with a greater gain in FIM score P = 0.067. There were no significant between‐group differences in mortality, hospital transfers or length of stay. Conclusion The Charlson age‐comorbidity index was not a prognostic marker for FIM gain. Age and comorbidity alone are not barriers to the rehabilitation of older patients.

  September 12, 2016   doi: 10.1111/ajag.12351   open full text
• Seat belt repositioning and use of vehicle seat cushions is increased among older drivers aged 75 years and older with morbidities.
  Julie Brown, Kristy Coxon, Cameron Fong, Elizabeth Clarke, Kris Rogers, Lisa Keay.
  Australasian Journal on Ageing. July 30, 2016
  Objective Good seat belt fit and positioning is important for crash protection. Older drivers experience problems in achieving good seat belt fit and often reposition seat belts and/or use seat cushions. Comfort influences these behaviours. This work examines the impact of functional morbidities on belt positioning and accessory use and whether comfort mediates this relationship Methods Mediation analysis was used to examine the relationship between morbidities affecting physical function, comfort, belt repositions and seat cushion use among 380 drivers aged 75 years and older. Results Musculoskeletal morbidities increase the likelihood of seat belt repositioning (OR 1.37, 95% CI 1.12–1.67) and comfort partially mediates this relationship (P = 0.03). Morbidities of any type also increase the likelihood of seat cushion use (OR 1.15 95% CI 1.04–1.27), but comfort plays no role in this relationship (P = 0.87). Conclusion Greater awareness among older drivers is needed, to ensure behavioural modifications do not impair their crash protection.

  July 30, 2016   doi: 10.1111/ajag.12349   open full text
• Mindfulness: A positive spirituality for ageing?
  Bruce Allen Stevens.
  Australasian Journal on Ageing. July 21, 2016
  Research indicates that the religious faith of people in aged care contributes to their well‐being. A more general spirituality, involving no established religion, is also likely to be of benefit, but will require new forms of expression that appeal to the next generation, many of whom reject established religions. The practice of mindfulness also has research support as a contributor to well‐being and may be a suitable and easily accepted form of spirituality for non‐religious people.

  July 21, 2016   doi: 10.1111/ajag.12346   open full text
• Nurses' perceptions of the impact of the aged care reform on services for residents in multi‐purpose services and residential aged care facilities in rural Australia.
  Julie Henderson, Eileen Willis, Lily Xiao, Luisa Toffoli, Claire Verrall.
  Australasian Journal on Ageing. June 23, 2016
  Aim To understand nurses' perceptions of the impact of the aged care reform on care and services for residents in multi‐purpose services (MPS) and residential aged care facilities (RACF) in rural South Australia. Methods An interpretative study using semi‐structured interviews. Participants comprised registered and enrolled nurses working with aged care residents in rural South Australia. Eleven nurses were interviewed, of these seven worked in MPS and four in RACF. Results Data were analysed for similarities and differences in participants' experiences of care delivery between MPS and RACF. Common issues were identified relating to funding and resource shortfalls, staffing levels, skill mix and knowledge deficits. Funding and staffing shortfalls in MPS were related by participants to the lower priority given to aged care in allocating resources within MPS. Nurses in these services identified limited specialist knowledge of aged care and care deficits around basic nursing care. Nurses in RACF identified funding and staffing shortfalls arising from empty beds due to the introduction of the accommodation payment. Dependence upon care workers was associated with care deficits in complex care such as pain management, medication review and wound care. Conclusion Further research is needed into the impact of recent reforms on the capacity to deliver quality aged care in rural regions.

  June 23, 2016   doi: 10.1111/ajag.12343   open full text
• What keeps you strong? A systematic review identifying how primary health‐care and aged‐care services can support the well‐being of older Indigenous peoples.
  Carol Davy, Elaine Kite, Graham Aitken, Garth Dodd, Janice Rigney, Jenny Hayes, Jan Van Emden.
  Australasian Journal on Ageing. June 20, 2016
  Aim The objective of this systematic review was to identify primary health‐care or aged‐care strategies that have or could support the well‐being of older Indigenous peoples. Methods A search was undertaken of primary databases including Medical Literature Analysis and Retrieval System Online and Cumulative Index to Nursing and Allied Health Literature. Papers which reported on the perspectives of older Indigenous peoples, community members and provider participants were included. Findings were pooled using a meta‐aggregative approach. Results Three high‐level synthesised findings – maintaining Indigenous identity, promoting independence and delivering culturally safe care – were believed to be important for supporting the well‐being of older Indigenous peoples. Conclusions As physical independence often diminishes with age, having the support of culturally safe primary health‐care and aged‐care services that understand the importance of maintaining an Indigenous identity and promoting independence will be crucial for the well‐being of older Indigenous peoples.

  June 20, 2016   doi: 10.1111/ajag.12311   open full text
• Functional limitation and cognitive impairment among 80+ year old Chinese.
  Jiakun Zheng, Junyi Liu, Ruopeng An.
  Australasian Journal on Ageing. June 19, 2016
  Aim This study examined functional limitation in relation to cognitive impairment among 80+ year old Chinese. Methods Cognitively‐intact adults ≥80 years old (n = 5161) came from the 1998 Chinese Longitudinal Healthy Longevity Survey. Cognitive impairment was assessed by Mini‐Mental State Examination. Functional limitation was assessed by Katz activities of daily living (ADLs). Cox regressions were performed to examine the relationship between functional limitation in 1998 and cognitive impairment onset during the follow‐up period of 1998–2012. Results Compared to those without ADLs limitation at baseline, participants with ADLs limitations were 49% more likely to develop cognitive impairment during follow‐up. A dose‐response relationship was identified – compared to those without ADLs limitation at baseline, those with one, two to five and all six ADLs limitations were 46, 50 and 180% more likely to develop cognitive impairment during follow‐up, respectively. Conclusion Baseline functional limitation strongly predicted cognitive impairment incidence in 80+ year old Chinese.

  June 19, 2016   doi: 10.1111/ajag.12341   open full text
• Analgesic use and pain in residents with and without dementia in aged care facilities: A cross‐sectional study.
  Edwin CK Tan, Renuka Visvanathan, Sarah N Hilmer, Agnes Vitry, Tina Emery, Leonie Robson, Kaisu Pitkälä, Jenni Ilomäki, J Simon Bell.
  Australasian Journal on Ageing. June 03, 2016
  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.

  June 03, 2016   doi: 10.1111/ajag.12295   open full text
• Foreign‐born aged care workers in Australia: A growing trend.
  Joel Negin, Jenna Coffman, John Connell, Stephanie Short.
  Australasian Journal on Ageing. June 01, 2016
  Aim To address Australian aged care workforce challenges, a deeper understanding of the current care workforce is needed especially given estimated increases in demand. We provide a national picture of the aged care workforce in Australia focusing on country of birth. Methods Data from the 2006 and 2011 Australian censuses. Results The majority of care workers are Australia‐born followed by those born in the United Kingdom, South‐East Asia and South Asia. While the number of carers from all regions has grown, the increase from 2006 to 2011 has been highest for carers from South Asia (333% increase) and sub‐Saharan Africa (145%). The state with the largest decrease in the proportion of Australian‐born care workers is Western Australia where Australian‐born workers dropped from 62% in 2006 to 49% in 2011. Conclusions Understanding the migration patterns of the aged care workforce in Australia is critical to health workforce planning given increasing demand.

  June 01, 2016   doi: 10.1111/ajag.12321   open full text
• Poster Presentations ‐ Free Papers.
  
  Australasian Journal on Ageing. May 30, 2016
  There is no abstract available for this paper.

  May 30, 2016   doi: 10.1111/ajag.12339   open full text
• Poster Presentations – Advanced Trainee Research.
  
  Australasian Journal on Ageing. May 30, 2016
  There is no abstract available for this paper.

  May 30, 2016   doi: 10.1111/ajag.12338   open full text
• Exploring the implementation of poslansia, Indonesia's community‐based health programme for older people.
  Yodi Christiani, Julie E Byles, Meredith Tavener, Paul Dugdale.
  Australasian Journal on Ageing. May 20, 2016
  Aim To explore the implementation of poslansia, a community‐based integrated health service implemented across Indonesia to improve the health status of older people through health promotion and disease prevention. Methods Data analysis of 307 poslansia surveyed in the 4th wave of Indonesia Family Life Survey (IFLS‐4). We examined the services provided in the programme, resources and perceived problems. Results The services provided by poslansia focused mostly on risk factor screening and treatment for minor illness, and less on health promotion activities. Lack of support from community health centres, no permanent place for holding poslansia and lack of participant interest in joining the programme were associated with fewer services provided in the programme (P < 0.05). Conclusion The findings indicate existing support from the community, community health centres and related institutions for poslansia is not adequate for optimal service function. Health awareness among the older population should also be increased for programme sustainability.

  May 20, 2016   doi: 10.1111/ajag.12305   open full text
• The health of older Aboriginal and Torres Strait Islander peoples.
  Dina LoGiudice.
  Australasian Journal on Ageing. May 07, 2016
  The health of Aboriginal Australians is poorer than that of all other Indigenous cultures in developed nations, and recent studies suggest high rates of dementia and other conditions that are common in old age. This has implications for health promotion, provision of services and planning for older age in these communities. This article provides an overview on the health of Older Aboriginal Australians.

  May 07, 2016   doi: 10.1111/ajag.12332   open full text
• Older peoples’ experiences of living in a residential aged care facility in Australia.
  Helen Walker, Penelope Paliadelis.
  Australasian Journal on Ageing. April 28, 2016
  Aim The objectives of the study were to investigate the lived experience of older people in residential aged care facilities (RACFs) in Australia, to explore their perceptions of their lives in RACFs and how care might be improved. Methods This qualitative study used a phenomenological approach to explore the lived experience of older persons in RACFs across two Australian states. In‐depth interviews regarding independence, dignity, autonomy, communication and relationships were conducted with 18 participants. The interviews were audiotaped, transcribed and thematically analysed. Results Three themes emerged reflecting the reality of RACF life for these participants: (i) loss of autonomy, dignity and control; (ii) valuing important relationships; and (iii) resigned acceptance. Conclusion Older people were not included in decision‐making and found it difficult to maintain their autonomy and dignity, and forge meaningful relationships. They traded their independence and dignity for the safety and assistance they needed; however, they accepted this trade‐off with stoicism and remained positive.

  April 28, 2016   doi: 10.1111/ajag.12325   open full text
• Clinical Practice Guidelines for Dementia in Australia: A step towards improving uptake of research findings in health‐ and aged‐care settings.
  
  Australasian Journal on Ageing. April 21, 2016
  There is no abstract available for this paper.

  April 21, 2016   doi: 10.1111/ajag.12330   open full text
• Developing a dementia‐friendly Christchurch: Perspectives of people with dementia.
  Karen Smith, Susan Gee, Tal Sharrock, Matthew Croucher.
  Australasian Journal on Ageing. April 08, 2016
  Aim Christchurch, New Zealand has a unique opportunity to potentially rebuild as a dementia‐friendly city in the wake of the 2010 and 2011 earthquakes. The present study gathered insights from people with dementia about what would make it possible for them to live better in Christchurch. Methods Twenty‐six older people living with dementia were interviewed using a semi‐structured questionnaire. Interviews were transcribed for thematic analysis. Results Participants talked about the importance of being connected and engaged; of accommodation from service providers and others in the community and raising awareness of dementia, and attributes of the physical environment requiring consideration in the rebuild. Conclusion The themes that emerged about what people with dementia seek from dementia–friendly communities reinforce previous research, but with an overlay of the difficulties of living in an earthquake‐damaged city.

  April 08, 2016   doi: 10.1111/ajag.12287   open full text
• Australian and New Zealand Society for Geriatric Medicine Position Statement Abstract: Ageing and indigenous health in Aotearoa New Zealand.
  
  Australasian Journal on Ageing. April 07, 2016
  There is no abstract available for this paper.

  April 07, 2016   doi: 10.1111/ajag.12217   open full text
• Health, healthy lifestyles and health examinations among the older people in Taiwan.
  Hui‐Chuan Hsu, Wen‐Chiung Chang, Dih‐Ling Luh, Ling‐Yen Pan.
  Australasian Journal on Ageing. April 07, 2016
  Aim This aim of this study was to examine the relationship between the utilisation of general health examinations and health and a healthy lifestyle. Methods The data were from a 5‐wave panel of older Taiwanese people. Health was defined as the absence of chronic diseases and physical function difficulties. A healthy lifestyle included no smoking, no alcohol consumption and engaging in regular exercise. Generalised linear modelling was applied. Results The individuals with more chronic diseases were more likely to undergo health examinations, but the rate of change declined over time. Having more physical function disabilities may reduce the likelihood of undergoing health examinations. Individuals who engaged in regular exercise were more likely to undergo health examinations. Conclusion Health examination utilisation is related to health and healthy lifestyle among older people.

  April 07, 2016   doi: 10.1111/ajag.12249   open full text
• Effect of humour therapy on psychotropic medication use in nursing homes.
  Jerome BY Leow, Lisa Pont, Lee‐Fay Low.
  Australasian Journal on Ageing. March 17, 2016
  Aim The aim of this study was to assess the effect of Play Up humour therapy on antipsychotic, benzodiazepine and antidepressant use in Australian nursing homes. Methods Play Up is a humour therapy program that has been implemented in Australian nursing homes. This study was an uncontrolled retrospective review of psychotropic medication charts of 406 residents in thirty‐three nursing homes before and after 12 weeks of participation in Play Up. Prevalence and mean daily equivalent doses of psychotropic medication use were analysed. Results There were significant reductions from before to after the Play Up program in the prevalence of any psychotropic medication use, antipsychotic use and benzodiazepine use (P = 0.001, 0.02, 0.007, respectively). Mean daily dose equivalents of pro re nata (PRN) antipsychotics and PRN benzodiazepines significantly reduced over time (P = 0.007; P = 0.001). Conclusions Play Up was associated with an overall decline in the use of psychotropic medications. Further trials are required to confirm and better define this association.

  March 17, 2016   doi: 10.1111/ajag.12319   open full text
• Staff perspectives of relationships in aged care: A qualitative approach.
  Cindy Jones, Wendy Moyle.
  Australasian Journal on Ageing. March 15, 2016
  Aim To explore aged care staff perceptions and experience of their relationships with co‐workers, older people and families via pragmatic exploratory interviews. Methods Thirty‐nine direct care staff from seven residential age care facilities and 12 community organisations were interviewed. Results Staff felt that their capacity to develop therapeutic relationships with older people and families was impeded by care tasks and concerns regarding professional boundaries. Positive relationships between staff–family and staff–staff are hindered by staff perceptions of undue care demands, high family expectations, and staff–staff conflict within a hierarchical context and between work shifts. Conclusion A relationship‐centred approach to care as well as staff training and education should be encouraged to assist the development of therapeutic relationships and the management of professional boundaries.

  March 15, 2016   doi: 10.1111/ajag.12276   open full text
• Geographic variation in psychotropic drug utilisation among older people in New Zealand.
  Henry C Ndukwe, Ting Wang, June M Tordoff, Matthew J Croucher, Prasad S Nishtala.
  Australasian Journal on Ageing. March 15, 2016
  Aim To examine psychotropic drug utilisation in older people in New Zealand by age, sex, health board domicile and deprivation status. Methods A repeated cross‐sectional analysis of population‐based drug utilisation data stratified by age, sex, ethnicity, health board and deprivation status was conducted from 2005 to 2013. Results Psychotropic utilisation increased between 2005 and 2013 (ranging from 7.0 to 74.0%) across all the health boards. In people aged 85 years and above, the hypnotic and sedative prevalence ratio compared to the 65‐ to 69‐year age group was 1.45 (95% CI 1.44, 1.46). Between 2005 and 2013, the antidepressants prevalence ratio increased (1.27 (95% CI 1.22, 1.33)) relative to anxiolytics. Conclusions Overall psychotropic drug utilisation increased over time. Despite safety concerns, hypnotic and sedative utilisation increased in the oldest vulnerable group. Shifts from anxiolytics to antidepressants in some health boards were consistent with guidelines for extended indications of antidepressant drug use.

  March 15, 2016   doi: 10.1111/ajag.12298   open full text
• The validity of three fall risk screening tools in an acute geriatric inpatient population.
  Mark Dominic Latt, K Florence Loh, Ludi Ge, Annie Hepworth.
  Australasian Journal on Ageing. March 15, 2016
  Aim We examined the validity of the Ontario Modified STRATIFY (OM) (St Thomas's Risk Assessment Tool in Falling Elderly Inpatients), The Northern Hospital Modified STRATIFY (TNH) and STRATIFY in predicting falls in an acute aged care unit. Methods Data were collected prospectively from 217 people presenting consecutively and falls identified during hospitalisation. Results Sensitivities of OM (80.0, 95% confidence interval (CI) 58.4 to 91.9%), TNH (85, CI 64.0 to 94.8%) and STRATIFY (80.0, CI 58.4 to 91.0%) were similar. The STRATIFY had higher specificity (61.4, CI 54.5 to 67.9%) than OM (37.1, CI 30.6 to 44.0%) and TNH (51.3, CI 44.3 to 58.2%). Accuracy (percentage of patients correctly classified as ‘faller’ or ‘non‐faller’) was higher using STRATIFY (63.1, CI 56.5 to 69.3%) and TNH (54.4, CI 47.8 to 61.0%) than with OM (41.0, CI 34.7 to 47.7%, P < 0.0001). Conclusion Screening tools have limited accuracy in identifying patients at high risk of falls.

  March 15, 2016   doi: 10.1111/ajag.12256   open full text
• Community care for Indigenous older people: An update.
  Melissa A Lindeman, Kate Smith, Dina LoGiudice, Mark Elliott.
  Australasian Journal on Ageing. March 11, 2016
  In this brief paper, we outline some important messages in the literature pertaining to community care for Indigenous older people. Such literature has been scarce until relatively recently. These key messages are particularly important as aged care sector reforms are implemented. We highlight significant research findings concerning health, care preferences and service delivery challenges for the provision of community care for this population group. To be successful, a service needs to be relevant, and to be relevant, services need to take a community development approach in their development and ongoing management.

  March 11, 2016   doi: 10.1111/ajag.12316   open full text
• Non‐medical needs of older patients in the emergency department.
  Bonnia Liu, David McD Taylor, Sophia L‐Y Ling, Paul MacGibbon.
  Australasian Journal on Ageing. March 11, 2016
  Aim To determine the non‐medical needs of older patients in the emergency department (ED). Methods We undertook a cross‐sectional survey of three age groups (50–64, 65–79, 80+ years) using a self‐administered questionnaire with five response options (strongly agree–strongly disagree) for 31 items. Results There were 548 patients enrolled. Significantly fewer older patients knew how to call for assistance (P < 0.01), knew how the ED works (P < 0.01), felt frightened by their illness (P < 0.01) or felt that the ED lights were too bright (P < 0.03). A substantial proportion of all patients did not agree that their illness and/or treatment had been well explained. Conclusion Older patients appear resilient but need to be told to call for assistance when needed, to know how to call for this assistance and how the ED works. Clear information regarding their illness and treatment should be provided, particularly to younger patients who may be anxious.

  March 11, 2016   doi: 10.1111/ajag.12265   open full text
• Nurturing spiritual well‐being among older people in Australia: Drawing on Indigenous and non‐Indigenous way of knowing.
  Pettina Love, Melissa Moore, Jeni Warburton.
  Australasian Journal on Ageing. March 11, 2016
  Aim The meaning of spiritual well‐being as a health dimension is often contested and neglected in policy and practice. This paper explores spiritual well‐being from both an Indigenous and a non‐Indigenous perspective. Method We drew on Indigenous and non‐Indigenous methodologies to explore the existing knowledge around spiritual well‐being and its relationship with health. Results The Indigenous perspective proposed that spiritual well‐being is founded in The Dreaming, informs everyday relationships and can impact on health. The non‐Indigenous perspective suggested that spiritual well‐being is shaped by culture and religion, is of increased importance as one ages, and can improve coping and resilience stressors. Conclusions Situating these perspectives side by side allows us to learn from both, and understand the importance of spirituality in people's lives. Further research is required to better address the spiritual well‐being/health connection in policy and practice.

  March 11, 2016   doi: 10.1111/ajag.12284   open full text
• Making themselves at home: Support needs of older Germans in Australia.
  Meg Polacsek, Jocelyn Angus.
  Australasian Journal on Ageing. March 11, 2016
  Aim This paper explores the experiences of older German Australians, with a focus on their support needs and preferences in later life. Methods Data were collected through qualitative semi‐structured interviews. Data analysis incorporated a systematic concept matrix approach to content analysis. Results The findings of the study indicate that older German Australians have adapted well to the Australian way of life. Their high English language proficiency allowed them to source services without the barrier of language often reported in studies of older migrants. They did not show high interest in ethno‐specific services. Conclusion Few studies have been conducted on older German Australians, and none focuses specifically on their experience of ageing in Australia. This study contributes to the body of knowledge on older migrants and, specifically, on those for whom language is not necessarily a major obstacle to obtaining aged care information or services.

  March 11, 2016   doi: 10.1111/ajag.12263   open full text
• Prevalence of the geriatric syndromes and frailty in older men living in the community: The Concord Health and Ageing in Men Project.
  Naomi Noguchi, Fiona M Blyth, Louise M Waite, Vasi Naganathan, Robert G Cumming, David J Handelsman, Markus J Seibel, David G Le Couteur.
  Australasian Journal on Ageing. March 11, 2016
  Aim To describe the age at which the geriatric syndromes and frailty become common in community‐dwelling men. Methods The Concord Health and Ageing in Men Project involves a population‐based sample of 1705 community‐dwelling men aged 70 and over from a defined geographic region in Sydney. Data were obtained by physical performance tests, clinical examinations, and questionnaire to determine the prevalence of the following conditions by five‐year age group. Results Poor mobility, recurrent falls, urinary incontinence, dementia and frailty phenotype were all uncommon (less than 10%) in men in their 70s, but the prevalence of each of these conditions exceeded 10% in men aged 85–89. The prevalence of Frailty Index‐defined frailty, multimorbidity, polypharmacy and instrumental activities of daily living dependence was constantly high in all age groups. Conclusions The different health‐care needs of the ‘old old’ aged 85 years and older should be accounted for in health service planning.

  March 11, 2016   doi: 10.1111/ajag.12310   open full text
• ‘Depression is not an illness. It's up to you to make yourself happy’: Perceptions of Chinese health professionals and community workers about older Chinese immigrants’ experiences of depression and anxiety.
  Betty Haralambous, Briony Dow, Anita Goh, Nancy A Pachana, Christina Bryant, Dina LoGiudice, Xiaoping Lin.
  Australasian Journal on Ageing. March 11, 2016
  Aim The aim of this study was to improve our understanding of depression and anxiety among older immigrant Chinese Australians. Methods The study was based on the National Ageing Research Institute's Cultural Exchange Model, an iterative process of exchange between researchers and stakeholders. The project involved a range of components including consultations with health professionals and community workers about perceptions of depression and anxiety within the Chinese community. This paper reports on these consultation findings. Results Thematic analysis generated five main categories to explain participants’ perceptions of depression and anxiety within the Chinese community. Themes included: lack of knowledge; personal weakness rather than illness; stigma; somatisation; and experience of migration in later life. Responses to questions about education and information dissemination were collated separately and reported. Conclusion Views of depression and anxiety among older Chinese people suggest that educating the community may be an important way to improve mental health literacy and help‐seeking behaviour.

  March 11, 2016   doi: 10.1111/ajag.12306   open full text
• Factors affecting optimal nutrition and hydration for people living in specialised dementia care units: A qualitative study of staff caregivers' perceptions.
  Debra Nell, Stephen Neville, Roana Bellew, Catherine O'Leary, Kathryn Louise Beck.
  Australasian Journal on Ageing. March 11, 2016
  Aim To explore the perceptions of staff caregivers regarding factors affecting optimal nutrition and hydration for individuals living in Specialised Dementia Care Units in New Zealand. Methods Qualitative descriptive study using a semi‐structured interview approach with 11 staff caregivers at two Specialised Dementia Care Units. Data were analysed using a general inductive approach. Results Two main themes were identified. The first theme ‘It's about the individual’ encompassed individual factors such as appetite, food appeal, and cognitive and functional abilities. The second theme ‘It's about the environment’ encompassed factors relating to the dining environment, the social aspects to dining and the provision of support with mealtime activities. Conclusions Factors affecting nutrition and hydration in people living with dementia are complex and inter‐related. Organisations providing specialised dementia care, their staff and foodservice providers should focus on both the individual and environment to ensure optimal nutrition and hydration for the people in their care.

  March 11, 2016   doi: 10.1111/ajag.12307   open full text
• Strength and stress: Positive and negative impacts on caregivers for older adults in Thailand.
  Rossarin Soottipong Gray, Laura Hahn, Sasinee Thapsuwan, Natjera Thongcharoenchupong.
  Australasian Journal on Ageing. March 11, 2016
  Aim To understand the experiences of caregivers with older people living in Thailand, particularly as related to quality of life and stress management. Method In‐depth interviews with 17 family caregivers were conducted and then data were thematically analysed. Results Carers experience not only negative impacts but also positive impacts from caregiving. Negative impacts include emotional stress, financial struggles and worry due to lack of knowledge. Positive impacts include affection from care recipients, good relationships with caregivers before needing care themselves and encouragement from the wider community. Opportunities to show gratitude, build karma (from good deeds) and ideas shaped largely by Buddhist teachings result in positive experiences. Negotiating between the extremes of bliss and suffering and understanding suffering as a part of life may help carers manage their stress. Conclusions Temples and centres for older people could be engaged to develop caregiving programs.

  March 11, 2016   doi: 10.1111/ajag.12266   open full text
• Potentially inappropriate medications (PIMs) in older hospital in‐patients: Prevalence, contribution to hospital admission and documentation of rationale for continuation.
  Danielle Ní Chróinín, Hugo M Neto, Diane Xiao, Anmol Sandhu, Carly Brazel, Nell Farnham, Jacinta Perram, Timothy S Roach, Emily Sutherland, Ric Day, Alexander Beveridge.
  Australasian Journal on Ageing. March 11, 2016
  Aim To establish prevalence, sequelae and documentation of potentially inappropriate medication (PIM) use in older hospital in‐patients. Methods Notes of all patients ≥65 years old, admitted to our tertiary teaching hospital (January 2013), were retrospectively reviewed, and the Screening Tool of Older Persons' potentially inappropriate Prescriptions applied. Results Amongst 534 patients, 54.8% (284) were on ≥1 PIM at admission, 26.8% on multiple; 60.8% were discharged on a PIM. Six percent of all admissions were potentially attributable to a PIM; falls associated with risk therapies were commonest (23/30), and often (65.2%) associated with serious injury. Pre‐specified subgroup analysis (n = 100) identified 101 PIMs‐at‐discharge amongst 47 patients. In 82.2%, a clinical rationale for continued prescription was documented, with this communicated to the GP by letter in 71.1%. Conclusion PIMs were common, and contributed to admission and injury. Hospitalisation provides an opportunity for medication rationalisation, and documentation of rationale for any PIM use.

  March 11, 2016   doi: 10.1111/ajag.12312   open full text
• Understanding baby boomer workers' well‐being in Australia.
  Helen Winefield, Lisel O'Dwyer, Anne Taylor.
  Australasian Journal on Ageing. March 11, 2016
  Aims The baby boomer generation poses challenges to understand how to enhance both the well‐being and the continuing workforce participation of older workers. We sought to explore the role of social relations both at work and in other domains of life, in relation to the health and well‐being of the baby boomer workforce in Australia. Methods Employed participants (n = 743) born 1946–1965 inclusive provided information about their work environment, financial security and loneliness. Regressions were used to explore the relationships of those variables to well‐being (work–life interference, absenteeism, job satisfaction, life satisfaction, health and psychological distress). Results Social environment indicators especially supervisor support and worker loneliness reliably increased the variance explained by demographics and work demands and control, in well‐being outcomes. Conclusion To maintain the well‐being and workforce participation of baby boomer generation workers, employers need to attend to creating worker‐friendly environments.

  March 11, 2016   doi: 10.1111/ajag.12302   open full text
• Comparison of the psychometric properties of four dementia knowledge measures: Which test should be used with dementia care staff?
  Karen A Sullivan, Margaret A Mullan.
  Australasian Journal on Ageing. March 11, 2016
  Objective To compare the psychometric properties of four measures of dementia institutional knowledge. Methods Fifty‐eight dementia care staff completed the Dementia Knowledge Assessment Tool Version Two (DKAT2), Alzheimer's Disease Knowledge Test (ADKT), Alzheimer's Disease Knowledge Scale (ADKS) and Dementia Knowledge Twenty (DK‐20). The convergent validity and reliability of each measure were examined. Results The level of dementia knowledge in this sample was similar to that reported in comparable surveys. The ADKT, DKAT‐2 and DK‐20 had marginal to acceptable internal consistency (α ≥ 0.67), and the ADKT, DK‐20 and ADKS were positively correlated with each other (r's = 0.45–0.60), demonstrating convergent validity. The DKAT2 had lower intercorrelations with the other measures (r's = 0.32–0.45). The ADKS had poor internal consistency (α = 0.29). Conclusion As the first head‐to‐head comparison of these tests in a single sample, this study should assist clinicians and researchers to select a dementia knowledge test.

  March 11, 2016   doi: 10.1111/ajag.12299   open full text
• Are older people prescribed antidepressants on the basis of fewer symptoms of depression, and for longer periods of time? A survey of 1825 New Zealanders.
  John Read, Kerry L Gibson, Claire Cartwright.
  Australasian Journal on Ageing. March 11, 2016
  Aim To determine whether older people are prescribed antidepressants at lower levels of depression and with fewer symptoms, and whether they are more likely to engage in chronic usage than younger adults. Methods An online survey about experiences with, and opinions about, depression and antidepressants was completed by 1825 New Zealand adults who had been prescribed antidepressants in the preceding five years. Results Participants over 55 were prescribed antidepressants with significantly fewer symptoms and were significantly less likely to meet DSM criteria for depression. They were also significantly more likely to have used the drugs for three years and still be using them. Conclusion Prescribing physicians and their older patients might benefit from discussing the pros and cons of antidepressants (including the additional risk factors with this age group) and the alternatives. If prescription does occur, careful monitoring to avoid unnecessary, potentially damaging, long‐term use is recommended.

  March 11, 2016   doi: 10.1111/ajag.12314   open full text
• Future of family support: Projected living arrangements and income sources of older people in Hong Kong up to 2030.
  Kok‐Hoe Ng.
  Australasian Journal on Ageing. November 29, 2015
  Aim The study aims to project future trends in living arrangements and access to children's cash contributions and market income sources among older people in Hong Kong. Method A cell‐based model was constructed by combining available population projections, labour force projections, an extrapolation of the historical trend in living arrangements based on national survey datasets and a regression model on income sources. Results Under certain assumptions, the proportion of older people living with their children may decline from 59 to 48% during 2006–2030. Although access to market income sources may improve slightly, up to 20% of older people may have no access to either children's financial support or market income sources, and will not live with their children by 2030. Conclusion Family support is expected to contract in the next two decades. Public pensions should be expanded to protect financially vulnerable older people.

  November 29, 2015   doi: 10.1111/ajag.12215   open full text
• Psychosocial factors significantly predict driving self‐regulation in Australian older adults.
  Ides Y. Wong, Simon S. Smith, Karen A. Sullivan.
  Australasian Journal on Ageing. November 29, 2015
  Aims This study aimed to investigate: (i) whether attitudes and beliefs about driving predict older adults’ driving self‐regulation, and how much variance in self‐regulation can be explained by these factors; and (ii) if driving confidence is controlled, whether attitudes and beliefs remain significant independent predictors of driving self‐regulation. Method The present study examined the psychosocial factors that underlie driving self‐regulation in 277 older adults within Australia. Participants completed standardised questionnaires about their driving, attitudes, belief and use of driving self‐regulation. Results Driving confidence, affective and instrumental attitude, and perceived behavioural control were all significant predictors of driving self‐regulation. The combination of these factors accounted for 56% of the variance in driving self‐regulation. Conclusion Driving self‐regulation is a complex behaviour influenced by a wide range of psychosocial factors. Improved understanding of these factors could inform strategies to improve older driver safety and influence the advice that people receive.

  November 29, 2015   doi: 10.1111/ajag.12252   open full text
• ‘They rush you and push you too much … and you can't really get any good response off them’: A qualitative examination of family involvement in care of people with dementia in acute care.
  Wendy Moyle, Marguerite Bramble, Michael Bauer, Wendy Smyth, Elizabeth Beattie.
  Australasian Journal on Ageing. October 28, 2015
  Aim To explore the role and needs of the family carer across different acute care contexts and their level of involvement in the care of their relative with dementia in this setting. Methods A pragmatic, exploratory‐descriptive qualitative approach. A convenience sample of 30 family carers across three sites completed semi‐structured interviews. Results Family carers wanted to be involved in the acute care of their family member with dementia. They acknowledged the importance of a central source of information, educated staff, guidelines on roles and processes, and positive communication, as well as respect from staff for the carer's knowledge of the older person and their needs. They also highlighted the need for medical staff to discuss with them the family member's treatment and care. Conclusion There is a need for family‐focused interventions to improve communication and involvement of family in the care of family members with dementia in the acute setting.

  October 28, 2015   doi: 10.1111/ajag.12251   open full text
• Australian employer usage of the practice of offering reduced working hours to workers close to retirement: Extent and determinants.
  Philip Taylor, Catherine Earl, Christopher McLoughlin.
  Australasian Journal on Ageing. October 26, 2015
  Aim This study aimed to determine factors associated with the implementation by employers of the practice of offering reduced working hours for workers nearing retirement. Methods Data came from a survey of 2000 employers of more than 50 employees each (30% response rate). Results A minority (33%) of employers offered reduced working hours to older workers nearing retirement. Factors associated with offering reduced working hours were: expecting workforce ageing to cause a loss of staff to retirement; being a large employer; being a public/not‐for‐profit sector employer; not experiencing difficulties recruiting labourers; having a larger proportion of workers aged over 50; experiencing national competition for labour; not experiencing difficulties recruiting machinery operators/drivers; not expecting workforce ageing to increase workplace injuries; and experiencing difficulties with the quality of candidates. Conclusion A minority of employers were found to offer reduced working hours to those nearing retirement. Factors associated with their propensity to do so included industry sector, size of employer, concerns about labour supply and the effects of workforce ageing.

  October 26, 2015   doi: 10.1111/ajag.12253   open full text
• Improving Australian care home medicine supply services: Evaluation of a quality improvement intervention.
  Julia Fiona‐Maree Gilmartin, Jennifer Lillian Marriott, Safeera Yasmeen Hussainy.
  Australasian Journal on Ageing. October 21, 2015
  Aim The study aims to determine the impact of a quality improvement intervention on how accurately and suitably medicines are supplied to residents of residential aged‐care facilities (RACFs). Methods Between September 2012 and January 2013, pharmacy‐supplied dose administration aids (DAAs) were audited at 45 Victorian RACFs (Australia). RACFs had previously received an intervention (education session/toolkit) and were involved in an earlier DAA audit. Recently supplied DAAs containing regular medicines were compared to prescriber‐prepared medicine charts to identify, and classify risks of, inaccurate or unsuitable packing incidents. Results Of 2389 DAAs audited for 983 residents, 770 incidents in 502 DAAs were identified. The overall DAA incident rate increased significantly from 11.5% pre‐intervention to 21.0% post‐intervention (P < 0.001). The proportion of DAAs affected by incidents classified as ‘insignificant’ or ‘minor’ risk increased post‐intervention (P < 0.001). Conclusions Further wide‐scale evaluation of RACF medicine supply services is needed. Interventions that are effective in reducing DAA incidents should be explored.

  October 21, 2015   doi: 10.1111/ajag.12236   open full text
• Medication use and potentially inappropriate medications in those with limited prognosis living in residential aged care.
  Claire Patricia Heppenstall, Joanna B Broad, Michal Boyd, Joanna Hikaka, Xian Zhang, Julia Kennedy, Martin J Connolly.
  Australasian Journal on Ageing. September 28, 2015
  Aim To compare the prevalence in residential aged care (RAC) of preventative and potentially inappropriate medications (PIMs) in those who died within 12 months versus those alive after 12 months. Methods Firstly, a cross‐sectional survey of 6196 people living in RAC in Auckland. Secondly, a research physician searched electronic hospital records in one District Health Board for a sub‐sample (n = 222) of these residents. Classes of medications and dates of death were obtained from the Ministry of Health databases. Those who died versus those alive at 12 months were compared. Results Over half of the 6196 participants received antihypertensives and/or antiplatelet agents. Cardiovascular preventative medications were significantly more common in those who died within 12 months. Seventy percent in high‐level care received psychotropics. PIMs were commonly used. Conclusions Use of preventative medications is common in RAC, especially during the last year of life. Psychotropics are very commonly used, despite being potentially inappropriate.

  September 28, 2015   doi: 10.1111/ajag.12220   open full text
• Fear and overprotection in Australian residential aged‐care facilities: The inadvertent impact of regulation on quality continence care.
  Joan Ostaszkiewicz, Beverly O'Connell, Trisha Dunning.
  Australasian Journal on Ageing. September 13, 2015
  Aim Most residents in residential aged‐care facilities are incontinent. This study explored how continence care was provided in residential aged‐care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care. Methods Using grounded theory methodology, 18 residential aged‐care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures. Results Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use. Conclusion There is a need to rethink the quality of continence care and its measurement in Australian residential aged‐care facilities.

  September 13, 2015   doi: 10.1111/ajag.12218   open full text
• Group sessions with Paro in a nursing home: Structure, observations and interviews.
  Hayley Robinson, Elizabeth Broadbent, Bruce MacDonald.
  Australasian Journal on Ageing. June 09, 2015
  Aim We recently reported that a companion robot reduced residents' loneliness in a randomised controlled trial at an aged‐care facility. This report aims to provide additional, previously unpublished data about how the sessions were run, residents' interactions with the robot and staff perspectives. Methods Observations were conducted focusing on engagement, how residents treated the robot and if the robot acted as a social catalyst. In addition, 16 residents and 21 staff were asked open‐ended questions at the end of the study about the sessions and the robot. Results Observations indicated that some residents engaged on an emotional level with Paro, and Paro was treated as both an agent and an artificial object. Interviews revealed that residents enjoyed sharing, interacting with and talking about Paro. Conclusion This study supports other research showing Paro has psychosocial benefits and provides a guide for those wishing to use Paro in a group setting in aged care.

  June 09, 2015   doi: 10.1111/ajag.12199   open full text
• Caring for acutely unwell older residents in residential aged‐care facilities: Perspectives of staff and general practitioners.
  Amy Stokoe, Carolyn Hullick, Isabel Higgins, Jacqueline Hewitt, Deborah Armitage, Ian O'Dea.
  Australasian Journal on Ageing. June 09, 2015
  Aim To explore the challenges and facilitators of managing acutely unwell residents in their residential aged‐care facilities (RACF) and transferring RACF residents to the emergency department of a tertiary referral hospital in Australia. Methods This exploratory study used a qualitative descriptive approach incorporating structured focus group interviews with nursing staff from RACFs and General Practitioners (GPs) within the local area. Four focus groups were held with staff from RACFs and one with GPs who visited one or more of the facilities during 2010. The interview data were analysed for themes relating to the study aims. Results Findings revealed both challenges and facilitators associated with managing acutely unwell older people including, communication, nursing staffing mix and numbers, use of advanced care directives, responsibilities of GPs and awareness of community services. Conclusion From these findings it is possible to make recommendations for alternative ways of practising and/or new models of care.

  June 09, 2015   doi: 10.1111/ajag.12221   open full text
• Bystander attitudes toward parents? The perceived meaning of filial piety among Koreans in Australia, New Zealand and Korea.
  Hong‐Jae Park, Chang Gi Kim.
  Australasian Journal on Ageing. June 09, 2015
  Aim The objective of this paper was to explore how present‐day filial piety is understood among Koreans in geographically different settings. Methods Data were collected from qualitative interviews with 61 Korean participants in Australia, New Zealand and Korea and then thematically analysed and evaluated. Results The findings from this study show that filial piety for Koreans consists of family care and support, along with respect for parents. The norm of filial piety is regarded as an important aspect of intergenerational family relationships in current Korean culture, while its practice is perceived as increasingly eroded within a context of major socio‐cultural and economic changes, including migration. Conclusion The results show that the tension between the social and economic aspects of filial piety often creates a ‘bystander’ attitude toward parents and provides fertile ground for the seeds of family conflict.

  June 09, 2015   doi: 10.1111/ajag.12223   open full text
• How do general practitioners engage with allied health practitioners to prevent falls in older people? An exploratory qualitative study.
  Alasdair Grant, Lynette Mackenzie, Lindy Clemson.
  Australasian Journal on Ageing. May 29, 2014
  Aim To explore general practitioners' (GPs') perceptions about their use of Chronic Disease Management (CDM) items to access allied health interventions, in particular occupational therapy and physiotherapy, with the purpose of preventing falls, as well as to identify GP support needs with regard to development of partnerships with local allied health practitioners. Method A qualitative study was conducted in the Sydney metropolitan area through individual semistructured interviews with eight GPs, which were recorded, transcribed and analysed thematically. Results Themes included (i) difficulties and opportunities associated with multidisciplinary care; (ii) potential for CDM items to be used to support falls prevention strategies; and (iii) the user‐friendliness of the CDM items. Conclusion Effective coordination of multidisciplinary care between GPs and allied health professionals was desired but difficult to achieve through the CDM system, making translation of falls prevention evidence into clinical practice challenging. Further education on falls prevention and CDM item modification is needed to bridge this gap.

  May 29, 2014   doi: 10.1111/ajag.12157   open full text
• Beyond family satisfaction: Family‐perceived involvement in residential care.
  Justine Irving.
  Australasian Journal on Ageing. May 29, 2014
  Family involvement is an important element of providing individualised care to people living in residential aged care facilities. To date, involvement from the perspective of the family has remained effectively unmeasured. Aim To explore perceived family involvement and its relationship with satisfaction and facility impressions. Method A questionnaire was posted to residents' next of kin from four South Australian residential aged care facilities. Results One hundred and fifty next of kin participated in the survey. Family‐perceived involvement was significantly and positively correlated with satisfaction and facility impressions. Conclusion The findings of this study add to the limited body of research into family involvement in long‐term residential care. Feedback from the family regarding particular aspects of involvement may also improve the experience of long‐term care for both family and resident, and assist with the identification of specific issues towards which organisations may target their quality improvement efforts.

  May 29, 2014   doi: 10.1111/ajag.12163   open full text
• Quality failures in residential aged care in Australia: The relationship between structural factors and regulation imposed sanctions.
  Richard Baldwin, Lynnette Chenoweth, Marie Rama, Zhixin Liu.
  Australasian Journal on Ageing. May 22, 2014
  Aim To examine the relationship between structural factors and the imposition of sanctions on residential aged care services across Australia for regulatory compliance failure. Methods Poisson Regression analysis was used to examine the association between the number of sanctions imposed and the structural characteristics of residential aged care services in Australia. Results Residential aged care services that have a greater likelihood of having government sanctions imposed on them are operated by for‐profit providers and located in remote locations and in Victoria, Queensland, South Australia, Northern Territory and the Australian Capital Territory. Conclusion The findings confirm the international literature on the relationship between residential aged care service location, ownership type and the likelihood of sanctions. In the light of the predicted expansion of residential aged care services, policy makers should give consideration to structural elements most likely to be associated with a failure to meet and maintain service standards.

  May 22, 2014   doi: 10.1111/ajag.12165   open full text
• Depression screening among older adults attending low‐vision rehabilitation and eye‐care services: Characteristics of those who screen positive and client acceptability of screening.
  Edith E. Holloway, Bonnie A. Sturrock, Ecosse L. Lamoureux, Jill E. Keeffe, Gwyneth Rees.
  Australasian Journal on Ageing. May 22, 2014
  Aim To investigate characteristics associated with screening positive for depressive symptoms among older adults accessing low‐vision rehabilitation and eye‐care services and to determine client acceptability of depression screening using the Patient Health Questionnaire‐2 (PHQ‐2) in these settings. Methods One‐hundred and twenty‐four older adults (mean = 77.02 years, SD = 9.12) attending low‐vision rehabilitation and eye‐care services across Australia were screened for depression and invited to complete a telephone‐administered questionnaire to determine characteristics associated with depressive symptoms and client acceptability of screening in these settings. Results Thirty‐seven per cent (n = 46/124) of participants screened positive for depressive symptoms, and the majority considered the new depression screening method to be a ‘good idea’ in vision services (85%). Severe vision loss (<6/60 in the better eye) was associated with an increased odds of screening positive for depressive symptoms (odds ratio 2.37; 95% confidence interval 1.08–6.70) even after adjusting for potential confounders. Participants who screened positive had a preference for ‘talking’ therapy or a combination of medication and ‘talking therapy’ delivered within their own home (73%) or via telephone (67%). Conclusion The PHQ‐2 appears to be an acceptable method for depression screening in eye‐care settings among older adults. Targeted interventions that incorporate home‐based or telephone delivered therapy sessions may improve outcomes for depression in this group.

  May 22, 2014   doi: 10.1111/ajag.12159   open full text
• Older people's attitudes towards resuming driving in the first four months post‐stroke.
  Annabel McNamara, Stacey George, Julie Ratcliffe, Ruth Walker.
  Australasian Journal on Ageing. April 28, 2014
  Aim Little is known about how older people recovering from stroke perceive their return to driving, particularly in the early stages of recovery when they may receive driving information. Methods Semistructured interviews were conducted with 21 participants (52% female, mean age 74.5 years) within the first 16 weeks post‐stroke, while inpatients in either acute or rehabilitation stroke wards. Interview data were analysed using content analysis. Results Three main themes emerged: ‘driving as independence’, ‘emphasis on physical recovery’, and ‘limits on driving pre‐stroke’. Conclusions For the most part, driving was not a key consideration for participants during this phase of their recovery. Physical restrictions and confidence were seen as the main deterrent to driving post‐stroke; however, this varied according to gender. Driving information is generally not retained in the first four weeks of recovery post‐stroke. This has implications for the content and timing of driving information given post‐stroke.

  April 28, 2014   doi: 10.1111/ajag.12135   open full text
• GPs, medications and older people: A qualitative study of general practitioners' approaches to potentially inappropriate medications in older people.
  Parker Magin, Susan Goode, Dimity Pond.
  Australasian Journal on Ageing. April 23, 2014
  Aim To explore the prescribing, and the rationale for this prescribing, of potentially inappropriate medications (PIMs) in older persons by Australian general practitioners (GPs). Methods This was a qualitative study employing semistructured interviews and thematic analysis. GPs who had patients taking at least one PIM were invited to participate. PIMs were defined by the Beers criteria. Results Twenty‐two GPs from four regions in three Australian states participated. While none were aware of the Beers criteria, participant GPs displayed good knowledge of the potential adverse effects of these medications. They were comfortable with the continued prescription of the medications. This was based on often quite complex harm‐benefit considerations of the biopsychosocial contexts of individual patients. Conclusions The concept of ‘appropriate’ versus ‘inappropriate’ medications implicit in classification systems such as the Beers criteria is at odds with complex considerations informing decision‐making prescribing PIMs in older persons.

  April 23, 2014   doi: 10.1111/ajag.12150   open full text
• Age‐related trends in late mortality following traumatic brain injury: A multicentre inception cohort study.
  Melissa T Nott, Thomas M Gates, Ian J Baguley.
  Australasian Journal on Ageing. April 23, 2014
  Aim To investigate age‐related mortality risk following traumatic brain injury (TBI). Methods Review of 2545 consecutive discharges from three metropolitan rehabilitation centres in New South Wales, between 1 January 1990 and 1 October 2007. Survival status was censored on 1 October 2009. Between‐group differences were assessed for older/younger patients. Multivariate Cox hazard regression was used to evaluate age‐related mortality risk. Crude mortality rates, standardised mortality ratios and cause of death data were derived for each age decade. Results After controlling for known mortality risk factors, older patients were three times more likely to die than younger patients. Crude mortality rates increased exponentially with advancing age. However, when compared to normative population data, younger adults with TBI (<50 years) had the highest risk of death relative to their non‐injured peers. Conclusions Crude mortality rates, which do not account for the naturally increasing rate of death associated with ageing, artificially inflate estimates of age‐related mortality risk following TBI.

  April 23, 2014   doi: 10.1111/ajag.12151   open full text
• Review of community facilities in Australian retirement villages: A content analysis.
  Bo Xia, Martin Skitmore, Jian Zuo, Laurie Buys.
  Australasian Journal on Ageing. April 23, 2014
  Aim Facilities in retirement villages form a supportive environment for older residents. The purpose of this paper is to investigate the provision of these facilities in retirement villages, which are regarded as a viable accommodation option for the ever‐increasing ageing population in Australia. Methods A content analysis of facilities in 124 retirement villages operated by 22 developers in Queensland and South Australia was conducted for the research purpose. Results The most widely provided facilities are community centres, libraries, barbeque facilities, hairdressers/salons and billiards/snooker/pool tables. Commercial operators provide more facilities than not‐for‐profit organisations, and larger retirement villages normally have more facilities because of the economics of scale involved. Conclusions The results of the study provide a useful reference for providing facilities within retirement villages that may support the quality lifestyles of older residents.

  April 23, 2014   doi: 10.1111/ajag.12153   open full text
• Community care for the Elderly: Needs and Service Use Study (CENSUS): Who receives home care packages and what are the outcomes?
  Lee‐Fay Low, Jennifer Fletcher, Meredith Gresham, Henry Brodaty.
  Australasian Journal on Ageing. April 21, 2014
  Aim Investigate factors associated with waiting times for home care packages and outcomes for care recipients and carers. Method Analyses of data collected every four months for 12 months from 55 community‐dwelling older adults eligible for government‐subsidised packaged care and their carers. Results Thirty of fifty‐five participants were offered a package; they waited from one to 237 days. Baseline quality of life was higher for those offered a package than those not. Baseline care needs and unmet needs, neuropsychiatric symptoms, and cognitive decline did not predict offers. Package receipt compared to non‐package receipt was associated with decreased carer burden over time but did not affect levels of unmet care needs, care needs or quality of life. Conclusions Being offered a home care package was not based on waiting time or unmet care needs. Reforms should include a transparent system of wait listing and prioritisation.

  April 21, 2014   doi: 10.1111/ajag.12155   open full text
• Access to mobile communications by older people.
  Toan Nguyen, Carol Irizarry, Rob Garrett, Andrew Downing.
  Australasian Journal on Ageing. April 17, 2014
  Aim To investigate how older people effectively identify, select and learn to use mobile communications technologies to enhance communication and safety, and support independent living. Methods One hundred and fifty‐three older South Australians participated in a purpose‐designed survey questionnaire. Results Older people relied on family and friends for information and advice (76%), and their children's assistance with buying (45%) and learning to use (48%) new technology. The most preferred learning method was face‐to‐face training (56%). Less than half (44%) were interested in trying out new designs/applications, functions and capabilities that could assist with independent living. The highest need was for personal security and emergencies (88%). Conclusions Findings suggest that the family and friends of older people play an important role in identifying, selecting and learning to use mobile communication technologies. The safety and emergency capabilities of mobile communications technologies were more important than having functions that could assist with independent living.

  April 17, 2014   doi: 10.1111/ajag.12149   open full text
• Development of self‐efficacy of newly graduated registered nurses in an aged care program.
  Rosalind Lau, Georgina Willetts, Kerry Hood, Wendy Cross.
  Australasian Journal on Ageing. April 14, 2014
  Aim To evaluate an aged care program in developing self‐efficacy of newly graduated registered nurses. Methods An evaluation of the program was conducted using a mixed methods approach. Twenty‐four nurses completed the pre‐ and post‐survey of aged care nursing self efficacy and attended one of three focus groups held to gain in‐depth understanding of their insight into the program. Results There was an increase in nurses' self‐efficacy post‐program. The increased self‐efficacy and new knowledge gained enhanced nurses' confidence and enabled them to critically appraise their workplace practices. Conclusions The improved confidence resulting from increased self‐efficacy and new knowledge gained from the aged care program enabled nurses to critically appraise the practices in their workplace, demonstrating the program's effectiveness. Aged care service providers should support continuing education for aged care nurses to ensure sustainability of a competent workforce to manage the increasing aged care population.

  April 14, 2014   doi: 10.1111/ajag.12156   open full text
• Prevalence of faecal incontinence in community‐dwelling older people in Bali, Indonesia.
  I Gede Putu Darma Suyasa, Lily Dongxia Xiao, Penelope Ann Lynn, Pawel Piotr Skuza, Jan Paterson.
  Australasian Journal on Ageing. April 14, 2014
  Aim To explore the prevalence rate of faecal incontinence in community‐dwelling older people, associated factors, impact on quality of life and practices in managing faecal incontinence. Method Using a cross‐sectional design, 600 older people aged 60+ were randomly selected from a population of 2916 in Bali, Indonesia using a simple random sampling technique. Three hundred and three participants were interviewed (response rate 51%). Results The prevalence of faecal incontinence was 22.4% (95% confidence interval (CI) 18.0–26.8). Self‐reported constipation (odds ratio (OR) 3.68, 95% CI 1.87–7.24) and loose stools (OR 2.66, 95% CI 1.47–4.78) were significantly associated with faecal incontinence. There was a strong positive correlation between total bowel control score and total quality‐of‐life score (P < 0.001, rs = 0.61) indicating significant alterations in quality of life. The current management practices varied from changing diet, visiting health‐care professionals, and using modern and traditional medicines. Conclusion Faecal incontinence is common among community‐dwelling older people in Bali.

  April 14, 2014   doi: 10.1111/ajag.12141   open full text
• Smart technologies to enhance social connectedness in older people who live at home.
  Meg E Morris, Brooke Adair, Elizabeth Ozanne, William Kurowski, Kimberly J Miller, Alan J Pearce, Nick Santamaria, Maureen Long, Cameron Ventura, Catherine M Said.
  Australasian Journal on Ageing. April 14, 2014
  Aim To examine the effectiveness of smart technologies in improving or maintaining the social connectedness of older people living at home. Methods We conducted a systematic review and critical evaluation of research articles published between 2000 and 2013. Article screening, data extraction and quality assessment (using the Downs and Black checklist) were conducted by two independent researchers. Results Eighteen publications were identified that evaluated the effect of smart technologies on dimensions of social connectedness. Fourteen studies reported positive outcomes in aspects such as social support, isolation and loneliness. There was emerging evidence that some technologies augmented the beneficial effects of more traditional aged‐care services. Conclusion Smart technologies, such as tailored internet programs, may help older people better manage and understand various health conditions, resulting in subsequent improvements in aspects of social connectedness. Further research is required regarding how technological innovations could be promoted, marketed and implemented to benefit older people.

  April 14, 2014   doi: 10.1111/ajag.12154   open full text
• Palliative care, ageing and spirituality: A guide for older people, carers and families by E. MacKinlay. Jessica Kingsley, London, UK, 2012. 144 pp. ISBN 978‐1‐84905‐290‐0. A$26.25. Available from http://www.jkp.com/catelogue/book/9781849052900.
  John Oldroyd.
  Australasian Journal on Ageing. March 21, 2014
  There is no abstract available for this paper.

  March 21, 2014   doi: 10.1111/ajag.12148   open full text
• Book award, 2013.
  Yvonne Wells.
  Australasian Journal on Ageing. March 21, 2014
  There is no abstract available for this paper.

  March 21, 2014   doi: 10.1111/ajag.12143   open full text
• Are older Western Australians exposed to potentially inappropriate medications according to the Beers Criteria? A 13‐year prevalence study.
  Sylvie D Price, C D'Arcy J Holman, Frank M Sanfilippo, Jon D Emery.
  Australasian Journal on Ageing. March 20, 2014
  Aim To examine time trends and factors associated with exposure to Beers’ potentially inappropriate medications (PIMs). Methods PIM consumption days accumulated from the pharmaceutical claims of 251 305 Western Australians aged ≥65 years (1993–2005) and person follow‐up times produced counts/rates. Logistic/Poisson regression generated odds/rate ratios. Results A total of 187 616 participants (74.7%) took ≥1 PIM (1993–2005), the cohort consuming 109 415 PIM daily doses/1000 person‐years. Annual exposure decreased from 45–47% to 40%, and annual consumption rate declined from 117 836 to 90 364 daily doses/1000 person‐years. Temazepam had the highest exposures (>17 000 daily doses/1000 person‐years). Number of medications taken (OR 35.03; 95% CI 34.37–35.71 for ≥10 vs. 0–2 drugs), annual drug intake (2.08; 2.04–2.12 for highest vs. lowest quartile), and high‐level residential aged care (1.96; 1.91–2.01) were most predictive of PIM exposure. Conclusions PIM exposure remains high in older Western Australians. Our findings identify patients most at risk and medications to consider on Australia‐specific PIM lists.

  March 20, 2014   doi: 10.1111/ajag.12136   open full text
• Interrelations of stress, optimism and control in older people's psychological adjustment.
  Susan Jane Bretherton, Louise Anne McLean.
  Australasian Journal on Ageing. March 13, 2014
  Aim To investigate the influence of perceived stress, optimism and perceived control of internal states on the psychological adjustment of older adults. Method The sample consisted of 212 older adults, aged between 58 and 103 (M = 80.42 years, SD = 7.31 years), living primarily in retirement villages in Melbourne, Victoria. Participants completed the Perceived Stress Scale, Life Orientation Test‐Revised, Perceived Control of Internal States Scale and the World Health Organisation Quality of Life‐Bref. Results Optimism significantly mediated the relationship between older people's perceived stress and psychological health, and perceived control of internal states mediated the relationships among stress, optimism and psychological health. The variables explained 49% of the variance in older people's psychological adjustment. Conclusion It is suggested that strategies to improve optimism and perceived control may improve the psychological adjustment of older people struggling to adapt to life's stressors.

  March 13, 2014   doi: 10.1111/ajag.12138   open full text
• Lower rates of appropriate initial diagnosis in older emergency department patients associated with hospital length of stay.
  Tee Juan Ong, Yohanes Ariathianto, Rabindra Sinnappu, Wen Kwang Lim.
  Australasian Journal on Ageing. March 13, 2014
  Aim Emergency department (ED) doctors are under time pressure to expedite decision‐making. This task would seem more difficult in older patients who present atypically, have multiple comorbidities and require more diagnostic tests. This study aimed to investigate the rate of appropriate initial diagnosis of older ED patients admitted under medical units, and whether time was a factor. Methods Retrospective review of all patients admitted under medical units from ED over a one‐month period was conducted. Results Four hundred ninety‐three records were reviewed. Mean time to ED review was 87 minutes, and to medical registrar review, 409 minutes. Overall rate of appropriate initial diagnosis made by ED was 85.8%, with significantly lower rate detected in older patients. Overall rate for medical registrar was 94.5%. Conclusions Admitted older ED patients received lower rates of appropriate initial diagnosis. Time may be a contributing factor to this lower rate. Length of stay was prolonged if initial diagnosis was inappropriate.

  March 13, 2014   doi: 10.1111/ajag.12142   open full text
• Heat‐health behaviours of older people in two Australian states.
  Alana Hansen, Peng Bi, Dino Pisaniello, Monika Nitschke, Graeme Tucker, Jonathan Newbury, Alison Kitson, Eleonora Dal Grande, Jodie Avery, Ying Zhang, Liza Kelsall.
  Australasian Journal on Ageing. March 12, 2014
  Aim A major heatwave occurred in Australia in early 2009 with considerable and varied health impacts in South Australia (SA) and Victoria. The aim of this study was to investigate the heat‐adaptive behaviours of older people in these states. Methods A computer‐assisted telephone survey of 1000 residents of SA and Victoria aged 65 years or older was conducted at the end of summer 2010–2011. Results The majority of respondents reported undertaking heat‐adaptive behaviours. In SA, there was a significantly higher proportion of households with air conditioning compared to Victoria, and a higher recall of heat‐health messages. In both states, self‐reported morbidity during heatwaves was higher in women, persons with poorer health and those with cardiovascular conditions. Conclusion An increase in global temperatures in conjunction with an ageing population is a concern for public health. Our findings suggest acclimatisation to hot weather may influence behaviours and health outcomes in older people.

  March 12, 2014   doi: 10.1111/ajag.12134   open full text
• What's loneliness got to do with it? Older women who use benzodiazepines.
  Sarah L Canham.
  Australasian Journal on Ageing. February 26, 2014
  Aim We examined qualitative data from a larger study of benzodiazepine‐using women older than 65 years, living in the United States for subjective experiences of loneliness and social isolation. Method Data from semistructured interviews with seven participants discussed aspects of social isolation or loneliness. Following a phenomenological design, data were coded and analysed for experience. Results Three themes emerged: ‘Dislike being alone’; ‘Loneliness and isolation’; and ‘Social isolation causes negative feelings’. Conclusion Social isolation and loneliness are negative aspects of the lived experience for older benzodiazepine‐using women and the loss of companions and transportation is important to this experience. Being isolated can cause depression, fear and insecurity. Future research should consider the role psychotropic medications have in coping with social isolation and loneliness among older adults. Clinicians should be aware of social isolation and loneliness in late life and discuss non‐pharmacologic treatment options with their ageing patients.

  February 26, 2014   doi: 10.1111/ajag.12133   open full text
• In‐reach nursing services improve older patient outcomes and access to emergency care.
  Maryann Street, Julie Considine, Patricia Livingston, Goetz Ottmann, Bridie Kent.
  Australasian Journal on Ageing. February 26, 2014
  Aims To identify the impact of in‐reach services providing specialist nursing care on outcomes for older people presenting to the emergency department from residential aged care. Methods Retrospective cohort study compared clinical outcomes of 2278 presentations from 2009 with 2051 presentations from 2011 before and after the implementation of in‐reach services. Results Median emergency department length of stay decreased by 24 minutes (7.0 vs 6.6 hours, P < 0.001) and admission rates decreased by 23% (68 vs 45%, P < 0.001). The proportion of people with repeat emergency department visits within six months decreased by 12% (27 vs 15%). The proportion of admitted patients who were discharged with an end of life palliative care plan increased by 13% (8 vs 21%, P = 0.007). Conclusions There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in‐reach services.

  February 26, 2014   doi: 10.1111/ajag.12137   open full text
• Probiotic treatment for the prevention of antibiotic‐associated diarrhoea in geriatric patients: A multicentre randomised controlled pilot study.
  Kelly Wright, Heathcote Wright, Michael Murray.
  Australasian Journal on Ageing. January 24, 2014
  Objective The objective of the study was to evaluate probiotic supplementation effectiveness in reducing antibiotic‐associated diarrhoea (AAD). Method A double‐blind randomised controlled trial (registration number: ACTRN 12609000429257); with primary outcome prevention of AAD and secondary outcome reduction in diarrhoea duration, patients were randomised to receive probiotic supplementation with Lactobacillus casei, Shirota strain or placebo. Results Eighty‐seven people (66–101 years old) were recruited to the study during their admission to the Geriatric Evaluation Management wards during August–October 2009. 41 received the active Yakult (Yakult Australia Pty Ltd, Dandenong South, Victoria, Australia) (12.2% diarrhoea) and 46 received placebo (8.7% diarrhoea). There was no significant difference in diarrhoea between the groups, Fisher's exact test, P = 0.729. The mean diarrhoea duration was 4 and 5 days for those administered Yakult and placebo, respectively. Conclusion There was no significant difference between groups. However, we noted a low prevalence of AAD and this affects the sample size that will be required for any future study targeting a beneficial effect of probiotic supplementation.

  January 24, 2014   doi: 10.1111/ajag.12116   open full text
• Nutritional screening tools and anthropometric measures associate with hospital discharge outcomes in older people.
  Elsa Dent, Ian Chapman, Cynthia Piantadosi, Renuka Visvanathan.
  Australasian Journal on Ageing. January 21, 2014
  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 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 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 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.

  January 21, 2014   doi: 10.1111/ajag.12130   open full text
• Aged Care Assessment Service practitioners: A review of current practice for assessment of cognition of older people of culturally and linguistically diverse backgrounds in Victoria.
  Freda Vrantsidis, Dina LoGiudice, Victoria Rayner, Briony Dow, Stephanie Antonopoulos, Susannah Runci, Daniel W. O'Connor, Betty Haralambous.
  Australasian Journal on Ageing. September 13, 2013
  Aim This paper describes current practices and gaps identified by Aged Care Assessment Service (ACAS) clinicians in the assessment of cognition of clients of culturally and linguistically diverse (CALD) background in Victoria. Method A web‐based survey, exploring practices and challenges faced by clinicians in assessing CALD clients and their families, was sent to all Victorian ACAS managers to distribute to their teams. Three focus groups were also conducted with ACAS clinicians to further explore these issues. Results Seventy‐nine web‐based surveys were returned and 21 ACAS clinicians attended a focus group. Challenges reported included the availability and quality of interpreters, and variability in training received and confidence in assessing cognitive impairment in CALD clients. Conclusion ACAS clinicians reported that assessment of cognition for those of CALD background was challenging. Based on this feedback, practice tip sheets were developed as educational aids to assist ACAS staff.

  September 13, 2013   doi: 10.1111/ajag.12056   open full text
• Learning from our older people: Pilot study findings on responding to heat.
  Margaret E. Loughnan, Matthew Carroll, Nigel Tapper.
  Australasian Journal on Ageing. August 06, 2013
  Aims With the advent of climate change, it is important that strategies be put in place to minimise the effects of heat. These impacts can be compounded by other factors such as location and age. This exploratory pilot study focuses on older people in a rural Victorian community that regularly experiences hot weather. Method Mixed methods – including a focus group, household interviews, daily diaries and collection of meteorological data. Results The community is generally well adapted to heat with all having modified their homes and behaviours to cope with extreme heat. There was, however, little understanding or planning regarding the potential health impacts of heat. Conclusions There is a clear need for community‐directed adaptation to best meet the needs of older people, particularly those living in urban areas, and for targeted public health campaigns to increase awareness of heat‐health risks and disseminate the strategies identified in this community.

  August 06, 2013   doi: 10.1111/ajag.12050   open full text
• Managing expectations: Providing palliative care in aged care facilities.
  Heather Lane, Jennifer Philip.
  Australasian Journal on Ageing. August 06, 2013
  Aim To explore the views and experiences of staff from RACFs and community palliative care services (CPCSs) on providing palliative and end‐of‐life care in RACFs. Method Qualitative exploratory interviews and focus groups were conducted with staff working in two RACFs and two CPCSs, and, following data saturation, a thematic analysis undertaken. Results 15 RACF and 15 CPCS staff participated. The overarching theme was of managing expectations in the provision of care. This included low expectations of the care available in RACFs, tensions in addressing complex decision‐making and concurrent administrative expectations, and differences between views of RACF and CPCS staff regarding their respective roles. Conclusion Improved understanding of the needs of RACF staff will improve the care of residents and, in turn, reduce hospitalisations.

  August 06, 2013   doi: 10.1111/ajag.12085   open full text
• Recruiting older people for research through general practice: The Brief Risk Identification Geriatric Health Tool trial.
  Christine McLean, Ngaire Kerse, Simon A Moyes, Terence Ng, Ssu‐Yu (Suei) Lin, Kathryn Peri.
  Australasian Journal on Ageing. July 29, 2013
  Aim To describe successful methods of recruitment and identify practice characteristics related to increased recruitment of older people for a randomised controlled trial. Methods General practices in three regions of New Zealand and community‐dwelling patients aged 75+ were recruited for the Brief Risk Identification Geriatric Health Tool trial. General practitioners (GPs) were faxed invitations with telephone follow‐up. Reply‐paid cards with telephone follow‐up were used to invite older people. GP and practice characteristics were examined in relationship to recruitment rate. Results During 2007–2008, 158 of 438 GPs (36%) in 60 of 116 practices approached (52%) were recruited. Regional variation was marked and 3893 of 8308 invited (49%) older people were recruited. The GP's length of time at the practice and training in New Zealand was associated with recruitment success. Conclusions Despite variability in practice recruitment, a reasonably large and representative sample of older people was recruited through general practices.

  July 29, 2013   doi: 10.1111/ajag.12058   open full text
• Residential aged care for people with intellectual disability: A matter of perspective.
  Ruth Webber, Barbara Bowers, Chris Bigby.
  Australasian Journal on Ageing. July 25, 2013
  Aim This paper explores the experiences of older people with intellectual disability (ID) who moved from a group home to residential aged care, from the perspective of family members, aged care staff and former group home staff. Method Interviews were conducted with staff and family members associated with 10 people with ID who recently moved from disability group homes into nine aged care residential facilities. Dimensional analysis was used to analyse 31 interviews. Results Aged care staff focused primarily on health outcomes and identified and addressed several previously undiagnosed conditions. The primary concern of staff from the residents' former group homes was social isolation. Families acknowledged the health benefits but were equally concerned about social isolation. Conclusion The findings highlight the importance of addressing health and social needs of people with ID and indicate that an increased accountability for both social and clinical outcomes is required.

  July 25, 2013   doi: 10.1111/ajag.12086   open full text
• Expert perceptions of the popular baby boomer image.
  Meredith Tavener, Julie Byles, Deborah Loxton.
  Australasian Journal on Ageing. July 19, 2013
  Aim This paper explored how gerontology experts described baby boomers, whether they challenged the popular image, and if they provided alternatives to the popularly reported baby boomer behaviours and characteristics. Methods Qualitative interviews were conducted with ten experts from different areas across Australia. The interviews were semi‐structured and guided by a ‘sense‐making’ approach to explore the baby boomer construct and identify expert narratives that differed from the popularly tendered image. Results The majority of experts were identified as baby boomers and made use of phrases associated with the popular baby boomer image, such as ‘cashed up’, ‘reinventing retirement’ and ‘sea change’. Lifestyle and wealth were recognised as staple features of the popular image. To a lesser degree, the experts also recognised alternative characteristics and behaviours, including people with disabilities and those who struggle financially. Conclusions Experts appeared to identify with the popular baby boomer label, but not necessarily the accompanying stereotypes.

  July 19, 2013   doi: 10.1111/ajag.12087   open full text
• Nutrition and older indigenous Australians: Service delivery implications in remote communities. A narrative review.
  Kellie Schouten, Melissa A Lindeman, John (Binda) Reid.
  Australasian Journal on Ageing. July 19, 2013
  Objective To describe the nutritional status of older indigenous people, barriers to achieving optimal nutrition, and the effectiveness of programs aimed at improving nutrition in older indigenous people in remote communities. Methods A comprehensive literature review was undertaken utilising electronic databases Scopus, CINAHL, Informit, Ovid MEDLINE, ProQuest, Web of Knowledge, PsycINFO, ATSI HealthInfoNet and Google Scholar. Grey literature was also accessed. Results Findings indicated there is a scarcity of representative data on nutritional status and risk in older indigenous people, and nutrition support programs have not been evaluated. Conclusions Older indigenous people suffer from poorer overall health, greater levels of overweight and obesity, and are at increased risk of poor nutritional status and malnutrition compared with the general population. This risk may be higher in remote areas. More representative data are needed to determine nutritional status, including levels of malnutrition. Support programs also need to be evaluated.

  July 19, 2013   doi: 10.1111/ajag.12057   open full text
• Geriatric medicine course to senior undergraduate medical students improves attitude and self‐perceived competency scores.
  Khai Loon Tam, Khobe Chandran, Solomon Yu, Shailaja Nair, Renuka Visvanathan.
  Australasian Journal on Ageing. July 19, 2013
  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.

  July 19, 2013   doi: 10.1111/ajag.12060   open full text
• Multilevel, cross‐sectional study on social capital with psychogeriatric health among older Japanese people dwelling at rural areas.
  Motoyuki Yuasa, Shigekazu Ukawa, Tamiko Ikeno, Tomoko Kawabata.
  Australasian Journal on Ageing. July 10, 2013
  Aim There has been increasing interest in the effect of social capital (SC) on health over the last decade both in Japan and internationally. This study elucidated whether components of SC are linked to the psychogeriatric health of older Japanese individuals. Method Data for 169 eligible older people dwelling across three rural areas were collected. Multilevel analyses were performed to examine associations between general trust, informal social interaction and formal group participation with self‐rated health, mini‐mental state examination (MMSE), self‐rating depression scale (SDS) and general self‐efficacy scale (GSES). Results Our study revealed that MMSE, SDS and GSES were significantly associated with informal social interaction and formal group participation after adjusting for area‐level SC. However, we observed no relationship between general trust and health outcomes. Conclusion The findings suggest that the strategic enhancement of social cohesion and social networks for older people may promote their health and quality of later life.

  July 10, 2013   doi: 10.1111/ajag.12024   open full text
• Exploring the effect of aquatic exercise on behaviour and psychological well‐being in people with moderate to severe dementia: A pilot study of the Watermemories Swimming Club.
  Christine Neville, Tim Henwood, Elizabeth Beattie, Elaine Fielding.
  Australasian Journal on Ageing. July 03, 2013
  Aim To explore the effects of a dementia‐specific, aquatic exercise intervention on behavioural and psychological symptoms in people with dementia (BPSD). Method Residents from two aged care facilities in Queensland, Australia, received a 12‐week intervention consisting of aquatic exercises for strength, agility, flexibility, balance and relaxation. The Psychological Well‐Being in Cognitively Impaired Persons Scale (PW‐BCIP) and the Revised Memory and Behaviour Problems Checklist (RMBPC) were completed by registered nurses at baseline, week 6, week 9 and post intervention. Results Ten women and one man (median age = 88.4 years, interquartile range = 12.3) participated. Statistically significant declines in the RMBPC and PW‐BCIP were observed over the study period. Conclusion Preliminary evidence suggests that a dementia‐specific, aquatic exercise intervention reduces BPSD and improves psychological well‐being in people with moderate to severe dementia. With further testing, this innovative intervention may prove effective in addressing some of the most challenging aspects of dementia care.

  July 03, 2013   doi: 10.1111/ajag.12076   open full text
• Long‐term care insurance and market for aged care in Japan: Focusing on the status of care service providers by locality and organisational nature based on survey results.
  Makoto Kubo.
  Australasian Journal on Ageing. June 30, 2013
  Aim The purpose of this paper is to examine the status of care service providers by locality and organisational nature. Method Questionnaires were sent to 9505 home‐based care service providers registered in the databases of 17 prefectures. The prefectures were selected according to population size. Results  Numerous for‐profit providers have newly entered the aged care service market and are operating selectively in Tokyo, a typical example of a metropolitan area. Furthermore, both for‐profit and non‐profit providers have suffered from a shortage of care workers and difficult management conditions, which tend to be more pronounced in Tokyo. Conclusion The market under long‐term care insurance was successful in terms of the volume of services, but most providers were sceptical as to whether competition in the market could facilitate quality care services.

  June 30, 2013   doi: 10.1111/ajag.12038   open full text
• Use of the Screening Tool of Older Person's Prescriptions (STOPP) in older people admitted to an Australian hospital.
  Elizabeth Manias, Snezana Kusljic, Claire Berry, Ella Brown, Emma Bryce, Justine Cliffe, Alexandra Smykowsky.
  Australasian Journal on Ageing. June 30, 2013
  Aims To determine the prevalence of potentially inappropriate medications (PIMs) in older people aged 65 years and over who were admitted to hospital, and to examine the medications and medication classes that comprised these PIMs with use of the Screening Tool of Older Person's Prescriptions. Method Using a retrospective clinical audit design, the medical records of 100 older patients were randomly selected and examined for the prevalence and characteristics of PIMs. The audit was undertaken of patients admitted over a 12‐month period to an Australian public teaching hospital. Results In total, 92 individual occurrences of PIMs were detected, and 54 patients had at least one PIM. The most common type of PIM experienced related to prescribed medications that adversely affected individuals who were prone to falls. Conclusion Many older patients experienced a PIM during their hospital admission, where the risk of an adverse event could outweigh the clinical benefit.

  June 30, 2013   doi: 10.1111/ajag.12054   open full text
• Self‐regulation of older drivers with cognitive impairment: A systematic review.
  Anna Devlin, Jane A McGillivray.
  Australasian Journal on Ageing. June 30, 2013
  Background Cognitive decline contributes significantly to the safety risk of older drivers. Some drivers may be able to compensate for the increased crash risk by avoiding complex driving situations or restricting their driving. Objective and Method A comprehensive English‐language systematic review was conducted to determine the level of evidence for older adult drivers with cognitive impairment engaging in self‐regulation. Results Twelve studies were included in the review. The majority of studies investigated driver avoidance, followed by driver restriction. Few studies ascertained the reasons for changing driving behaviour. Conclusions The evidence supports the view that drivers with cognitive impairment do restrict their driving and avoid complex driving situations. However, it remains to be determined whether the drivers who do engage in self‐regulation require insight into their own driving abilities or whether external factors result in self‐regulation of driving behaviour.

  June 30, 2013   doi: 10.1111/ajag.12061   open full text
• Measuring the positive and negative aspects of the caring role in community versus aged care setting.
  Julie F Pallant, Carol Reid.
  Australasian Journal on Ageing. June 17, 2013
  Aim To investigate the positive and negative aspects of family caregiving in two settings: community and aged care facility. Methods Postal questionnaires included the short Zarit Burden Interview (ZBI) and a scale developed for this study: Positive Aspects of Caring Scale (PACS). Results Analysis of responses of 90 carers showed high burden levels, with no difference between care settings. Carers of an older person with a cognitive condition showed higher burden. There was no association between carer burden and positive attitudes. Carers in community settings recorded lower levels of positive attitudes. Conclusion The two measures (ZBI and PACS) may be a useful clinical tool to provide a balanced assessment of carers' experiences. The high burden found in both carer groups indicates the need for greater awareness, and improved support for carers, across the care continuum, from home to aged care facility.

  June 17, 2013   doi: 10.1111/ajag.12046   open full text
• The injury profile and acute treatment costs of major trauma in older people in New South Wales.
  Kate Curtis, Daniel Leonard Chan, Mary Kit Lam, Rebecca Mitchell, Kate King, Liz Leonard, Scott D'Amours, Deborah Black.
  Australasian Journal on Ageing. June 17, 2013
  Aims Describe injury profile and costs of older people trauma in New South Wales; quantify variations with peer group costs; identify predictors of higher costs. Methods Nine level 1 New South Wales trauma centres provided data on major traumas (aged ≥55 years) during 2008–2009 financial year. Trauma register and financial data of each institution were linked. Treatment costs were compared with peer group Australian Refined Diagnostic Related Groups costs, on which hospital funding is based. Variables examined through multivariate analyses. Results Six thousand two hundred and eighty‐nine patients were admitted for trauma. Most common injury mechanism was falls (74.8%) then road trauma (14.9%). Median patient cost was $7044 (Q1‐3: $3405–13 930) and total treatment costs $76 694 252. Treatment costs were $5 813 975 above peer group average. Intensive care unit admission, age, injury severity score, length of stay and traumatic brain injury were independent predictors of increased costs. Conclusion Older people trauma attracts greater costs and length of stay. Cost increases with age and injury severity. Hospital financial information and trauma registry data provides accurate cost information that may inform future funding.

  June 17, 2013   doi: 10.1111/ajag.12059   open full text
• Enduring Powers of Attorney: Promoting attorneys' accountability as substitute decision makers.
  Cheryl Tilse, Jill Wilson, Ben White, Lindy Willmott, Anne‐Louise McCawley.
  Australasian Journal on Ageing. June 13, 2013
  Aim The misuse and abuse of Enduring Powers of Attorney (EPAs) by attorneys, particularly in relation to financial decision‐making, is a growing concern. This paper explores the opportunities to enhance accountability of attorneys at the time of the execution of the document in Queensland. Method A four‐stage multi‐method design comprised a critical reference group; semi‐structured interviews with 32 principals or potential principals, attorneys and witnesses; two focus groups with service providers and a state‐wide survey of 76 principals, attorneys and witnesses. Results Across all methods and user groups, understanding the role and obligations of the attorney in an EPA was consistently identified as problematic. Conclusions Promoting accountability and understanding can be addressed by greater attention to the role of the attorney in the forms/ guidelines and in the structure and witnessing of the forms, increased direction about record keeping and access to appropriate advice and support.

  June 13, 2013   doi: 10.1111/ajag.12052   open full text
• Promoting the use of enduring powers of attorney in older adults: A literature review.
  Leander K Mitchell, Nancy A Pachana, Jill Wilson, Katharine Vearncombe, Bronwyn Massavelli, Gerard J Byrne, Cheryl Tilse.
  Australasian Journal on Ageing. June 05, 2013
  This review aims to identify factors that facilitate the establishment of enduring powers of attorney (EPOAs), and those that create a barrier to their establishment. The primary aim was to provide guidance about how to encourage future planning while people are cognitively able to make such important decisions. A detailed search of the literature was conducted to identify research looking at the motivating factors behind putting future‐planning strategies in place. The literature highlighted a number of broad areas motivating the establishment of EPOAs, including: demographic factors; intrapersonal and personality factors; health and psychological factors; cognitive factors; and socio‐emotional factors. While a number of factors play a role in determining whether or not a person establishes an EPOA, the factor most malleable to change is the awareness and knowledge of older adults and their families regarding the utility of EPOAs.

  June 05, 2013   doi: 10.1111/ajag.12043   open full text
• Hospital Dementia Services Project: Aged care and dementia services in New South Wales hospitals.
  Brian Draper, Charles Hudson, Ann Peut, Rosemary Karmel, Natalie Chan, Diane Gibson.
  Australasian Journal on Ageing. June 05, 2013
  Aims To describe the availability of aged care and dementia services in public hospitals in New South Wales (NSW), Australia in 2006/2007. Method Hospitals were surveyed about issues relevant to dementia in acute care including the types of aged care wards and staff, policies, practices, clinics, community services and resources for dementia care. Results Responses were obtained from 163 hospitals (82%); responding hospitals represented 93.4% of NSW hospital beds, 96.7% of multiday episodes of care. Hospitals that had a Specialist Mental Health Service for Older People (SMHSOP) and an Aged Care Service (ACS) had the highest levels of dementia‐related services and policies. Few hospitals without ACS or SMHSOP had clinics for dementia assessment, secure beds for disturbed behaviour, or services to manage patients with dementia and medical or behavioural comorbidity in the community. Conclusion Dementia services in NSW hospitals are closely aligned with ACS and SMHSOP, with limited dementia services in hospitals without ACS or SMHSOP.

  June 05, 2013   doi: 10.1111/ajag.12042   open full text
• Alcohol consumption and tobacco smoking among community‐dwelling older Australian men: The Concord Health and Ageing in Men Project.
  Jenni Ilomäki, Danijela Gnjidic, David G Le Couteur, J Simon Bell, Fiona M Blyth, David J Handelsman, Robert G Cumming, Markus J Seibel, Louise M Waite, Vasi Naganathan, Sarah N Hilmer.
  Australasian Journal on Ageing. June 05, 2013
  Aim To describe the prevalence and correlates of alcohol consumption and tobacco smoking among older Australian men. Method Self‐reported alcohol and tobacco use was assessed among a random sample of community‐dwelling men aged ≥70 years living in Sydney (n = 1705) from 2005 to 2007. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with alcohol and tobacco use. Results The prevalence of heavy/excessive drinking was 19.2%, daily drinking 33.7%, and binge drinking 14.1%. Daily drinking was associated with chronic pain (OR = 1.38, 95% CI: 1.07–1.78). Binge drinking was associated with anxiety (OR = 1.93, 95% CI: 1.05–3.54) and being widowed (OR = 1.74, 95% CI: 1.11–2.73). Six per cent of men were current smokers and 56.7% were former smokers. Former smoking was associated with polypharmacy (OR = 1.47, 95% CI: 1.14–1.91) and each additional comorbid condition (OR = 1.11, 95% CI: 1.03–1.19). Conclusions Nearly one‐fifth of older men drank heavily or excessively. This highlights the need for public health initiatives to reduce alcohol consumption in older people.

  June 05, 2013   doi: 10.1111/ajag.12048   open full text
• Do continence management strategies reduce falls? A systematic review.
  Frances A Batchelor, Briony Dow, May‐Ann Low.
  Australasian Journal on Ageing. June 04, 2013
  Urinary incontinence is associated with increased fall risk, and fall prevention programs include recommendations to manage continence as one component of fall reduction. However, the evidence to support this recommendation is unclear. The aim of this study was to identify continence management interventions that are effective in decreasing falls. A systematic review of the literature was conducted. Studies were included if they evaluated the effect of any type of continence management strategy on falls in older adults. The included studies were assessed for quality, and data relating to participants, interventions and outcomes were extracted by two independent reviewers. Four articles met the inclusion criteria. Two studies were randomised controlled trials, one a retrospective cohort study and one an uncontrolled intervention study. Interventions included pharmacological agents, a toileting regime combined with physical activity and an individualised continence program. Only the study evaluating the combination of physical activity and prompted voiding found an effect on falls. It is surprising that there has been so little research into continence management interventions that include fall outcomes. A toileting regime combined with physical activity may reduce falls in residential care. There is a need for further studies investigating the impact of continence management on falls.

  June 04, 2013   doi: 10.1111/ajag.12047   open full text
• General practitioners' opinions and attitudes towards medical assessment of fitness to drive in older adults.
  Sami Omer, Catherine Dolan, Borislav D Dimitrov, Camilla Langan, Geraldine McCarthy.
  Australasian Journal on Ageing. May 30, 2013
  Objective The study sought to assess opinions and attitudes of general practitioners (GPs) in Ireland towards fitness to drive (FTD) assessment in people older than 65 years old as well as to gather information on current assessment practices. Method A postal‐based cross‐sectional survey was carried out with 603 GP practices randomly selected using the Irish College of General Practitioners database. A questionnaire was posted to the selected GPs to assess their opinions and attitudes towards FTD assessment. Results Response rate was 42.6%. The prevalence of GPs not confident in assessing FTD was less than 15% with 81% reporting the need for more education on assessing FTD, with 82% identifying that mandatory reporting of unsafe drivers posed a conflict of interest. Only 37% of GPs always/often used the Irish Road Safety Authority handbook when assessing FTD with 14% not aware of its existence. Of responders, 89% were of the opinion that a clinical assessment tool would be of benefit in assessing FTD. Conclusion Our study highlights the need for education and training to be provided to Irish GPs on provision of FTD assessment in the older people patient population.

  May 30, 2013   doi: 10.1111/ajag.12045   open full text
• The prevalence and risk factors for psychological distress in male and female older people affected by the Wenchuan earthquake.
  Xiaoyi Cao, Xiaolian Jiang, Samantha Pang, Sijian Li, Yijuan Cheng, Lang Tian.
  Australasian Journal on Ageing. May 14, 2013
  Aims The aim of this study was to examine the prevalence of psychological distress in survivors 60 years old and older by sex and analyse risk factors for psychological distress in male and female older survivors 2 years after the Wenchuan earthquake. Methods This was a cross‐sectional study. Two hundred fifty‐seven older people were involved and a multistage random sampling method was utilised. Logistic regression analysis was used to determine risk factors for psychological distress among older men and women. Results A higher prevalence of psychological distress was observed in older women than in older men. Loss of family members and displacement from pre‐earthquake residence were significant risk factors for psychological distress in older men. Significant risk factors for psychological distress in older women were lower educational level, chronic diseases, loss of family members, and displacement from original residence. Conclusions Health‐care providers should take sex‐based strategies to improve mental health among older survivors in a long‐term post‐disaster recovery programme.

  May 14, 2013   doi: 10.1111/ajag.12039   open full text
• Accuracy of self‐reported anthropometric measures in older Australian adults.
  Maria Pasalich, Andy H. Lee, Linda Burke, Jonine Jancey, Peter Howat.
  Australasian Journal on Ageing. May 13, 2013
  Aim To determine the accuracy of self‐reported anthropometric measurements in older Australian adults 60–70 years. Method Self‐reported anthropometric data from 103 community‐dwelling participants (mean age 66 years) were compared with actual measurements. Difference and agreement were assessed using paired t‐tests, correlation coefficients and Bland–Altman plots. Results Underreporting occurred for weight and hip circumference, especially among men, whereas waist circumference was slightly overreported, resulting in apparent underestimations of body mass index (by 0.42 kg/m2) but overestimations of waist‐to‐hip ratio (WHR, by 0.02). Concordance correlation coefficients were generally high except for WHR. Self‐reported circumference measures appeared to be more accurate than the derived WHR. The Bland–Altman plots revealed wide limits of agreement for all measures. Conclusion Self‐reported values correlated well with measured values and average discrepancies were small. However, use of self‐reported anthropometric data may be preferable in population studies for describing overall distribution than for monitoring changes at an individual level.

  May 13, 2013   doi: 10.1111/ajag.12035   open full text
• Safe to crush? A pilot study into solid dosage form modification in aged care.
  Nicole Mercovich, Greg J Kyle, Mark Naunton.
  Australasian Journal on Ageing. May 13, 2013
  Aims To observe solid dosage form modification in aged care facilities (ACFs), and assess staff levels of self‐perceived knowledge of medication modification and the types of resources available to them. Method Observation of medication rounds in a convenience sample of Australian Capital Territory ACFs and assess staff knowledge of dosage form modification and available resources. Results From 160 observations across six medication rounds, 29 residents had a total of 75 medications modified by the nursing staff prior to administration, with 32% of these identified as inappropriate. The methods used for crushing and administration resulted in drug mixing, spillage and incomplete dosing. The staff reported adequate resources; however, a lack of knowledge on how to locate and use these resources was evident. Conclusions Improved staff training on how to use available resources is needed to reduce the observed high incidence of inappropriate medication crushing.

  May 13, 2013   doi: 10.1111/ajag.12037   open full text
• Successful transition to later life: Strategies used by baby boomers.
  Kay Wilhelm, Liesbeth Geerligs, Carmelle Peisah.
  Australasian Journal on Ageing. May 02, 2013
  Aim We sought to understand strategies employed by ‘Baby Boomers’ to maintain well‐being and facilitate transition to later life. Method A non‐clinical cohort (n = 139) provided qualitative data about well‐being strategies. Thematic data analysis provided insights for those with high and low life satisfaction (based on Satisfaction with Life Scale) and quantitative data from previous waves provided predictors of life satisfaction decades later. Results Longitudinal predictors were depression history (cognitive trait and repeated episodes) and quality of partner's care. ‘Highly satisfied older people’ reported proactive strategies, contrasted with lack of planning by ‘dissatisfied older people’. ‘Resilient older people’, with high life satisfaction despite repeated depressive episodes reported benefit from strategies dealing with adversity, including depression. Discussion Strategies of ‘satisfied older people’ support theories of proactive coping and demonstrate the importance of developing adaptational skills to support later life satisfaction. ‘Resilient older people’ demonstrate that adaptive strategies can lead to achievement of life satisfaction despite repeated depressive episodes.

  May 02, 2013   doi: 10.1111/ajag.12025   open full text
• A focus group study investigating medical decision making in octogenarians of high socioeconomic status with successful outcomes following cardiac surgery.
  John C Oldroyd, Michele R Levinson, Gemma Stephenson, Alice Rouse, Tina Leeuwrik.
  Australasian Journal on Ageing. April 28, 2013
  Aim To explore medical decision making in octogenarians having cardiac surgery. Methods Five focus groups conducted in a private hospital setting with octogenarians of high socioeconomic status who had successful cardiac surgery in the previous 3–13 months. Results Octogenarians motivations for having cardiac surgery include survival, relief of symptoms, convenience and improving quality of life. The decision to have surgery involved clinical advice by doctors that the time had come to take up a surgical option. Patient's decisions did not take into account alternative treatment options either because these had not been presented by doctors or because medical management had failed. The final decision was made by patients. Conclusions Decisions to have cardiac surgery in octogenarians are made by patients after discussions with family based on their risks as communicated by their doctors. This underlines the importance of effective risk communication by doctors to help patients make appropriate medical decisions.

  April 28, 2013   doi: 10.1111/ajag.12022   open full text
• Living Longer Living Stronger™: A community‐delivered strength training program improving function and quality of life.
  Freda Vrantsidis, Keith Hill, Betty Haralambous, Emma Renehan, Kay Ledgerwood, Jaya Pinikahana, Stephanie Harper, Mitsuko Penberthy.
  Australasian Journal on Ageing. April 23, 2013
  Aim This study investigated changes in function and quality of life for older adults participating in Living Longer Living Stronger™, a community‐delivered strength training program for people aged over 50. Methods Assessments were conducted at baseline, 4 and 8 months using measures of function, balance, mobility, strength, mental health and quality of life. Results Thirty‐five participants (mean age 66 years, 69% female) completed 4 months of the program; 24 completed 8 months. Using repeated‐measures anova, significant improvements were found at 4 and 8 months for step test, gait stride length, 6‐minute walk test, timed sit to stand, physical performance test and reported health transition (SF‐36). At 4 months (n = 35), vitality (SF‐36), quality of life and left shoulder abductor strength significantly improved; at 8 months (n = 24), role physical and mental health (SF‐36) and gait velocity significantly improved. Conclusion The program appears to be an effective community‐delivered strength training program.

  April 23, 2013   doi: 10.1111/ajag.12008   open full text
• Prospective observational study of dementia in older patients admitted to acute hospitals.
  Catherine Travers, Gerard J Byrne, Nancy A Pachana, Kerenaftali Klein, Len C Gray.
  Australasian Journal on Ageing. April 22, 2013
  Aim Few Australian studies have examined the impact of dementia on hospital outcomes. The aim of this study was to determine the relative contribution of dementia to adverse outcomes in older hospital patients. Method Prospective observational cohort study (n = 493) of patients aged ≥70 years admitted to four acute hospitals in Queensland. Trained research nurses completed comprehensive geriatric assessments using standardised instruments and collected data regarding adverse outcomes. The diagnosis of dementia was established by independent physician review of patients' medical records and assessments. Results Patients with dementia (n = 102, 20.7%) were significantly older (P = 0.01), had poorer functional ability (P < 0.01), and were more likely to have delirium at admission (P < 0.01) than patients without dementia. Dementia (odds ratio = 4.8, P < 0.001) increased the risk of developing delirium during the hospital stay. Conclusion Older patients with dementia are more impaired and vulnerable than patients without dementia and are at greater risk of adverse outcomes when hospitalised.

  April 22, 2013   doi: 10.1111/ajag.12021   open full text
• Systematic review of non‐transportation rates and outcomes for older people who have fallen after ambulance service call‐out.
  A Stefanie Mikolaizak, Paul M Simpson, Anne Tiedemann, Stephen R Lord, Jacqueline CT Close.
  Australasian Journal on Ageing. April 17, 2013
  Aim To review the evidence regarding non‐transported older people who have fallen in relation to non‐transportation rates, outcomes and impact of alternate care pathways. Method Electronic databases were systematically searched until December 2011 as well as reference lists of included studies. Studies were eligible if they included data on non‐transportation rates, information on outcomes or alternate care pathways for older people who have fallen. Results Twelve studies were included. Non‐transportation rates following a fall ranged from 11% to 56%. Up to 49% of non‐transported people who have fallen had unplanned health‐care contact within 28 days of the initial incident. Attendance by specially trained paramedics and individualised multifactorial interventions significantly reduced adverse events including subsequent falls, emergency ambulance calls, emergency department attendance and hospital admission. Conclusion Limited but promising evidence exists to show appropriate interventions can improve the health outcomes of non‐transported older people who have fallen. Further studies are needed to explore alternative care pathways and promote more efficient use of our health services.

  April 17, 2013   doi: 10.1111/ajag.12023   open full text
• Working at the frontline in cases of elder abuse: ‘It keeps me awake at night’.
  Jane Cairns, Anthea Vreugdenhil.
  Australasian Journal on Ageing. April 16, 2013
  Aim To explore the experiences of frontline health and welfare practitioners in working with older people experiencing abuse. Methods In‐depth interviews with 16 Tasmanian community‐based health and welfare practitioners regarding their experiences of working in 49 recent cases of elder abuse. Interview transcripts were analysed using thematic analysis. Results All participants found working in cases of elder abuse challenging and the work itself was perceived as difficult, complex and at times dangerous. The cumulative effect of intimidating work contexts, practice dilemmas and a lack of support resulted in frustration and stress for many practitioners. Nevertheless, participants were committed to providing ongoing services and support for older people experiencing abuse. Conclusion Frontline practitioners working in cases of elder abuse face significant challenges and could be better supported through strengthening organisational elder abuse policies, increased management support and more age‐inclusive family violence support services.

  April 16, 2013   doi: 10.1111/ajag.12017   open full text
• Evaluating the potential of group singing to enhance the well‐being of older people.
  Jane W Davidson, Beverley McNamara, Lorna Rosenwax, Andrea Lange, Sue Jenkins, Gill Lewin.
  Australasian Journal on Ageing. April 16, 2013
  Aim To evaluate the effect of a singing program developed specifically for older community‐dwelling people on measures of health and well‐being. Method An eight‐week singing program was developed and evaluated using standardised measures of health and well‐being, measures designed to examine specific singing program outcomes, and semi‐structured interviews. Participants aged 70 years and older were recruited through a home care service provider (n = 17) and an advertisement in a community newspaper (n = 19). Results Standard outcome measures indicated that the program had little effect on health and well‐being. However, study‐specific measures indicated that many participants had positive gains. Those in the home care group required more assistance to attend and continue in the program. Participants reported that the community‐based singing facilitator was essential to the program's success. Conclusion Well‐structured community‐based singing programs have the potential to impact positively upon the well‐being of older people, but program viability depends on support with recruitment, transport and funding.

  April 16, 2013   doi: 10.1111/j.1741-6612.2012.00645.x   open full text
• Residential aged care: The de facto hospice for New Zealand's older people.
  Martin J Connolly, Joanna B Broad, Michal Boyd, Ngaire Kerse, Merryn Gott.
  Australasian Journal on Ageing. March 11, 2013
  Aim To describe short‐term mortality among residential aged care (RAC) residents in Auckland, New Zealand. Method Prospective follow‐up, 6828 residents (median age 86 years, 69.8% women) from census‐type survey (10/9/2008); 152 facilities. Mortality data from central sources. Results Eight hundred and sixty‐one (12.6%) died by 6 months. Survival related to RAC length of stay before the survey: those resident <1 month (subgroup, n = 380) having 80.0% survival, 1–6 months 83.2% and >6 months 87.4% (P < 0.0001). In those admitted to private hospital from acute hospital (n = 104 of the subgroup of 380), 6‐month mortality was 36.5% (P < 0.0001 vs other ‘short stayers’). Significant mortality predictors were: private hospital admission from acute hospital (hazard ratio (HR) = 2.02), unscheduled GP visit during the prior 2 weeks (HR= 1.90), personal care disability (HR= 1.90) and acute hospital admission number during previous 2 years (≥3; HR= 5.40). Conclusions RAC mortality (especially post admission) is high. Training and resource in the sector should reflect this.

  March 11, 2013   doi: 10.1111/ajag.12010   open full text
• Local governance responses to social inclusion for older rural Victorians: Building resources, opportunities and capabilities.
  Rachel Winterton, Samantha Clune, Jeni Warburton, John Martin.
  Australasian Journal on Ageing. March 08, 2013
  Aim To explore how local governance enables access to resources, creates opportunities and increases capability for older people in rural communities to experience social inclusion. Method Twenty‐six semi‐structured interviews were undertaken with community stakeholders across two rural communities in north‐east Victoria. Stakeholders were drawn from local government, and a range of community groups and organisations, as identified in a scoping study. Results Through the provision of community resources (e.g. physical and human infrastructure, organisational partnerships), local services and supports offer social and productive environments for participation. They also build individual resources (e.g. health, skills, finances, networks) to enable older people to participate within these environments, and provide assistance to allow older people to use individual and community resources. Conclusions Community resources are integral in facilitating the development of older people's individual resources, and opportunities and capabilities for participation. These enable greater choice in participation, and contribute to the sustainability of community resources serving ageing populations.

  March 08, 2013   doi: 10.1111/ajag.12015   open full text
• Hospital admissions in poorly nourished, compared with well‐nourished, older South Australians receiving ‘Meals on Wheels’: Findings from a pilot study.
  Natalie Luscombe‐Marsh, Ian Chapman, Renuka Visvanathan.
  Australasian Journal on Ageing. March 04, 2013
  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 the age‐related decline in health, although a potential reduction in hospital admissions warrants investigation.

  March 04, 2013   doi: 10.1111/ajag.12009   open full text
• Ageing in an inconvenient paradise: The immigrant experiences of older Korean people in Aotearoa New Zealand.
  Hong‐Jae Park, Chang Gi Kim.
  Australasian Journal on Ageing. January 22, 2013
  Aim The purpose of this paper is to explore the immigrant experiences of older Korean people and their intergenerational family relationships in the New Zealand context. Methods Data were collected from qualitative interviews with older people, community leaders and professionals in Christchurch and Auckland. Data analysis was conducted using concept mapping techniques in the cross‐cultural context where two languages were simultaneously used. Results The findings of the study show that older Korean people in New Zealand were likely to face multiple challenges due to the combined effects of immigration and ageing in a new country. Some older people experienced difficulties in managing their immigrant lives and intergenerational relationships in the transnational family context in which their family members were dispersed across two or more nations. Conclusion The immigrant experiences of older migrants might be affected by an ‘invisible’ source of isolation and exclusion at familial, community, societal and transnational levels.

  January 22, 2013   doi: 10.1111/j.1741-6612.2012.00642.x   open full text
• Attitudes towards family–staff relationships in Australian residential aged care settings: Development and psychometric evaluation of the ‘Family and Staff Relationship Attitude Tool’ (FASRAT).
  Michael Bauer, Deirdre Fetherstonhaugh, Virginia Lewis.
  Australasian Journal on Ageing. December 20, 2012
  Aim To develop and psychometrically evaluate the Family and Staff Relationship Attitude Tool (FASRAT) for use in Australian residential aged care facilities to assess the attitudinal beliefs of residential aged care staff towards staff–family relationships. Methods Development and testing of the psychometric properties of the 26‐item FASRAT occurred in three phases which included item development based on a systematic review of the research literature, interviews with aged care staff and families, expert panel review and testing with aged care staff. Results Content validity and internal consistency of the FASRAT support its use as an instrument to measure staff attitudinal beliefs about staff–family relationships in the residential aged care setting. Conclusion The FASRAT will enable residential aged care facilities to measure the attitudinal beliefs of its staff about staff–family relationships and provide a basis for the development and implementation of interventions to address identified gaps which impact on relationship quality.

  December 20, 2012   doi: 10.1111/ajag.12006   open full text
• Waiting times for Aged Care Packages: The need to know.
  Maria Griffiths, Robyn Russell, Gillian Brunker, Margaret Boccalatte, Paul Goldstraw.
  Australasian Journal on Ageing. November 21, 2012
  Aim To establish local waiting times for access to Aged Care Packages (ACPs). ACPs are federally funded and designed to support older people to remain independent in their own homes for as long as possible. Access to an ACP is via the Aged Care Assessment Services (ACAS) process. Initial investigations suggested that significant waiting times existed locally. Methods Analysis of ACAS data was undertaken retrospectively and prospectively to identify type of ACP and date of approval. Date of provision was obtained from ACP providers. Results Two hundred and eighty‐five ACPs were approved, but only 35 were provided. At up to 12 months after approval, 88% of the cohort were still waiting to receive an appropriate package. Conclusion Long waiting times exist, which has implications both for the individual and the care/health sectors. It is suggested that monitoring waiting times should be a requirement for the future.

  November 21, 2012   doi: 10.1111/j.1741-6612.2012.00641.x   open full text
• Perceived factors which shape decision‐making around the time of residential care admission in older adults: A qualitative study.
  Claire P Heppenstall, Sally Keeling, H Carl Hanger, Tim J Wilkinson.
  Australasian Journal on Ageing. October 29, 2012
  Aim To understand the perceived factors that shape decision‐making around the time of residential care admission in older people. Method Two qualitative methods (telephone interviews at intervals post discharge from geriatric inpatient care and face‐to‐face interviews with older people and their family carers) were used as part of a multiphase mixed methods study of a cohort of 144 older people discharged from medical wards in a subacute assessment, treatment and rehabilitation facility. Results Key topics and themes were derived from interviews: the role of the informal carer and other community supports, attitudes to decision‐making and loneliness were key aspects of social context. Physical health, the experience of repeated hospital admissions and health professionals' attitudes to repeated admissions were also seen as important. Conclusions Social context as an essential component of older people's decisions to enter aged residential care is highlighted in this qualitative study.

  October 29, 2012   doi: 10.1111/j.1741-6612.2012.00644.x   open full text
• Social support and health of older people in Middle Eastern countries: A systematic review.
  Maryam Tajvar, Astrid Fletcher, Emily Grundy, Mohammad Arab.
  Australasian Journal on Ageing. October 29, 2012
  The aim of this study is to systematically review quantitative studies exploring the association between social support (SS) and the health of older people in Middle Eastern countries. Sixteen electronic databases and other resources were searched to identify studies that met the inclusion criteria of the review. Abstracts of identified papers were screened for relevancy, following which the authors determined eligibility, applied quality criteria and extracted the data. Twenty‐two studies met the inclusion criteria. Even allowing for the diversity of the studies included, this review offered strong and consistent evidence for a positive relation between SS and mental health, while there was inconsistent evidence of an association between SS and other health outcomes. The limited evidence for the Middle Eastern region confirms findings from other settings on the importance of SS for mental health in later life. Current evidence is inadequate to assess whether SS is associated with physical health.

  October 29, 2012   doi: 10.1111/j.1741-6612.2012.00639.x   open full text
• Older Australians' views about the impact of ageing on their nutritional practices: Findings from a qualitative study.
  Sonya Brownie.
  Australasian Journal on Ageing. October 25, 2012
  Aim:  To explore older people's views about how getting older has influenced their dietary practices. Methods:  Focus groups with independently living residents aged 60 years and older in northern NSW, Australia. An inductive approach to thematic analysis was used. Results:  Five focus groups (n= 29) were conducted. The majority of participants were women (79%), mean age 73 years. The main findings were that reduced ability to eat large meals; health maintenance and disease management; food messages; food taste and convenience; and living arrangements appear to impact food choices and eating behaviour in this sample. Conclusion:  In the presence of reduced and/or modified food intake, older people might benefit from an understanding of the concept of nutrient density in order to help them attain and maintain nutritional adequacy. Lifelong exposure to food messages (sometimes conflicting) resulted in many participants feeling confused about appropriate dietary practices for this age group.

  October 25, 2012   doi: 10.1111/j.1741-6612.2012.00607.x   open full text
• Supporting housing and neighbourhoods for healthy ageing: Findings from the Housing and Independent Living Study (HAIL).
  Julie E Byles, Lynette Mackenzie, Sally Redman, Lynne Parkinson, Lucy Leigh, Cassie Curryer.
  Australasian Journal on Ageing. October 25, 2012
  Aim To identify the extent to which homes and neighbourhoods of older community‐dwelling people are ‘supportive’. Method Cross‐sectional survey, in‐home observation and interviews involving 202 participants (75–79 years). Measures included SF‐36 health‐related quality of life and Late Life Function and Disability Instrument (LLFDI) scores, and self‐reported home usability, access, safety and neighbourhood. Associations between home and neighbourhood characteristics were assessed using χ2‐tests, t‐tests and Pearson correlations. Results Older people rated neighbourhood satisfaction highly (3.0 men, 3.2 women; 4 being the highest score). Many homes failed objective adaptability and safety ratings, particularly bathrooms (80% did not have a shower grab rail, 77% did not have non‐slip floors); 27% of homes scored ≥8 of 25 possible hazards. There were significant correlations between perceptions of housing and neighbourhood and SF‐36 and disability scores. Conclusion Many homes and neighbourhoods may not accommodate increased frailty or disability of older people into the future.

  October 25, 2012   doi: 10.1111/j.1741-6612.2012.00646.x   open full text
• Inequality in oral health‐care utilisation exists among older Thais despite a universal coverage policy.
  Tewarit Somkotra.
  Australasian Journal on Ageing. October 19, 2012
  Aim To assess socioeconomic‐related inequality in oral health‐care utilisation among older Thais. Method The data on 8951 and 11 402 older Thais (≥60 years) from national representative Thailand Health and Welfare Surveys (HWS) of 2003 and 2009, respectively, were analysed. Descriptive analyses were performed on oral health‐care utilisation, and a concentration index (CI) quantified the extent of socioeconomic‐related inequality in oral health‐care utilisation. Results Analyses indicated that socioeconomic‐related inequalities in oral health‐care utilisation among older Thais existed, and tended to favour those of higher socioeconomic status. However, the older poor were more likely to utilise oral health care at public facilities, particularly primary care facilities, than those of higher socioeconomic status. Conclusion Despite universal coverage policy, socioeconomic‐related inequalities in oral health‐care utilisations exist among the older Thais. To alleviate these, strengthening the primary health‐care system deserves particular attention.

  October 19, 2012   doi: 10.1111/j.1741-6612.2012.00617.x   open full text
• Evaluation of a blended learning model in geriatric medicine: A successful learning experience for medical students.
  Gustavo Duque, Oddom Demontiero, Sarah Whereat, Piumali Gunawardene, Oliver Leung, Peter Webster, Luis Sardinha, Derek Boersma, Anita Sharma.
  Australasian Journal on Ageing. October 17, 2012
  Background Despite the increasingly ageing population, teaching geriatric medicine at medical schools is a challenge due to the particularities of this subspecialty and the lack of student interest in this subject. Methods We assessed a blended system that combines e‐learning and person‐to‐person interaction. Our program offered the students a hands‐on learning experience based on self‐reflection, access to technology, interactive learning, frequent interaction with the multidisciplinary team, more exposure to patients, and regular feedback. Results Our results indicate that the students appreciate this system as a rich and effective learning experience demonstrated by their positive feedback and by their significant improvement in knowledge assessed at the end of their rotation. Conclusion Implementing an interactive blended system is a beneficial approach to teaching geriatric medicine in medical schools and to motivating medical students' interest in this important medical subspecialty.

  October 17, 2012   doi: 10.1111/j.1741-6612.2012.00620.x   open full text
• Considering relocation to a retirement village: Predictors from a community sample.
  Dimity A Crisp, Tim D Windsor, Kaarin J Anstey, Peter Butterworth.
  Australasian Journal on Ageing. October 17, 2012
  Aim To identify characteristics distinguishing older adults who have considered relocation to a retirement village in the future from those who have not. Method Community‐living residents (n = 517), aged 55 to 94, randomly selected from the Australian Capital Territory completed a postal survey. Results Consistent with prior research, the majority of respondents had not considered relocation to a retirement village. Retired persons, those aged 55–64 years, and persons reporting sufficient financial resources, poorer physical health and poorer current neighbourhood cohesion were most likely to have considered future relocation. Conclusions The identification of factors characterising older adults seeking retirement village housing in the future is important in developing an understanding of the needs and expectations of the older population, and may allow aged care providers to better target the development of services to population needs (e.g. health‐care supports). Further investigation into the specific expectations of the 55–64 year cohort is required.

  October 17, 2012   doi: 10.1111/j.1741-6612.2012.00618.x   open full text
• Self‐reported hearing, vision and quality of life: Older people in New Zealand.
  Shiran Zhang, Simon Moyes, Chris McLean, Grant Searchfield, David Welch, Robert Jacobs, Ngaire Kerse.
  Australasian Journal on Ageing. October 17, 2012
  AimTo establish associations between sensory‐related disability and quality of life (QOL).MethodsA total of 3817 people aged 75 years and older, including 173 Māori aged 61 years and older, were surveyed. Measures included: sociodemographic and health factors; World Health Organization quality of life (WHOQOL)‐BREF for QOL; and self‐rated hearing‐ and vision‐related disability.ResultsHearing disability was reported by 866 (51%) men and 736 (36%) women. A total of 974 (26% of all, 61% of hearing disabled) used hearing aids. A total of 513 (30%) men and 618 (30%) women reported vision disability. Vision and hearing disability were both independently associated with lower QOL, with hearing difficulty affecting physical and social domains more, and the environmental domain least. Vision difficulty impacted the environmental domain most and the social domain least. QOL impact was higher for those with both hearing and visual disability (631, 17%).ConclusionsHearing and vision disability are associated with poorer QOL.

  October 17, 2012   doi: 10.1111/j.1741-6612.2012.00627.x   open full text
• Prevalence of physical activity behaviour in older people: Findings from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project and Australian national survey data.
  Jane Sims, Carole L Birrell, Susan Hunt, Colette Browning, Richard A Burns, Paul Mitchell.
  Australasian Journal on Ageing. October 17, 2012
  Aim Many older people lead sedentary lives. National Health Survey physical activity prevalence data provide limited coverage of the ‘old old’ (≥75 years). Method The Dynamic Analyses to Optimise Ageing (DYNOPTA) project's dataset provided physical activity data for 13 420 participants. Physical activity (walking, moderate‐ and vigorous‐intensity activities in the previous week) was measured. Data were weighted and prevalence was calculated. Results The frequency of walking in DYNOPTA was similar to that in the national sample. Walking remained relatively stable until a decline among persons aged 80 years and over; moderate and vigorous activity declined in all but a minority of persons aged 70 years and over. Although DYNOPTA participants reported more physical activity than those in the contemporary national survey, the rates of sedentary behaviour were high. Conclusion We require more information about the ‘oldest old’ (85+ years). There is great scope for increasing physical activity, even walking, among older people.

  October 17, 2012   doi: 10.1111/j.1741-6612.2012.00648.x   open full text
• Effects of work participation, intergenerational transfer and savings on life satisfaction of older Malaysians.
  Sor‐Tho Ng, Tengku‐Aizan Hamid.
  Australasian Journal on Ageing. October 14, 2012
  Aim To examine the effects of work participation, intergenerational transfer and savings on life satisfaction of community‐dwelling older Malaysians. Method Data from the 1999 Survey on Perceptions of Needs and Problems of the Elderly on older persons aged 60+ were used. The life satisfaction score is constructed based on the 10 questions adopted from Life Satisfaction Inventory‐A by Neugarten, Havighurst and Tobin. Multiple regression analysis is used to estimate the expected level of life satisfaction. Results Controlling for other variables in the model, respondents who provided and received assistance to/from children, with savings have significantly higher life satisfaction compared to their counterparts, while work participation does not have any significant effect on life satisfaction. Conclusion Intergenerational transfer and savings are important predictors of life satisfaction. The interdependence between generations should remain and savings habit needs to be cultivated to ensure a higher life satisfaction in old age.

  October 14, 2012   doi: 10.1111/j.1741-6612.2012.00619.x   open full text
• e‐ageing: Development and evaluation of a flexible online geriatric medicine educational resource for diverse learners.
  Natasha Watson, Alicia Massarotto, Lisa Caputo, Leon Flicker, Christopher Beer.
  Australasian Journal on Ageing. October 14, 2012
  Aims To determine preferred content and format for online education modules in aged care among inter‐professional learners; to develop resources that meet user preferences. Methods Stakeholders were interviewed. A survey was administered to all health/medical students and teachers at The University of Western Australia. An iterative process was used to develop modules, and user feedback was collated. Results The educational needs of each discipline related primarily to foundational level knowledge in major aged care topics. Stakeholders sought modules incorporating communication skills, cultural and social issues and the importance of a multidisciplinary approach to aged care. Students from all disciplines sought online materials that are interactive, engaging, case‐based and locally relevant. Online modules were developed. Evaluation of the modules by users has been strongly positive. Conclusion There was consensus regarding the major curricular areas that online resources should encompass. The e‐ageing modules developed in this project have been evaluated positively by users.

  October 14, 2012   doi: 10.1111/j.1741-6612.2012.00622.x   open full text
• Complications observed in older new haemodialysis patients.
  Feng‐Chi Kuo, Chin‐Ling Chiang, Shih‐Yi Lee, Chih‐Jen Wu, Han‐Hsiang Chen, Yu‐Wei Chen.
  Australasian Journal on Ageing. October 11, 2012
  Aim We aimed to evaluate the manifestations observed in older patients new to haemodialysis (HD) and the subsequent influence on health insurance. Methods Two hundred and fifty‐five new patients (130 were younger than 65 years and 125 were older than 65 years) who had received conventional HD for at least 1 year were reviewed. Results Older patients had significantly more arteriovenous (AV) shunt failures (0.7 ± 0.1 vs 0.4 ± 0.07, P = 0.006) and hospitalisations (0.8 ± 0.1 vs 0.4 ± 0.09, P = 0.03). Stepwise multivariate linear regression analysis showed that the events of AV shunt failure were an independent risk factor for hospitalisation events. Conclusions Older HD patients had significantly more AV shunt failures and hospitalisations than younger patients did. AV shunt failure is an independent risk factor of hospitalisation, which is a major additional expenditure of an HD program in terms of health insurance.

  October 11, 2012   doi: 10.1111/j.1741-6612.2012.00633.x   open full text
• Residential respite care is associated with family carers experiencing financial strain.
  Christina Aggar, Susan Ronaldson, Ian D Cameron.
  Australasian Journal on Ageing. September 30, 2012
  Aim Care services for older people are provided with the expectation of supporting carers in their caregiving role. The aim of the study is to investigate the association between the utilisation of care services by older people and the caregiving experience. Methods Cross‐sectional design, involving a cohort of family carers (n = 119) of frail older people (≥70 years) enrolled in a clinical trial of frailty treatment in metropolitan Sydney from 2008 to 2011. The caregiving experience is measured in five domains: health, daily schedule, finance, family support and self‐esteem (Caregiver Reaction Assessment tool). Results Multivariate regression analysis demonstrated an association between the utilisation of residential respite care and financial strain (β = −0.613, P = 0.049), after controlling for functional ability, co‐residence and age. Conclusion There is a need to consider carers' financial barriers and concerns in regards to the utilisation of respite care services.

  September 30, 2012   doi: 10.1111/j.1741-6612.2012.00637.x   open full text
• Effect of comorbidity on relative survival following hospitalisation for fall‐related hip fracture in older people.
  Diane Hindmarsh, Ming Loh, Caroline F Finch, Andrew Hayen, Jacqueline CT Close.
  Australasian Journal on Ageing. September 30, 2012
  Aim To assess the effect of comorbidity on relative survival after hip fracture. Methods Relative survival analysis was undertaken in 16 838 fall‐related hip fracture hospitalisations in New South Wales, Australia. Comorbidity was measured on the basis of additional diagnosis codes on the same hospital separation as the hip fracture using the Charlson Comorbidity Index (CCI). Interval‐specific relative survival and relative excess risk of death were calculated. Results Comorbidity was more frequently documented in men across the age groups. Survival decreased with increasing age and increasing comorbidity, but the relative impact of comorbidity was greater in the younger‐old age group (65–74 years). The excess mortality in men was not accounted for by age or comorbidities. Conclusions This study demonstrates an association between increasing comorbidity and death particularly in the first 3 months post hip fracture. It also highlights a relative excess risk of death in men after hip fracture after adjusting for age and comorbidity.

  September 30, 2012   doi: 10.1111/j.1741-6612.2012.00638.x   open full text
• Epidemiology of ambulance responses to older people who have fallen in New South Wales, Australia.
  Paul M Simpson, Jason C Bendall, Jillian Patterson, Anne Tiedemann, Paul M Middleton, Jacqueline CT Close.
  Australasian Journal on Ageing. September 11, 2012
  Aim To quantify the size and scope of the operational burden arising from older people who have fallen for a large ambulance service and to describe this population. Methods Retrospective analysis of ambulance records from New South Wales, Australia for emergency calls classified as ‘falls’ in the period 1 July 2008 to 30 June 2009. Results There were 42 331 responses to people aged 65 years or older, constituting 5.1% of total emergency workload. The median age of patients was 83 (interquartile range 76–87) and 62% were women. The transport rate was 76%. Transport to hospital was more likely during the day (odds ratio (OR) 1.8, 95% confidence interval (CI) 1.7–1.9) and on weekends (OR 1.06, 95%CI 1.0–1.1). Conclusion Falls by older people constitute approximately 5% of all emergency responses, of which one quarter are not transported to emergency department (ED) after paramedic assessment. Increasing the sophistication of ambulance dispatch processes to older people who have fallen, and continuing with the development of new models of care aimed at decreasing unnecessary transports to the EDs, should be a priority when planning ambulance service delivery for older people who have fallen.

  September 11, 2012   doi: 10.1111/j.1741-6612.2012.00621.x   open full text
• Correlates of dementia attitudes in a sample of middle‐aged Australian adults.
  Lyn Phillipson, Christopher A Magee, Sandra C Jones, Ellen Skladzien.
  Australasian Journal on Ageing. September 04, 2012
  Aims To examine sociodemographic factors associated with attitudes regarding dementia. Method A cross‐sectional, convenience sample of 616 adults aged 40–65 years completed an online survey examining sociodemographic factors and dementia attitudes. The associations between sociodemographic variables and dementia attitudes were examined using general linear modelling. Results Four attitudinal factors were identified. Three were associated with negative attitudes (Personal Avoidance, Fear of Labelling and Fear of Discrimination) and one with more positive attitudes (Person Centredness). Demographic factors (e.g. age, sex, education) were significantly associated with some attitudinal factors. For example, men (P = 0.001) and individuals with lower education levels (P = 0.03) had higher scores on the Personal Avoidance factor. Conclusions This study is the first to examine correlates of attitudes towards dementia in an Australian sample. Future research could improve understanding of distinct factors associated with dementia and lead to strategies to reduce stigmatised views of people with dementia in the community.

  September 04, 2012   doi: 10.1111/j.1741-6612.2012.00624.x   open full text
• Desired characteristics and outcomes of community care services for persons with dementia: What is important according to clients, service providers and policy?
  Lee‐Fay Low, Fiona White, Yun‐Hee Jeon, Meredith Gresham, Henry Brodaty.
  Australasian Journal on Ageing. August 23, 2012
  Aim To examine views of Australian consumers, service providers and policy representatives on important characteristics and outcomes for community care. Method Interviews, with 32 consumers (one person with dementia (PWD) and 31 carers), 32 service providers and four policy representatives, were analysed thematically. Results Outcomes important to consumers and service providers were that PWD can stay at home safely with personalised activities and socialisation; and that carers receive emotional support, respite and continue paid employment. Consumers and service providers said it was important that community care services were flexible and reliable and provided adequate hours of care and there was continuity of appropriate and well‐trained staff. Overall responses of policy representatives were congruent with consumers and service providers but did not comprehensively cover the issues. Conclusions Community care policies and service practices need to be re‐examined to make sure that they are person‐centred and reflect consumer needs, for instance by integrating client and carer services and providing appropriate activities for PWD.

  August 23, 2012   doi: 10.1111/j.1741-6612.2012.00625.x   open full text
• Which cardiovascular risk factors are associated with cardiovascular disease and predict future events in advanced age in New Zealand?
  Ruth O Teh, Ngaire M Kerse, Elizabeth M Robinson, Robert N Doughty, Gillian A Whalley.
  Australasian Journal on Ageing. August 23, 2012
  Aim To examine the relationships between cardiovascular risk factors, cardiovascular health at baseline, and cardiovascular disease (CVD) events 28 months later, in advanced age. Methods 108 adults in advanced age were recruited. Data were collected through a standardised questionnaire including a measure of physical activity, comprehensive physical assessment and fasting blood samples. CVD events at follow‐up were ascertained from hospital records. Results Sixty‐seven per cent of participants had CVD at baseline. Physical activity (OR (95% CI): 0.99 (0.98–1.0); P = 0.04) and high‐density lipoprotein (HDL) (OR (95% CI): 0.3 (0.09–1.0); P = 0.046) were independently associated with CVD. The 28‐month incidence rate of CVD was 6 cases/100 person‐years. Baseline diastolic BP (OR (95% CI): 0.9 (0.9–1.0); P = 0.03) and waist circumference (OR (95% CI): 1.06 (1.01–1.1); P = 0.01) were independently associated with subsequent CVD events at follow‐up. Conclusion Physical activity and HDL levels were inversely associated with CVD at baseline but did not predict future CVD events. CVD in advanced age warrants further investigation.

  August 23, 2012   doi: 10.1111/j.1741-6612.2012.00626.x   open full text
• What are older adults seeking? Factors encouraging or discouraging retirement village living.
  Dimity A Crisp, Tim D Windsor, Kaarin J Anstey, Peter Butterworth.
  Australasian Journal on Ageing. August 09, 2012
  Aims (1) To identify factors that older adults find encouraging or discouraging about the prospect of relocation to a retirement village; and (2) to identify the features or facilities often associated with retirement communities that are most appealing to prospective residents. Method Randomly selected community residents (n = 517), aged 55–94 years, from the Australian Capital Territory, completed postal surveys to identify the characteristics associated with retirement villages that influence relocation decisions. Results The provision of outdoor living areas, support in maintaining independence, assisted living facilities and accessibility to medical facilities were identified as factors that would encourage relocation. Luxury services (e.g. heated swimming pools) were indicated as least likely to encourage relocation. Negative perceptions most influential in discouraging relocation reflected a fear of losing independence and privacy. Conclusions Through identifying the expectations of prospective residents, retirement village providers may better tailor facilities to the needs of their target demographic.

  August 09, 2012   doi: 10.1111/j.1741-6612.2012.00623.x   open full text
• Predictors of eligibility for long‐term care funding for older people in Japan.
  Shingo Moriya, Ayumi Murata, Shinji Kimura, Nobuo Inoue, Hiroko Miura.
  Australasian Journal on Ageing. May 17, 2012
  Aim:  To determine the predictors of Japanese long‐term care insurance system (LTCI) certification. Methods:  Care needs of 784 persons aged 65–84 were followed through LTCI over 5 years. Each participant's score was divided into quartiles according to handgrip strength and one‐leg standing time with eyes open. Cox proportional hazard models were conducted for the onset of certification of LTCI. Results:  Over the 5‐year period 64 women (14%) and 30 men (9%) were certified. Adjusted hazard ratios for certification were significantly higher for those of the lowest groups of one‐leg standing time with eyes open at baseline than those in the highest groups, but no significance was found for handgrip strength. Other predictors were age and low social activity for women; and living alone and diabetes for men. Conclusions:  One‐leg standing time with eyes open predicts the onset of care‐need certification in older people.

  May 17, 2012   doi: 10.1111/j.1741-6612.2012.00601.x   open full text
• The prevalence of vitamin D deficiency and relationship with fracture risk in older women presenting in Australian general practice.
  Penelope J Robinson, Robin J Bell, Alfred Lanzafame, Catherine Kirby, Andrew Weekes, Leon Piterman, Susan R Davis.
  Australasian Journal on Ageing. July 25, 2011
  Aim:  To investigate vitamin D status among older women and to explore relationships between vitamin D and fracture risk and vertebral fractures.Methods:  A total of 267 general practitioners recruited 2466 women aged >70 years with no known osteoporosis or fragility fracture. Serum 25‐hydroxy vitamin D (25(OH)D), bone mineral density by dual‐energy X‐ray absorptiometry (DXA) and vertebral fracture on thoracolumbar X‐ray were determined.Results:  A total of 2368 women, median age 76 years, provided data and of these 13% were on vitamin D supplements. 25(OH)D levels were available for 907 (44.1%) of those not taking vitamin D. 88.3% of these had a level below 75 nmol/L. Serum 25(OH)D was negatively associated with age (P = 0.003) and body mass index (P < 0.001), and positively associated with lower latitude, femoral neck DXA T‐score (P = 0.044) and being Caucasian (P < 0.001).Conclusions:  The vitamin D status of community‐dwelling older Australian women is inadequate, yet the use of supplements is low.

  July 25, 2011   doi: 10.1111/j.1741-6612.2011.00553.x   open full text