The objective of this study was to report older Australians' views about what they want from aged care reforms expressed in submissions to the Productivity Commission's ‘Inquiry into Caring for Older Australians’ and the ‘Conversations on Ageing’ (Conversations).
Consumer responses to the ‘Inquiry into Caring for Older Australians’ (n = 59) and findings from the Conversations (n = 31) conducted by the Honourable MarkButler with the Council on the Ageing were summarised.
Older people wanted to be included as full citizens in community life with their contributions acknowledged, including as carers. They wanted high quality, accessible and respectful services that supported their independence and over which they had control. They wanted fair and transparent funding arrangements and care that caters for diversity in Australia's older people. They wanted reform to be soon and to have bipartisan support.
This paper provides consumer perspectives to inform aged care policy, practice and research in Australia.
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.
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.
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.
Health-care providers should take sex-based strategies to improve mental health among older survivors in a long-term post-disaster recovery programme.
To determine whether the Aged Care Funding Instrument (ACFI) provides more funding than the Residential Classification Scale (RCS) for residents in the Hellenic Residential Care Facility.
All residents within the care facility were assessed over a six 6-month period using ACFI, RCS and Clifton Assessment Procedures for the Elderly (CAPE) scores. Differences in funding levels were calculated using ACFI and RCS instruments against a standardised CAPE score.
CAPE dependency RCS funding per resident per day varied from $32.20 for grade A to $116.20 for grade E4 residents. CAPE ACFI funding varied from $20.20 for grade A to $127.50 for grade E4. There was no significant difference in mean overall funding between the two scales (ACFI $92.50 vs RCS $90.35, P = 0.76).
The ACFI does provide a small but not significant increase in funding to residents in residential care. It redirects funding to higher dependency residents.
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.
Observation of medication rounds in a convenience sample of Australian Capital Territory ACFs and assess staff knowledge of dosage form modification and available resources.
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.
Improved staff training on how to use available resources is needed to reduce the observed high incidence of inappropriate medication crushing.
To determine the accuracy of self-reported anthropometric measurements in older Australian adults 60–70 years.
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.
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.
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.
Early signs of dementia may raise concerns in family members as to the safety of the affected person when engaged in common activities. Here we report on the relative frequency of such concerns using data from the three waves of the Canadian Study of Health and Aging (CSHA). Our focus is on driving, cooking and paying bills, with a prediction that most carers' concern would be over driving.
Participants were 2780 Canadians over 65 years, who underwent the first wave of CSHA and were subsequently followed during the next two waves.
As predicted, concerns about driving were relatively more common than concerns about cooking and handling finances (P = 0.021) in the cognitively intact group, with the opposite order observed in the group with dementia.
Carer concerns for those diagnosed with dementia shift with the progression of cognitive changes, with concerns declining over the 10-year period.
We sought to understand strategies employed by ‘Baby Boomers’ to maintain well-being and facilitate transition to later life.
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.
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.
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.
To explore medical decision making in octogenarians having cardiac surgery.
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.
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.
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.
Predictors of short- and long-term all-cause mortality of older stroke patients were explored.
Cox regression models were used to estimate the relative risk and 95% confidence intervals (CI) in the database entries of 636 older stroke patients aged 70 years and over.
National Institutes of Health Stroke Scale (NIHSS) score on admission, age and coronary heart disease were significantly associated with 28-day death. The hazard ratios for the predictors of long-term mortality were as follows: NIHSS score, 1.1 (95% CI: 1.07–1.1); serum glucose level, 1.08 (95% CI: 1.01–1.2); serum triglyceride level, 0.6 (95% CI: 0.4–0.8); age, 1.04 (95% CI: 1.01–1.08); and coronary heart disease, 2.7 (95% CI: 1.4–5.4).
NIHSS score on admission, age and coronary heart disease are independent predictors of short- and long-term mortality. Higher glucose and lower triglyceride level are significantly associated with the long-term mortality.
The study is based on an innovative demonstration project which trialled the implementation of the Finnish ‘workability’ framework and research measures. It aimed, firstly, to test the applicability of the Workability Index (WAI) to the Australian residential aged care workforce, focusing on personal care assistants (PCAs), and secondly, to assess the effectiveness of actions aimed at improving workability. The facility manager implemented multidimensional ‘actions’ according to the workability framework. The Workability Survey (WAS) and WAI and intervention instruments were administered (n = 64). Completed responses to ‘pre’ and ‘post’ instruments formed matched pairs (n = 15) which were analysed. The WAI increased by 3 points after all ‘actions’ were implemented, providing a statistically significant result. The only significant ‘action’ was increasing the number of PCAs in high care. Workability provides a useful research workforce development instrument measuring interactions between aged care workers and organisational demands and the outcomes of ‘actions’.
]]>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.
Assessments were conducted at baseline, 4 and 8 months using measures of function, balance, mobility, strength, mental health and quality of life.
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.
The program appears to be an effective community-delivered strength training program.
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.
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.
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.
Older patients with dementia are more impaired and vulnerable than patients without dementia and are at greater risk of adverse outcomes when hospitalised.
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.
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.
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.
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.
To evaluate the effect of a singing program developed specifically for older community-dwelling people on measures of health and well-being.
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).
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.
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.
To explore the experiences of frontline health and welfare practitioners in working with older people experiencing abuse.
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.
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.
Frontline practitioners working in cases of elder abuse face significant challenges and could be better supported through the strengthening of organisational elder abuse policies, increased management support and more age-inclusive family violence support services.
To describe short-term mortality among residential aged care (RAC) residents in Auckland, New Zealand.
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.
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).
RAC mortality (especially post admission) is high. Training and resource in the sector should reflect this.
To explore how local governance enables access to resources, creates opportunities and increases capability for older people in rural communities to experience social inclusion.
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.
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.
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.
To evaluate whether ‘Meals on Wheels’ (MOW) improves health and reduces hospital admissions in poorly nourished (PN) older people.
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.
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).
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.
To investigate processes at the end of life for patients who died in a subacute evaluation and management facility for older people.
A retrospective chart audit for patients (n = 55) who died in the previous 2 years was undertaken recording a number of significant variables.
Despite diagnosis of comorbid medical conditions most participants were admitted for improved functioning or assessment for alternative accommodation. Consistent with this focus, the key contact person was most often an allied health team member. Not For Resuscitation order and/or power of attorney documents on admission were uncommon (<30%) as were referrals to palliative care specialist staff (13%), although an end-of-life discussion was recorded (90%) and often included as a new goal of care (71%).
Factors likely to improve end-of-life care include advance care planning, earlier recognition of short prognosis and staff education.
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.
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.
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.
The immigrant experiences of older migrants might be affected by an ‘invisible’ source of isolation and exclusion at familial, community, societal and transnational levels.
This study examines the consistency and acceptability by employers of the Certificate III in Aged Care as a qualification for unregistered care workers in metropolitan NSW.
An expert committee developed consistency measures and surveyed 10 registered training organisations providing courses leading to this qualification to establish course consistency. Ten employers of graduates from these organisations were surveyed to examine the courses' acceptability as preparation for care workers.
Training organisations provided widely different content, clinical experience and levels of supervision for students at varying rates of cost and duration. Facilities were not satisfied by levels of skills and knowledge of graduates and did not employ those from 20% of the sample surveyed.
Care workers' qualifications should be regulated by the Australian Health Practitioner Regulation Agency and the title and roles of these workers become more defined and clarified as a result.
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.
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.
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.
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.
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.
Retrospective and prospective analysis was undertaken of ACAS data for the type of ACP and the date of approval. This was correlated with the date of provision from ACP providers.
Two hundred and eighty-five ACPs were approved, but only 35 provided. At up to 12 months after approval, 88% of the cohort were still waiting to receive an appropriate package.
Long waiting times exist. There are implications for the individual and the care/health sectors. It is suggested that monitoring waiting times should be a requirement for the future.
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.
]]>To determine whether Emergency Department length of stay (EDLOS) greater than 8 hours (EDLOS > 8 hours) and less than 4 hours (EDLOS < 4 hours) were independently associated with inpatient mortality taking into account about patient comorbidities and age and to determine the impact of EDLOS on inpatient length of stay (IPLOS).
This was a retrospective data analysis of emergency presentations and inpatient admissions during 2007 at The Northern Hospital, Victoria.
Taking into account age and disease states, EDLOS > 8 hours was not associated with inpatient mortality (odds ratio 1.1; 95% confidence interval (CI) 0.9–1.4, P = 0.4), nor was EDLOS < 4 hours (odds ratio 0.9; 95% CI 0.6–1.4, P = 0.6) associated with reduced mortality. EDLOS > 8 hours was significantly associated with longer IPLOS (P < 0.001) adjusting for medical comorbidities. Mean EDLOS and IPLOS were significantly longer for patients over 75 years of age.
EDLOS > 8 hours and EDLOS < 4 hours are not independently associated with mortality. A longer EDLOS is independently associated with longer IPLOS.
Perceptions of older people are changing both nationally and internationally, with policy developments that emphasise the value of older workers and the extension of working life to accommodate a longer life-course. For national economies older workers produce benefits of increasing tax dollars and personal savings and reduce claims on the state through pensions. In terms of migration, older adults bring assets and other benefits generated elsewhere into the host economy, as skilled workers or as active retirees. It has also been argued that older societies may be more productive as a consequence of the contribution of older citizens. Nations that create barriers to older migration, such as is currently the case for Australia, run the risk not only of perpetuating age discrimination, but failing to take advantage of population change in a global context. The authors critically examine this area and raise a series of questions for future policy.
]]>To understand the perceived factors that shape decision-making around the time of residential care admission in older people.
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.
Key topics and themes were derived from these 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.
Social context is an essential component of older people's decisions to enter aged residential care and this is highlighted in this qualitative study.
To identify the extent to which homes and neighbourhoods of older community-dwelling people are ‘supportive’.
Cross-sectional survey, in-home observation and interviews involving 202 participants (75–79 years). SF-36 health-related quality of life and Late Life Function and Disability Instrument (LLFDI) scores, self-reported measures of home usability, access, safety and neighbourhood were assessed. Associations between home and neighbourhood characteristics were assessed using χ2-tests, t-tests and Pearson correlations.
Older people rated neighbourhood satisfaction highly (3.0 men, 3.2 women; 4 being 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.
Many homes and neighbourhoods may not accommodate increased frailty or disability of older people into the future.
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 female (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.
To assess socioeconomic-related inequality in oral health-care utilisation among older Thais.
The data of 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 concentration index (CI) quantified the extent of socioeconomic-related inequality in oral health-care utilisation.
Analyses indicated that socioeconomic-related inequalities in oral health-care utilisation among older Thais existed, and tended to favour those of higher socioeconomic status as revealed by the positive values of CI of both HWS 2003 and HWS 2009. 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.
Despite universal coverage policy, socioeconomic-related inequalities in oral health-care utilisations exist among the older Thais. To alleviate these, strengthening of the primary health-care system deserves particular attention.
To identify characteristics distinguishing older adults who have considered relocation to a retirement village in the future from those who have not.
Community-living residents (n = 517), aged 55 to 94, randomly selected from the Australian Capital Territory completed a postal survey.
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.
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.
Many older people lead sedentary lives. National Health Survey physical activity prevalence data provide limited coverage of the ‘old old’ (≥75 years).
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.
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.
We require more information about the ‘oldest old’ (85+ years). There is great scope for increasing physical activity, even walking, among older people.
To establish associations between sensory-related disability and quality of life (QOL).
A total of 3817 people aged 75 years and older, 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; hearing- and vision-related disability was self-reported.
Hearing 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 environmental domain least. Vision difficulty impacted environmental domain most and social domain least. QOL impact was increased for those with both hearing and visual disability (631, 17%).
Hearing and vision disability are associated with poorer QOL.
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.
We assessed a blended system that combines e-learning and person-to-person interaction. Our programme 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.
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.
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.
To determine preferred content and format for online education modules in aged care among inter-professional learners; to develop resources that meet user preferences.
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.
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.
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.
To examine the effects of work participation, intergenerational transfer and savings on life satisfaction of community-dwelling older Malaysians.
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.
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.
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.
We aimed to evaluate the manifestations observed in older patients new to haemodialysis (HD) and the subsequent influence on health insurance.
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.
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.
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.
To assess the effect of comorbidity on relative survival after hip fracture.
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.
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.
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.
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.
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).
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.
There is a need to consider carers' financial barriers and concerns in regards to the utilisation of respite care services.
The ageing of the population may not be accompanied by an increase in accurate knowledge about older adults. Palmore's Facts on Aging Quiz (FAQ) has been among the most popular measures of knowledge, and the original, true–false format measure has been used in a variety of English-speaking countries. However, the more recent multiple-choice version, which has methodological advantages with respect to reliability and validity, has no current Australian translation.
Here we report on the adaptation of version 2 of the FAQ in multiple-choice format (FAQ-2(MC)).
Data from 151 university undergraduates (132 female, mean age 19.9 years (SD = 5.1), range 17 to 53 years) completed the FAQ-2(MC) in exchange for course credit. The mean percentage correct on the Australian FAQ-2(MC) was 51.5%.
Our adaptation suggests the utility of this Australian multiple-choice version of the FAQ and reinforces the need for local verification of items.
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.
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.
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).
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.
To examine sociodemographic factors associated with attitudes regarding dementia.
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.
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.
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.
To examine the relationship between cardiovascular risk factors, cardiovascular health at baseline and predictors of cardiovascular disease (CVD) events at 28 months in advanced age.
A total of 108 adults in advanced age were recruited. A standardised questionnaire, comprehensive physical assessments, physical activity and fasting blood samples were analysed. CVD events at follow-up were ascertained from hospital records.
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.
Physical activity and HDL levels were inversely associated with CVD at baseline but were not predictive of future CVD events. CVD in advanced age warrants further investigation.
To examine views of Australian consumers, service providers and policy representatives on important characteristics and outcomes for community care.
Interviews with 32 consumers (one person with dementia (PWD) and 31 carers), 32 service providers and four policy representatives were analysed thematically.
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, 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.
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.
(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.
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.
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.
Through identifying the expectations of prospective residents, retirement village providers may better tailor facilities to the needs of their target demographic.
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 is predictive for the onset of care-need certification in older people.
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.
To identify opportunities and challenges in promoting community support for rural older women experiencing intimate partner violence (IPV).
Using community-based participatory research principles, we engaged in an academic–community partnership to analyse the research literature, estimate IPV incidence and prevalence, ascertain professional and older IPV victim perspectives through focus groups and interviews, and develop a collaborative community response plan. This study took place from 2008 to 2010 in the USA.
IPV in late life is underreported by victims and often unrecognised by the academic and service community. Professionals, while agreeable to collaborating to support older IPV victims, sought coordination and leadership from domestic violence agencies. Older victims stressed the need for improved professional sensitivity to their unique needs and more service options.
The insights generated during this project produced a framework on which rural communities can build to address the hidden and growing problem of late life IPV.
This paper undertakes a comprehensive review of the growing international literature on the adoption and use of information and communication technologies (ICTs) among older people. Issues associated with access and adoption of ICTs among older people living in rural communities will be explored, drawing on social capital as a theoretical lens through which to identify how these new technologies can build healthy ageing. ICTs as bridging social capital can address some of the challenges of service provision in rural Australia and provide access to more extensive information and resources. ICTs can also contribute to bonding social capital through access to other forms of communication to build on local connectedness. However, rural, older people face particular challenges of access, which may exacerbate the cycle of rural social exclusion. In the context of the Australian National Broadband rollout, it is timely to consider how some of these disparities can be addressed.
]]>Aim: The aim of this study was to develop the evidence-based Healthy Ageing Quiz (HAQ).
Methods: Phase 1 activities (focus groups with 33 older adults, literature review and discussion with an advisory panel) informed the development of a draft HAQ. Phase 2 involved assessing the quiz's psychometric properties and collecting respondent feedback.
Results: Phase 1 provided broad topics for formulating quiz questions. In Phase 2, 297 and 122 respondents returned a quiz for validity and reliability testing respectively (over 70% response rate). The HAQ was found to be both valid (r =−0.7 to 0.6) and reliable (r = 0.8).
Conclusions: The development of the HAQ was guided by the literature and input from older people and experts in healthy ageing. The quiz showed good psychometric properties and was acceptable to respondents. It allows older adults and people approaching old age to evaluate their current lifestyle in order to maximise their chances of ageing well.
Aim: This paper presents data on the amount of contact a large cohort of first-time Australian grandparents have with their grandchild, and the amount of child care they provide. It compares these with grandparents' expectations and desired levels.
Method: Prospective grandparents were assessed on multiple measures before the birth of their grandchild, and at 6, 12, 24 and 36 months thereafter.
Results: At the 12-month assessment, grandmothers had approximately 15 hours per week contact, and provided approximately 7.5 hours per week of child care. The corresponding figures for grandfathers were 9.5 hours and 5 hours respectively. Approximately 10% of grandparents reported no contact with their grandchild, and 30–40% reported undertaking no child care. Almost half the grandparents desired more contact than they were actually getting.
Conclusion: Accurate quantification of contact and care is a prerequisite for investigation of the impact of the transition to grandparenthood on health and well-being.
Aim: To explore access, satisfaction, awareness and needs for medicines and disease information (MADI) sources for older Arabic-speaking Australians.
Method: Five focus groups were conducted (in Arabic) with 29 participants with a chronic disease, aged over 65 years, and unable to speak or read English fluently. Discussions were audiotape recorded, simultaneously interpreted into English, transcribed verbatim and content analysed.
Results: Arabic-speaking general practitioners were identified as the main source of MADI, despite dissatisfaction with their counselling. Written Arabic MADI was not accessed by participants, who revealed low English and Arabic literacy levels and a reliance on family members to act as interpreters. Male participants were more concerned and active about their health and medicine information than female participants.
Conclusions: This study highlighted limited availability and access to Arabic MADI for older Arabic-speaking Australians, with reliance on Arabic-speaking health-care professionals for information and family members as interpreters. An accessible and sustainable system for MADI is required.
Aim: To determine whether older community-dwelling people underestimate their own perceived chance of falling compared with that of other older people (comparative optimism), and whether a history of falls is associated with comparative optimism.
Method: A sample of community-dwelling South Australians aged ≥65 years (n= 389) completed a computer-assisted telephone interview about their 12-month fall history, their perceived chance of falling and their rating of other older people's chance of falling.
Results: Respondents were comparatively optimistic about their chance of falling (Z =−8.1, P < 0.001). Those who had fallen in the last 12 months had a lower comparative optimism score (Z =−3.0, P < 0.003).
Conclusion: As older people were comparatively optimistic about their likelihood of falling, they might not find fall prevention messages relevant. When older people present with a fall, clinicians could provide fall prevention information consistent with how older people present themselves.
Aim: To provide new measures of employee retention in the aged care sector and to identify how employment retention varies across key groups of workers in the sector.
Method: The techniques of survival analysis were applied to staff record data from a representative provider of aged and community care services.
Results: We showed that 63% of carer employment spells end within 2 years. Fifty-seven per cent of nurse employment spells ended within this time period. Employment retention was poorest among young recruits, men and workers on casual contracts.
Conclusion: The high rates of staff turnover add substantial costs and risks to aged care organisations and should be the focus of workforce strategies. Casual employment is one potential contributory factor. However, the role of wages and other working conditions should also be examined. Given the importance of mature-age women in the sector, strategies should focus on their circumstances and needs.
This study aimed to compare perceptions about elder abuse among health professionals and students in the same health disciplines.
The Caregiving Scenario Questionnaire (CSQ) was disseminated to Australian health professionals from two metropolitan health services and to university health care students.
One hundred and twenty health professionals and 127 students returned surveys. Significantly more students than health professionals identified locking someone in the house alone all day and restraining someone in a chair as abusive.
There is a need for further definition clarification and education about detection and management of elder abuse for health students and professionals in Australia. Student education should include consideration of the real-life situations likely to be encountered in practice. Education for both students and health professionals should include strategies for carers to manage difficult situations such as the one described in the CSQ.
To ascertain care staff's knowledge of dementia relating to aetiology and/or pathology, symptoms and care/treatment; and explore their perceptions of the importance and adequacy of dementia education and training opportunities.
Thirty-five care staff working in three secure dementia care facilities were recruited. Dementia knowledge was surveyed using the Staff Knowledge of Dementia Test (SKDT). Perceptions of dementia education and training were examined via semi-structured individual interviews.
An average of 21 out of 33 SKDT questions (SD = 4.0) was correctly answered. Knowledge discrepancy was attributed to participants’ cultural and ethnic origin and the length of residency in Australia of migrant care staff. Participants acknowledged the importance of dementia education and training but were critical of the content relevancy to direct care practices.
There is a need to improve care staff knowledge of dementia, and dementia education and training should include direct practical competencies required for effective care delivery.
To examine the general practitioner (GP) consultation patterns for primary health-care services provided in residential aged care facilities (RACFs) by consultation type.
Analyses of service provision and RACF population data for the period 1998–2011. All Medicare-subsidised services provided by GPs across Australia in RACFs were included and categorised by consultation type and by time of service delivery (business or after-hours).
Overall service delivery increased from 12 118 per 1000 residents in financial year (FY) 1998–99 to 17 079 per 1000 residents in FY2010–11, a 41% increase. Since FY2007–08, the rate of brief consultations has grown by an average of 20% each year. Delivery of after-hours consultations also increased.
The pattern of GP services provided in RACFs has changed substantially over time. To some extent these changes reflect regulatory adjustments; however, the pattern is at odds with the ever-increasing dependence levels of residents.
A new model of care for the management of patients with delirium was developed and evaluated.
A four-bedded Close Observation Unit (COU) was introduced. The model comprised education for assistants in nursing (AINs), environmental adaptations and AIN-to-patient ratio of 1:4. Outcomes in all patients with delirium before and after introduction of the new model of care were compared.
One hundred and five patients were admitted to COU, of whom 100 (95%) were diagnosed with delirium. In-hospital mortality improved after introduction of the unit (15% vs 5%; P = 0.002) without significant change in length of stay, discharge destination or falls frequency.
A dedicated unit for delirium management within medicine achieved a reduction in mortality.