Australasian Journal on Ageing最新文献

Objective

Due to the high and increasing number of older people from culturally and linguistically diverse (CALD) backgrounds in Australia, it is essential to ensure that the upcoming Support at Home program and other new initiatives incorporate culturally responsive aged care provision. Failing to address these challenges perpetuates inequalities in access to quality care for CALD older adults.

Methods

This paper reviews recent reforms and initiatives in aged care, identifies culturally responsive provisions and proposes new approaches for upcoming reforms that focus on CALD older people and their support networks. We summarise current standards of cultural appropriateness in aged care to identify areas for improvement.

Results

There are instructive interactions between cultural responsiveness and standardising or mainstreaming provision in recent aged care policies and initiatives. We argue that culturally adapting the aged care assessments and Support at Home frameworks through co-production collaborations in the Aged Care Data and Digital Strategy (2024–2029) is not just beneficial but necessary. These actions involve (i) developing culturally tailored assessment tools that consider linguistic and cultural factors, such as using bilingual questionnaires and incorporating culturally responsive communication materials, and (ii) incorporating cultural competence training. Implementing these changes, though complex, will enable equitable and inclusive aged care. It involves overcoming language and cultural barriers that impede effective communication and care.

Conclusions

We advocate for ongoing testing and evaluation of these approaches to determine their feasibility for integration into digitisation plans within the aged care sector.

Objective

To assess the prevalence of falls and examine associations between falls and potential risk factors in older adults of the Torres Strait Region of Australia.

Methods

Two hundred and fifty people aged ≥45 years residing in the Torres Strait, who identified as Torres Strait Islander, Aboriginal or both, were asked whether they had sustained any falls in the past year. Associations between self-reported falls and predictor variables were examined using logistic regression.

Results

21% of participants reported at least one fall; 9% reported ≥2 falls. Participants who reported any falls in the past year were more than twice as likely to have urinary incontinence and poor mobility (p < .01) compared to participants who did not report any falls.

Conclusions

Around one in five respondents reported one or more falls in the past year, demonstrating that falls are a significant issue for older adults of the Torres Strait. Fall prevention strategies that are effective in other populations are likely to be beneficial to the region but need to be informed by local consultation and implemented in partnership with the people of the Torres Strait.

Objectives

To identify the prevalence of and factors associated with medication use in people living with dementia in the community.

Methods

A cross-sectional study using baseline data from a randomised controlled trial known as the Interdisciplinary Home-bAsed Reablement Program (I-HARP) between 2018 and 2021 in Sydney, Australia. Participants included people with mild–moderate dementia and their carers. Medication use was classified according to the Anatomical Therapeutic Chemical codes, while potentially inappropriate medications (PIMs) were defined using 2019 Beer's Criteria and 2024 Australian list. Logistic regression models were used to identify factors associated with use of medication classes.

Results

A total of 130 people with dementia and their carers were included. Of the people with dementia, 35% were using antidementia medication, 48% psychotropics, 76% PIMs and 65% polypharmacy (≥5 medications). Polypharmacy was associated with the use of psychotropics (adjusted OR [aOR]: 5.09, 95% confidence interval [CI]: 1.94–13.39) and PIMs (aOR: 17.38, 95% CI: 5.12–59.02). Higher education level was associated with lower odds of psychotropic use (aOR: .33, 95% CI: .15–.76), and age over 80 years was associated with lower odds of antidementia medication use (aOR: .29; 95% CI: .12–.72).

Conclusions

The use of PIMs, psychotropics and polypharmacy were common in this sample of people with dementia living in the community. Associations were seen between participant characteristics and medication use. Future research should focus on reviewing PIMs and polypharmacy in people with dementia living in the community to assess the impact on health outcomes.

Introduction

Those aged 80 years and over are the fastest-growing sector of the Australian population but are often excluded from research. Oldest old people living alone, in disadvantaged neighbourhoods, and with ill health or dementia, face additional barriers that may hinder their participation in research.

Methods

This paper contributes timely critical commentary on methodological and ethical approaches to engaging under-represented people in research. We draw on our experiences and reflections from a study of social exclusion of people aged 80 years and older living alone in government housing in Melbourne, Australia.

Results and Discussion

We suggest key factors to facilitate representation of this population group in future research. These factors include using doorknocking to gain access, cultivating trust with participants and gatekeepers, and conducting face-to-face home interviews. We also interrogate ethical and safety issues for researchers and oldest old participants including the potential for informed consent protocols to exclude this population group.

Conclusion

To avoid unintentionally excluding the oldest old, researchers need to consider older persons' self-determination and advocate for methods that ensure oldest old perspectives inform future healthy ageing planning and reduce possible health and well-being inequities.

Introduction

Frailty is in an increasing focus for acute care systems due to its association with adverse health outcomes. The Clinical Frailty Scale (CFS) is a judgement-based frailty assessment tool, which classifies the frailty status of older adults, but more research involving general medicine inpatients is necessary. The objectives of this study were to describe the predictive ability of CFS, administered by geriatric medicine trained nurses, for adverse outcomes including the following: acute unit and total length of stay (LOS), new nursing home (NH) admission, 12-month mortality and readmission within 30-day.

Methods

Results

Of 394 patients included, 60% were mild–moderately frail, and 21% severely frail. In a multivariable analysis, patients classified as severely frail (CFS 7–9) had significantly high odds of death during admission (OR = 13.64), new NH admission (OR = 34.97) and acute LOS (OR = 1.74), compared to non-frail patients (CFS1-4). Mild–moderately frail (CFS 5–6) patients had significantly higher odds for new NH admission (OR = 4.36), acute unit LOS (OR = 1.49) and total LOS (OR = 1.61) compared to non-frail patients. In a Cox regression multivariable survival analysis, the severely frail had a sixfold significantly higher likelihood (HR = 6.19) of 12-month mortality, and the mild–moderately frail had a doubled likelihood (HR = 2.13), compared to the non-frail.

Conclusions

The CFS has clinical utility for identifying general medicine older inpatients at-risk of various adverse outcomes.

Objectives

Physical restraints and hand restraints are used in medical settings to provide protection and control. However, few studies have investigated their use among community-dwelling older adults. The study explored variables associated with the use of physical restraints and hand restraints among older adults receiving home care services and the reasons behind their use.

Methods

This cross-sectional study recruited 128 older adults receiving home care services and with catheters. Data were collected regarding demographic characteristics; activities of daily living (ADLs); muscle strength; family function; the use of nasogastric tubes, urinary catheters, and tracheal tubes; and the type and duration of restraint use and the reasons behind such use.

Results

Among the participants, 76% experienced the use of physical restraints, and 34% experienced the use of hand restraints. The variables related to physical restraints were ADLs (adjusted odds ratio [AOR] = 0.95, p = .02) and the presence of a paid caregiver (AOR = 3.33, p = .02). The variables related to hand restraints were ADLs (AOR = 0.93, p = .03), use of a nasogastric tube (AOR = 13.46, p = .03) and the presence of a paid caregiver (AOR = 6.38, p = .02). The primary reasons behind restraint use were to prevent fall and extubation events.

Conclusions

The use of physical restraints among older adults with catheters may be affected by their functioning in ADLs and the presence of paid caregivers to ensure their safety. Thus, implementing interventions that target functional capabilities and caregiving skills may help reduce the use of restraints.

Objectives

Dual-task walking performance is an early marker of dementia. However, there is uncertainty about which measure of the dual-task test is a better marker. The objective of this study was to determine which dual-task measure best differentiates between normal cognition, mild cognitive impairment (MCI) and dementia.

Methods

Participants (n = 116) were aged ≥60 years attending a cognitive clinic in Melbourne, Australia. Single- and dual-task gait speed were obtained using a 16 metre distance and stopwatch. The cognitive task involved reciting alternate letters of the alphabet sitting and walking. Dual-task interference in gait and cognition was calculated as: single-task-dual-task/single task × 100 and summed to obtain total interference. Multiple linear regression was used to determine differences in single and dual-task measures between those with no cognitive impairment (n = 11), MCI (n = 54) and dementia (n = 51).

Results

The mean age of the sample was 76.9 (SD 6.4) years and 48.3% (n = 56) were female. Compared to those with dementia: (a) those with MCI had a higher dual-task letter rate and lower cognitive and total interference (all indicate better performance) (p < .05) and (b) those with no cognitive impairment had a higher single- and dual-task letter rate (both indicate better performance) (p < .05). There were no differences between those with no cognitive impairment and those with MCI (all p > .05).

Conclusions

In a cognitive clinic, measurement during dual-task walking differentiated those with dementia from those with MCI or no cognitive impairment. However, differences appear to be driven by performance on the cognitive, rather than the gait task.

Objectives

The aim of this project was to evaluate the feasibility and acceptability of virtual reality (VR) as a leisure activity for people living in residential aged care. Virtual reality experiences may offer alternatives for residents with limited mobility, or during times when older people are unable to leave residential care.

Methods

The intervention used VR videos delivered via a head-mounted device. Video content was created by a local artist specifically for use with older Western Australian adults and used local content. VR sessions were videotaped for analysis. The evaluation included structured observation of video content to assess mood and engagement and post-intervention interviews with participants.

Results

Mood and engagement scores indicated overall favourable mood and considerable positive engagement with the VR experience. Interview content analysis reflected the enjoyment participants took in visiting places they had once been and the surprising ways that the experience made them feel and act as though they were actually there. Videos featuring coastal visits were the most popular and videos featuring music were the most engaging. Some participants found the head-mounted device uncomfortable. VR was considered potentially beneficial for residents with limited mobility or living with cognitive impairment.

Conclusions

Overall VR is a feasible and acceptable leisure activity for older people in residential care. The use of local content has the potential to prompt memories and generate new conversations. Future use of VR may consider different modes of video delivery and advancements in evaluation.

Objective

Given the differing cultural contexts and service needs of older persons in the west and the east, programs or policies should be thoughtfully redesigned to accommodate these diverse societies. This paper presents a systematic scoping review of ageing in place (AIP) strategies in Japan, Singapore and Thailand, emphasising how they are tailored to address the unique challenges of ageing populations in Asia.

Methods

A systematic literature search was conducted through seven databases. Empirical, peer-reviewed studies in English that discussed AIP-related programs or policies involving aged populations in the target countries were included. Themes were identified using the policy triangle framework, allowing for a comprehensive comparison of AIP across the countries.

Results

Three key components of AIP, place, support network and workforce, were identified from 44 included studies. Each country exhibits distinctive approaches to implementing these components. Japan has extensive AIP systems with comprehensive services and strong community and family support. Singapore offers innovative aged care with significant government involvement, though on a smaller scale. Thailand's localised initiatives focus on community health care and age-friendly city assessments, with a less developed AIP infrastructure.

Conclusions

The study proposes a comprehensive framework for developing ageing policies in Asia, emphasising the need for a person-centred approach in developing AIP strategies that cater to the diverse needs of ageing populations, and underscores the importance of integrating health-care services, community support and home environment modifications. The three AIP elements advocate for a person-centred approach, providing valuable insights for policymakers to effectively manage challenges of rapidly ageing populations.

Objective

This study aimed to translate previous implementation science research describing the implementation of perioperative medicine for older people undergoing surgery (POPS) services into a format that is comprehensible and relevant to clinical leaders contemplating implementing a POPS service.

Methods

We conducted a multistage expert end-user review process to design a POPS implementation guide. Our expert research team created a draft POPS service implementation guide using previous implementation science research that described the core elements and implementation of a POPS service. Next, we invited multidisciplinary (allied health, anaesthetics, geriatric medicine, nursing and surgery) clinical leaders in perioperative medicine (n = 12) from five contextually different health services to review the guide. These clinical leaders then participated in two rounds of review and refinement of the implementation guide.

Results

The first draft of the POPS service implementation guide was reviewed by clinical leaders (n = 4) with participants querying implementation science-based language and concepts, the format of the guide and its practical use. We revised the guide accordingly, and the next draft was reviewed by the second group of clinical leaders (n = 8). Feedback from the second group review was supportive of the guide's comprehensibility and relevance, and only minor changes were made to the final version of the POPS service implementation guide.

Conclusions

We used an implementation science-based approach to create a POPS service implementation guide that is comprehensible and relevant to clinical leaders in perioperative care. The next steps are to use the guide and assess its utility to support implementation of a POPS service.