Australasian Journal on Ageing最新文献

Approximately one in four older patients in hospital are living with dementia and up to two thirds of these patients experience behavioural and psychological symptoms of dementia (BPSD) during their hospital stay.¹ Behavioural and psychological symptoms of dementia, such as agitation, aggression, resistance to care, sleep disturbance and wandering develop from disease-induced vulnerabilities to a variety of internal (physiological and psychological) and external (social and physical) stressors.² In hospital, multiple factors, including acute illness (with or without delirium), unmet needs, unfamiliar and complex patient–carer relationships and physical environments, may trigger new or exacerbate preexisting BPSD. Despite BPSD being highly prevalent and associated with poor patient outcomes and occupational violence, it remains a relatively under-studied topic.

Pajaro, To and Whitehead,³ in the Australasian Journal on Ageing, make a valuable contribution to the evidence base regarding BPSD in hospital. Their 1-year retrospective evaluation of admissions from a residential aged care facility (RACF) to a tertiary hospital's acute geriatrics multidisciplinary team identified 608 patients with dementia, 82 of whom presented to hospital due to BPSD. Approximately half of these patients were admitted to a subacute geriatrics or psychogeriatrics unit for ongoing care. Changed behaviours, including agitation/aggression and resistance to care, were common to all patients and did not determine whether patients were discharged from hospital by the acute geriatrics team or admitted to a subacute unit. However, factors, including younger age, male sex, independent mobility, previous specialist input for BPSD, higher psychotropic use and ‘code blacks’ in hospital, were associated with admission to a subacute unit (and a significantly longer length of stay), highlighting that patients with more severe BPSD that may be less responsive to non-pharmacological strategies and carry a higher risk of harm to others are likely to require specialist inpatient care. Pajaro, To and Whitehead³ acknowledge their study's limitations, including its retrospective nature, small sample size and lack of BPSD severity measures. It also examined admissions of RACF residents only, when a recent prospective Australian study revealed that 50% of patients presenting with severe BPSD were from home and not RACFs.⁴ Nevertheless, it is one of only a handful to report on hospitalisation directly related to BPSD, and it compels us to consider how our hospitals meet (or do not meet) the needs of these patients and support the well-being of the staff caring for them.

Best practice management of BPSD includes identifying and addressing physiological and psychological needs (such as fear, pain and hunger) and social and environmental triggers (such as unfa

Cities across Aotearoa New Zealand are undergoing rapid demographic transitions towards super-aged communities. Such changes necessitate innovations to support healthy ageing that incorporate social and environmental developments in addition to health service improvements. The World Health Organization (WHO) Age-Friendly Cities (AFC) framework and global network provide guidance and pathways to enhance livability and well-being for ageing societies. New Zealand's engagement with the WHO AFC network has been both recent and inconsistent, with only seven municipalities formally participating since 2018, and limited uptake among larger population centres. Drawing on published action plans and evaluation reports at city and district level, demographic trend data at national and sub-national scale, and government and WHO policy and procedural documents, this paper critically examines the progress and challenges associated with AFC initiatives in New Zealand since 2018. While there is evidence of gradual increases in AFC commitment at both national and local level in New Zealand, including growth of a local proxy network, significant gaps and limitations remain with engagement and implementation. Five key challenges are identified, including the lack of operationalisation and measurement of indicators of AFC development and success, overreliance on implementation partners, a lack of sustainable funding commitments, limited support for community advocates and volunteers, and challenges engaging cities and districts in the context of competing urban design frameworks. Actionable recommendations are proposed to strengthen AFC development, including improved integration of AFC principles in urban planning, formalised key performance indicators, and enhanced support for community champions.