The development of a dysphagia screening test is an urgent issue in the field of frailty prevention among community-dwelling older people. The purpose of this study was to evaluate the screening performance of a 100-mL water swallowing test (WST).
The study employed a cross-sectional design. Participants were 304 (65 men and 239 women, mean age = 80 years) Japanese community-dwelling older adults aged over 65 years. We investigated swallowing disorder using the 10-item Eating Assessment Tool (EAT-10), and compared choking signs, swallowing time and number of swallows, and their combination in the 100-mL WST. We calculated the sensitivity and specificity of these indices. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off value of swallowing time and number of swallows in the 100-mL WST based on the Youden Index among participants without choking signs.
The sensitivity and specificity of choking signs in the 100-mL WST were 20% and 91%, respectively. The discriminating ability of swallowing time and number of swallows among participants without any choking signs was .76 and .72, respectively, in the area under the ROC curve. Diagnostic sensitivity and specificity to discriminate dysphagia from normal swallowing ability were 65% and 74% when the cut-off was >10 s based on maximisation of the Youden Index. The 100-mL WST performed best when the indices of choking signs and swallowing time were combined, with a sensitivity and specificity of 72% and 68%, respectively.
The 100-mL WST would be an adequate screening tool when compared to the EAT-10.
In 2022, it was estimated that 401,300 Australians were living with dementia, and in 2021, dementia was the second leading cause of death (10% of all deaths) in Australia.1 A recent study by Livingston et al.2 revealed that there are several modifiable risk factors that can increase the risk of dementia, with the highest risk factor being untreated mid-life hearing loss. As dementia screening practices do not consider the role of hearing loss on cognitive assessments, and vice versa, older adults with comorbid hearing and cognitive impairment are often misdiagnosed.3
Initially, our aim was to identify gaps in the knowledge, attitudes and practices of general practitioners, hearing health-care professionals and clinicians in memory clinics, to aid in providing recommendations for additional training, guidelines and communication strategies. As recommended by the National Health and Medical Research Council (NHMRC),4 we conducted a community conversation to help gain ideas from those within the community regarding supporting patients with comorbid hearing and cognitive impairment. A total of 10 participants who were older than 65 years of age attended the discussion, with all having either hearing loss or caring for someone with dementia.
The questions and key responses given through the discussion are shown in Table 1.
Overall, participants highlighted that the following directions should be taken: have audiology and memory clinics closer to each other for ease of access to the other profession, and have more practical experience and training of other related fields within courses for studying students to increase the scope of practice for each profession.
These responses further support the notion that training and clear guidelines need to be set in place to allow audiology and memory clinics, together with general practitioners, to further improve the patient experience for individuals with cognitive impairment/dementia and hearing loss. There is a growing body of evidence to highlight the association between hearing loss and dementia,5 but there is a clear lack of evidence to help aid in translating this knowledge into clinical practice. For clearer guidelines to be set in place, further consumer and community driven research is warranted in this area.
No conflicts of interest declared.
Through interviews with older adults and professionals in Chongqing, China, this paper explores the challenges and opportunities faced by smart cities that undertake to better support ageing-in-place.
We undertook a qualitative multi-methods approach, engaging 46 professional stakeholders and 64 older people to examine the role of smart cities in enabling older people to age-in-place in Chongqing, China.
With the development of smart cities, technology has the potential to facilitate ageing-in-place by creating opportunities for heathy and active ageing. This study identified specific priorities in delivering age-friendly smart cities, including the following: shaping smart environments around the everyday lives of older people, designing inclusive and equitable smart cities and ensuring strong forms of institutional governance, trust and relationship building with older people.
The age-friendly city and communities movement (AFCC) and smart city policy instruments have potential for realising active ageing by supporting mobility, access to services and civic participation. However, there exists a disconnect between smart city policy and practice in delivering tangible well-being outcomes for older people. Addressing this requires greater cross-sectoral working, reconciling smart city policy priorities with AFCC domains and creating the institutional and governance framework to enable socially sustainable cities to support ageing-in-place.
To describe staff and family members' opinions about closed-circuit television (CCTV) in communal and private areas of residential aged care facilities (RACF), and to investigate how this relates to perceptions of care quality.
A cross-sectional survey was developed to capture perceptions of CCTV's influence on care quality, and acceptable locations for CCTV placement. Data were recorded as ordinal-scale and open responses. Non-parametric tests of association were conducted.
The survey was completed by 81 staff and 74 family members. Both staff and family were satisfied with care quality and safety, irrespective of CCTV use. More family members were in favour of CCTV in both public and private areas, compared to staff who favoured public areas. Staff and family assumed there was real-time monitoring, leading to a belief that CCTV monitoring would improve safety and prevent falls and abuse. Concerns were raised that CCTV could be used instead of improving staff-to-resident ratios and interaction.
Overall, participants supported the use of CCTV more in public than in private areas and believed it reveals and prevents poor care. There was no association between CCTV use and satisfaction with care. Closed-circuit television can have positive impacts if all stakeholders are involved in implementation.
The aim of this study was to validate the Kimberley Indigenous Cognitive Assessment—Cognitive Component (KICA-Cog) adapted for dementia screening in Torres Strait Islander Peoples.
Data were obtained from a broader dementia prevalence study completed in the Torres Strait and Northern Peninsula Area between 2015 and 2018. Modifications were made to items from the original KICA-Cog to ensure they were culturally appropriate for the Torres Strait. All participants completed a KICA-Cog and had a comprehensive dementia assessment with a geriatrician experienced in cross-cultural assessment.
A total of 255 Torres Strait residents aged 45 years and over completed a KICA-Cog and underwent geriatric assessment. The adapted KICA-Cog showed good validity for dementia diagnosis with a cut point of 33/34 associated with a sensitivity of 81% and specificity of 92% with an area under the ROC curve of 0.91.
The KICA-Cog, when modified for the Torres Strait, is a valid cognitive screening tool for dementia. Caution is required when interpreting test scores, as the adapted KICA-Cog had slightly lower sensitivity (ability to detect people with dementia) than the original KICA-Cog. As with all short cognitive tests, individuals with a low KICA-Cog scores should undergo further medical investigations before a dementia diagnosis is considered.
This study examines the impacts of urbanisation-induced displacement on rural older villagers and the issues of rebuilding ageing in place in Suzhou Municipality in China's Jiangsu Province.
The study employed a qualitative research method involving three measures of data collection, including 20 older-adult interviews, 14 key informant interviews (with street and community administrators, managers of service companies, managers of nursing homes and community doctor) and participant observation of older villagers' daily life in urban resettlement communities.
The displacement and resettlement of villagers for urbanisation had serious negative impacts on older villagers, including financial insecurity, relative deprivation and radical changes to the living environment. The community services were limited and insufficient, but the resettlement of the whole village in the same place enabled the village community to maintain social and cultural continuities, which facilitated older villagers' adaptation to the new urban place. Filial piety, though weakened and transformed, continued to play an important role in regulating old-age support, but descending familism reduced family resources for old-age support.
This study highlights the importance of examining the impacts of external social and economic forces, such urbanisation in China, on ageing in place. We draw three conclusions based on empirical research in Suzhou: (1) the resettlement of older villagers in urban areas did not significantly narrow the rural–urban gap in old-age support in Suzhou; (2) urbanisation-induced displacement in China affected older residents differently from gentrification in Western countries, due to different processes of compensation and resettlement as well as China's rural–urban welfare gap; and (3) community services for displaced older villagers are limited, but social and cultural continuities before and after resettlement have helped older villagers adapt to the new urban place.
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