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Croot K, Allison KC, Sachdev PS, Brodaty H, Crawford JD, Lam BC, Lee T, Henry JD, Draper B, Close J, Ong MY, Rossie M, Kochan NA. Development of the Computer and Technology Attitude Questionnaire (CaTAQ) to inform performance on computerised cognitive testing in older adults in the CogSCAN Study. Alzheimers Dement 2020. [DOI: 10.1002/alz.045676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Lavrencic L, Donovan T, Moffatt L, Allan W, Daylight G, Garvey G, Hill TY, Draper B, Cumming R, Broe GA, Delbaere K, Radford K. Identifying dementia risk factors and implementing a culturally grounded risk‐reduction intervention in urban and regional Aboriginal Australian communities. Alzheimers Dement 2020. [DOI: 10.1002/alz.041446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lam BCP, Crawford JD, Lipnicki DM, Numbers KT, Kochan NA, Draper B, Trollor JN, Brodaty H, Sachdev PS. The latent construct of dementia phenotype: Validation and longitudinal examination in the Sydney Memory and Ageing Study. Alzheimers Dement 2020. [DOI: 10.1002/alz.040876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Giebel C, Cations M, Draper B, Komuravelli A. Ethnic disparities in the uptake of anti‐dementia medication in young and late onset dementia. Alzheimers Dement 2020. [DOI: 10.1002/alz.036176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lavrencic LM, Bennett H, Daylight G, Draper B, Cumming R, Mack H, Garvey G, Lasschuit D, Hill TY, Chalkley S, Delbaere K, Broe GA, Radford K. Cognitive test norms and comparison between healthy ageing, mild cognitive impairment, and dementia: A population‐based study of older Aboriginal Australians. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Larke BM, Broe GA, Daylight G, Draper B, Cumming RG, Allan W, Donovan T, Costa D, Lah S, Radford K. Patterns and preferences for accessing health and aged care services in older Aboriginal and Torres Strait Islander Australians. Australas J Ageing 2020; 40:145-153. [PMID: 33155390 DOI: 10.1111/ajag.12864] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine preferences for health and aged care services in Aboriginal and Torres Strait Islander Australians and explore related factors. METHODS Mixed-method, cross-sectional study including 336 Aboriginal and Torres Strait Islander people aged 60 years and older from regional and urban areas. RESULTS Exclusive preference for Aboriginal Community Controlled services was most common. This preference significantly increased when preferences for, and use of, aged care and disability services were considered. The likelihood of holding an exclusive preference for Aboriginal Community Controlled services was higher in regional settings compared to urban and in those reporting lower engagement in traditional activities during childhood. CONCLUSIONS These findings suggest that the majority of older Australian Aboriginal and Torres Strait Islander people prefer aged and disability care provided by Aboriginal services. Given the anticipated increase in service demand in this population, there is a growing need for culturally safe services, particularly in regional settings.
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Samaras K, Makkar S, Crawford JD, Kochan NA, Wen W, Draper B, Trollor JN, Brodaty H, Sachdev PS. Metformin Use Is Associated With Slowed Cognitive Decline and Reduced Incident Dementia in Older Adults With Type 2 Diabetes: The Sydney Memory and Ageing Study. Diabetes Care 2020; 43:2691-2701. [PMID: 32967921 DOI: 10.2337/dc20-0892] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/11/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes (diabetes) is characterized by accelerated cognitive decline and higher dementia risk. Controversy exists regarding the impact of metformin, which is associated with both increased and decreased dementia rates. The objective of this study was to determine the association of metformin use with incident dementia and cognitive decline over 6 years in participants with diabetes compared with those not receiving metformin and those without diabetes. RESEARCH DESIGN AND METHODS A prospective observational study was conducted of N = 1,037 community-dwelling older participants without dementia aged 70-90 years at baseline (the Sydney Memory and Ageing Study). Exclusion criteria were dementia, major neurological or psychiatric disease, or progressive malignancy. Neuropsychological testing measured cognitive function every 2 years; a battery of tests measured executive function, memory, attention/speed, language, and visuospatial function individually. These were used to determine the measure of global cognition. Incident dementia was ascertained by a multidisciplinary panel. Total brain, hippocampal, and parahippocampal volumes were measured by MRI at baseline and 2 years (n = 526). Data were analyzed by linear mixed modeling, including the covariates of age, sex, education, BMI, heart disease, hypertension, stroke, smoking, and apolipoprotein Eε4 carriage. RESULTS Of n = 1,037, 123 had diabetes; 67 received metformin (DM+MF) and were demographically similar to those who did not (DM-noMF) and participants without diabetes (no-DM). DM+MF had significantly slower global cognition and executive function decline compared with DM-noMF. Incident dementia was significantly higher in DM-noMF compared with DM+MF (odds ratio 5.29 [95% CI 1.17-23.88]; P = 0.05). CONCLUSIONS Older people with diabetes receiving metformin have slower cognitive decline and lower dementia risk. Large randomized studies in people with and without diabetes will determine whether these associations can be attributed to metformin.
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Radford K, Lavrencic LM, Delbaere K, Draper B, Cumming R, Daylight G, Mack HA, Chalkley S, Bennett H, Garvey G, Hill TY, Lasschuit D, Broe GA. Factors Associated with the High Prevalence of Dementia in Older Aboriginal Australians. J Alzheimers Dis 2020; 70:S75-S85. [PMID: 30507573 PMCID: PMC6700619 DOI: 10.3233/jad-180573] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Dementia prevalence in Aboriginal and Torres Strait Islander Australians is three to five times higher than the general Australian population. A better understanding of the underlying biomedical and social risk factors is needed to guide dementia prevention in Aboriginal Australians. The current study is the first to examine potential risk factors for dementia in the majority urban and regional population, with a representative sample of 336 Aboriginal Australians aged 60 years and older. Participants included 45 people with a dementia diagnosis (n = 27 probable/possible Alzheimer's disease); and 286 people without dementia. Univariate logistic regression analyses (controlling for age) identified childhood trauma, mid-life factors (history of unskilled work, past high-risk alcohol use), and medical factors (history of stroke, head injury with loss of consciousness, epilepsy) as risk factors for dementia. Multivariable analysis revealed age, childhood trauma, unskilled work, stroke, and head injury as independent predictors of all-cause dementia. A range of comorbid factors related to dementia was also identified (i.e., functional impairment, incontinence, recent hospital admission, low body mass index, living in residential care, depression, current high-risk alcohol use, social isolation, low physical activity levels). These findings extend previous outcomes in a remote Aboriginal population by highlighting that life-course social determinants of health, in addition to neurological disorders, likely play an important role in elevating dementia risk. Certain psychosocial and medical exposures are highly prevalent in Aboriginal Australians, similar to other indigenous populations, and should be considered when designing targeted and culturally appropriate prevention initiatives to reduce the burden of dementia.
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Mitchell R, Ting HP, Draper B, Close J, Harvey L, Brodaty H, Driscoll TR, Braithwaite J. Frailty and risk of re-hospitalisation and mortality for aged care residents following a fall injury hospitalisation. Australas J Ageing 2020; 40:e44-e53. [PMID: 32881277 DOI: 10.1111/ajag.12847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/07/2020] [Accepted: 07/20/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To examine the role of frailty in risk of re-hospitalisation and mortality for aged care residents following a fall injury hospitalisation. METHODS Retrospective analysis of linked hospitalisation and aged care data of adults aged ≥65 years residing in aged care. A semi-competing risk analysis examined risk of hospital readmission. RESULTS Residents who had intermediate or high frailty, who were aged 70-79 or 80-89 years, who had 1-2 or ≥3 comorbidities, sustained a hip fracture, and who had either low, moderate or high complex health-care requirements had a higher risk of being readmitted to hospital. Frailty was not associated with mortality for those with no hospital readmission or mortality after readmission. CONCLUSION Frailty is an important prognostic factor associated with readmission for residents of aged care hospitalised for a fall injury. Frailty screening could assist to identify people at a high risk of re-hospitalisation following a fall injury.
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Xiao LD, McKechnie S, Jeffers L, De Bellis A, Beattie E, Low LF, Draper B, Messent P, Pot AM. Stakeholders' perspectives on adapting the World Health Organization iSupport for Dementia in Australia. DEMENTIA 2020; 20:1536-1552. [PMID: 32864991 DOI: 10.1177/1471301220954675] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In Australia, informal caregivers (family, friends and neighbours) play a crucial role in supporting people with dementia to remain at home. Within the community aged care policy, informal caregivers are acknowledged as assisting with managing care. However, they usually receive very limited dementia care education and training to support them in their role. The World Health Organization (WHO) developed iSupport for Dementia, a comprehensive online dementia education and skill training programme, to address the gap in supporting informal caregivers. AIM The aim of the study was to identify stakeholders' perspectives regarding adapting the WHO iSupport for use by informal caregivers of people with dementia in Australia. METHODS An interpretive description study design was used. Data were collected in focus groups with informal caregivers and care staff of dementia and aged care service providers conducted in May-July 2018. A thematic analysis was utilised to analyse data and identify findings. RESULTS In total, 16 informal caregivers and 20 care staff participated in the study. Five themes were identified. First, informal caregivers perceived iSupport as an opportunity to provide an online one-stop shop to meet their education needs and their needs to manage care services. Second, both informal caregivers and care staff believed that an integrated caregiver network moderated by a health professional was much needed to enable informal caregivers to share learning experiences and enhance social support. Third, both informal caregivers and care staff strongly suggested that dementia and aged care service providers had a role to play in promoting the iSupport. Fourth, informal caregivers were concerned about the time commitment to participate in the iSupport programme. Finally, informal caregivers expected the iSupport to be user-friendly. CONCLUSION Stakeholders perceived the adaptation of the WHO iSupport in Australia would strengthen informal caregiver education and optimise support for informal caregivers.
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Derrig H, Lavrencic LM, Broe GA, Draper B, Cumming RG, Garvey G, Hill TY, Daylight G, Chalkley S, Mack H, Lasschuit D, Delbaere K, Radford K. Mild cognitive impairment in Aboriginal Australians. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2020; 6:e12054. [PMID: 32864414 PMCID: PMC7443744 DOI: 10.1002/trc2.12054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Aboriginal Australians have among the highest rates of dementia worldwide, yet no study has investigated the subtypes, risk factors, or longer term outcomes of mild cognitive impairment (MCI) in this population. METHODS A total of 336 community-dwelling Aboriginal Australians aged ≥60 years participated in a longitudinal study, completing a structured interview at baseline. MCI (amnestic subtype, aMCI; non-amnestic subtype, naMCI) and dementia were diagnosed via cognitive screening, medical assessment, and clinical consensus. Associations between life-course factors and baseline MCI subtypes were examined using logistic regression. Conversion to dementia was assessed at 6-year follow-up. RESULTS Prevalent aMCI (n = 24) was associated with older age (odds ratio [OR] = 1.68, 95% confidence interval [CI]: 1.12 to 2.53), head injury (OR = 3.19, 95% CI: 1.35 to 7.56), symptoms of depression (OR = 1.52, 95% CI: 1.04 to 2.24), and lower blood pressure (OR = 0.53, 95% CI: 0.33 to 0.86). Prevalent naMCI (n = 29) was associated with low education (OR = 4.46, 95% CI: 1.53 to 13.05), unskilled work history (OR = 5.62, 95% CI: 2.07 to 13.90), higher body mass index (OR = 1.99, 95% CI: 1.30 to 3.04), and moderate to severe hearing loss (OR = 2.82, 95% CI: 1.06 to 7.55). A small proportion of MCI cases reverted to intact at follow-up (15%), but most remained stable (44%), developed dementia and/or died (41%). DISCUSSION Sociodemographic and clinical factors both contributed to baseline MCI and were distinct for MCI subtypes, with similar patterns of conversion to dementia for amnestic and non-amnestic MCI.
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Altendorf A, Draper B, Wijeratne C, Schreiber J, Kanareck D. Neglect of Older People: Touching on Forensic and Pathophysiological Aspects. THE GERONTOLOGIST 2020; 60:e449-e465. [PMID: 31348828 DOI: 10.1093/geront/gnz084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Neglect of older people is common and may result in fatal and nonfatal outcomes. Normal changes of aging and disease-related symptoms may overlap with markers of neglect and lead to under-detection. This review aims to delineate medical, psychiatric, and pathophysiological indicators in the victim-identified in forensic case reports-to point out areas of overlap and raise awareness in Health Care Professionals. RESEARCH DESIGN AND METHODS Medical and forensic databases were searched with the search terms: neglect, elder, elderly, forensic, homicide for detailed case reports on elder neglect. Cases were reviewed as to victim age, sex, medical/psychiatric diagnosis, perpetrator, victim-to-perpetrator relationship, cause of death (if fatal), location of incident, autopsy findings (if fatal), and ancillary studies. A total of 168 publications were retrieved, of these 11 publications, containing a total of 25 cases, yielded sufficient detail on each case to be included in the qualitative analysis. RESULTS Neglect is associated with poor physical, psychological, and mental health. Neglect can be a direct cause of death or contribute to a fatal outcome by exacerbating existing conditions. Red flags of neglect included malnutrition, dehydration, poor hygiene, untreated decubitus ulcers, hypothermia, contractures, and an uncooperative caregiver. However, incontrovertible evidence of neglect is not always easy to obtain due to age and disease-related changes. DISCUSSION AND IMPLICATIONS The findings document the extent and seriousness of elder neglect and highlight the importance of detailed documentation as well as collaboration between clinicians, allied health professionals, law enforcement and medical forensic services to improve patient outcomes and reduce the risk of further incidents.
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Campbell G, Darke S, Degenhardt L, Townsend H, Carter G, Draper B, Farrell M, Duflou J, Lappin J. Prevalence and Characteristics Associated with Chronic Noncancer Pain in Suicide Decedents: A National Study. Suicide Life Threat Behav 2020; 50:778-791. [PMID: 32162732 DOI: 10.1111/sltb.12627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/09/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aims were to estimate the prevalence of CNCP in suicide decedents, and compare sociodemographic and clinical characteristics of people who die by suicide (i) with and without a history of CNCP and (ii) among decedents with CNCP who are younger (<65 years) and older (65 + years). METHOD We examined all closed cases of intentional deaths in Australia in 2014, utilizing the National Coronial Information System. RESULTS We identified 2,590 closed cases of intentional deaths in Australia in 2014 in decedents over 18 years of age. CNCP was identified in 14.6% of cases. Decedents with CNCP were more likely to be older, have more mental health and physical health problems, and fewer relationship problems, and were more likely to die by poisoning from drugs, compared with decedents without CNCP. Comparisons of older and younger decedents with CNCP found that compared to younger (<65 years) decedents with CNCP, older decedents (65 + years) were less likely to have mental health problems. CONCLUSIONS This is the first national study to examine the characteristics of suicide deaths with a focus on people with CNCP. Primary care physicians should be aware of the increased risk for suicide in people living with CNCP, and it may be useful for clinicians to screen for CNCP among those presenting with suicidal behaviors.
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Kwan E, Draper B, Endre ZH, Harvey SB, Brown MA. Prevalence, Types and Recognition of Cognitive Impairment in Dialysis Patients in South Eastern Sydney. Intern Med J 2020; 51:2034-2041. [PMID: 32672898 DOI: 10.1111/imj.14976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In international studies, cognitive impairment is a common but underdetected issue in dialysis patients. Chronic Kidney Disease (CKD) shares risk factors with and is an independent risk factor for cognitive impairment. There is a lack of Australian data of cognitive impairment in this at-risk population. This has implications on service planning because cognitive impairment in CKD is associated with higher mortality, morbidity, and healthcare costs. AIMS This study examines the prevalence, types, and clinician recognition of cognitive impairment within an Australian dialysis population. METHODS A cross-sectional study of haemodialysis and peritoneal dialysis patients in South-East Sydney screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA). Participant interviews, medical records, physician and carer questionnaires, were used to determine the types of cognitive impairment and rate of recognition. RESULTS 106 participants were included (median age 66 years, median dialysis duration 2 years) and 58 (54.7%) were cognitively impaired on the MoCA, of whom old age psychiatrists subclassified 21 (36.2%) as having dementia, and 31 (53.4%) with 'Cognitive Impairment, No Dementia'. 36/58 (62.0%) of the cognitively impaired participants on the MoCA were suspected of having cognitive impairment by nephrologists but only 14/58 (24.1%) had this documented in medical records. CONCLUSION Although cognitive impairment is common in dialysis patients, there are low levels of detection by clinical teams. Cognitive screening of dialysis patients should be incorporated as part of wider assessment and determination of management goals such as individuals' capacity to self-care and provide informed consent to treatments. This article is protected by copyright. All rights reserved.
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Numbers K, Crawford JD, Kochan NA, Draper B, Sachdev PS, Brodaty H. Participant and informant memory-specific cognitive complaints predict future decline and incident dementia: Findings from the Sydney Memory and Ageing Study. PLoS One 2020; 15:e0232961. [PMID: 32396544 PMCID: PMC7217434 DOI: 10.1371/journal.pone.0232961] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/24/2020] [Indexed: 11/21/2022] Open
Abstract
Subjective Cognitive Complaints (SCCs) may represent one of the earliest stages of preclinical dementia. The objective of the present study was to extend previous work by our group to examine the relationship between participant-reported and informant-reported memory and non-memory SCCs, cognitive decline and incident dementia, over a six-year period. Participants were 873 community dwelling older adults (Mage = 78.65, SD = 4.79) without dementia and 843 informants (close friends or family) from the Sydney Memory and Ageing Study. Comprehensive neuropsychological testing and diagnostic assessments were carried out at baseline and biennially for six years. Linear mixed models and Cox proportional hazard models were performed to determine the association of SCCs, rate of cognitive decline and risk of incident dementia, controlling demographics and covariates of mood and personality. Participant and informant memory-specific SCCs were associated with rate of global cognitive decline; for individual cognitive domains, participant memory SCCs predicted decline for language, while informant memory SCCs predicted decline for executive function and memory. Odds of incident dementia were associated with baseline participant memory SCCs and informant memory and non-memory SCCs in partially adjusted models. In fully adjusted models, only informant SCCs were associated with increased risk of incident dementia. Self-reported memory-specific cognitive complaints are associated with decline in global cognition over 6-years and may be predictive of incident dementia, particularly if the individual is depressed or anxious and has increased neuroticism or decreased openness. Further, if and where possible, informants should be sought and asked to report on their perceptions of the individual’s memory ability and any memory-specific changes that they have noticed as these increase the index of diagnostic suspicion.
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Shand F, Torok M, Cockayne N, Batterham PJ, Calear AL, Mackinnon A, Martin D, Zbukvic I, Mok K, Chen N, McGillivray L, Phillips M, Cutler H, Draper B, Sara G, Christensen H. Protocol for a stepped-wedge, cluster randomized controlled trial of the LifeSpan suicide prevention trial in four communities in New South Wales, Australia. Trials 2020; 21:332. [PMID: 32293516 PMCID: PMC7161184 DOI: 10.1186/s13063-020-04262-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite increasing investment in suicide prevention, Australian suicide rates have increased steadily in the past decade. In response to growing evidence for multicomponent intervention models for reducing suicide, the LifeSpan model has been developed as the first multicomponent, evidence-based, system-wide approach to suicide prevention in Australia. The LifeSpan model consists of nine evidence-based strategies. These include indicated, selective and universal interventions which are delivered simultaneously to community and healthcare systems over a 2-year implementation period. This study will evaluate the effectiveness of the LifeSpan model in reducing suicide attempts and suicide deaths in four geographically defined regions in New South Wales, Australia. METHODS We outline the protocol for a stepped-wedge, cluster randomized controlled trial. Following a 6-month transition phase, the trial sites will move to the 2-year active implementation phase in 4-monthly intervals with evaluation extending a minimum of 24 months after establishment of the full active period. Analysis will be undertaken of the change attributable to the invention across the four sites. The primary outcome for the study is the rate of attempted suicide in the regions involved. Rate of suicide deaths within each site is a secondary outcome. DISCUSSION If proven effective, the LifeSpan model for suicide prevention could be more widely delivered in Australian communities, providing a valuable new approach to tackle rising suicide rates. LifeSpan has the potential to significantly contribute to the mental health of Australians by improving help-seeking for suicide, facilitating early detection, and improving aftercare to reduce re-attempts. The findings from this research should also contribute to the evidence base for multilevel suicide prevention programs internationally. TRIAL REGISTRATION Australia New Zealand Clinical Trials Register, ID: ACTRN12617000457347. Prospectively registered on 28 March 2017. https://www.anzctr.org.au/TrialSearch.aspx#&&conditionCode=&dateOfRegistrationFrom=&interventionDescription=&interventionCodeOperator=OR&primarySponsorType=&gender=&distance=&postcode=&pageSize=20&ageGroup=&recruitmentCountryOperator=OR Protocol Version: 1.0, 31 May 2019.
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Mitchell R, Draper B, Brodaty H, Close J, Ting HP, Lystad R, Harris I, Harvey L, Sherrington C, Cameron ID, Braithwaite J. An 11-year review of hip fracture hospitalisations, health outcomes, and predictors of access to in-hospital rehabilitation for adults ≥ 65 years living with and without dementia: a population-based cohort study. Osteoporos Int 2020; 31:465-474. [PMID: 31897545 DOI: 10.1007/s00198-019-05260-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/05/2019] [Indexed: 12/30/2022]
Abstract
UNLABELLED This study examined hip fracture hospitalisation trends and predictors of access to rehabilitation for adults aged ≥ 65 years living with and without dementia. The hospitalisation rate was 2.5 times higher for adults living with dementia and adults who lived in aged care were between 4.8 and 9.3 times less likely to receive rehabilitation. INTRODUCTION To examine hip fracture hospitalisation temporal trends, health outcomes, and predictors of access to in-hospital rehabilitation for older adults living with and without dementia. METHODS A population-based retrospective cohort study of adults aged ≥ 65 years hospitalised with a hip fracture during 2007-2017 in New South Wales, Australia. RESULTS Of the 69,370 hip fracture hospitalisations, 27.1% were adults living with dementia. The hip fracture hospitalisation rate was 2.5 times higher for adults living with dementia compared with adults with no dementia (1186.6 vs 492.9 per 100,000 population). The rate declined by 6.1% per year (95%CI - 6.6 to - 5.5) for adults living with dementia and increased by 1.0% per year (95%CI 0.5-1.5) for adults with no dementia. Multivariable associations identified that adults living with dementia who experienced high frailty and increasing age were between 1.6 and 1.8 times less likely to receive in-hospital rehabilitation. Adults who were living in long-term aged care facilities were between 4.8 and 9.3 times less likely to receive in-hospital rehabilitation which varied by the presence of dementia or delirium. CONCLUSION Consistent criteria should be applied to determine rehabilitation access, and rehabilitation services designed for older adults living with dementia or in aged care are needed. HIGHLIGHTS • Adults living with dementia were able to make functional gains following hip fracture rehabilitation. • Need to determine consistent criteria to determine access to hip fracture rehabilitation. • Rehabilitation services specifically designed for adults living with dementia or in aged care are needed.
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Mitchell R, Draper B, Harvey L, Brodaty H, Close J. 56 Examining Fall-Related HIP Fractures in Long-Term Residential Aged Care and the Community: Trends, Health Outcomes and Treatment Costs. Age Ageing 2019. [DOI: 10.1093/ageing/afz164.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Hip fracture risk is higher for older adults living in residential aged care facilities (RACF) and their health outcomes worse compared to older adults living in the community. Pre-hip fracture residential status is not well recorded within hospital records, necessitating linkage of hospital and residential aged care data to better ascertain residential location pre-fracture.
Aim
To examine temporal trends, characteristics and health outcomes following a fall-related hip fracture hospitalisation of people living in RACFs to those living in the community.
Method
A retrospective analysis of fall-related hip fracture hospitalisations of people aged ≥65 years during 2008-2013 in New South Wales, Australia. Linked hospitalisation and RACF data were examined. Negative binomial regression examined the significance of hospitalisation temporal trends.
Results
There were 28,897 hip fracture hospitalisations and 32.5% were living in RACFs at time of fracture. The hospitalisation rate was 2,180 per 100,000 (95%CI: 2,097.0-2,263.7) for RACF residents and 390 per 100,000 (95%CI 384.8-395.8) for the community-living. Over 5 years, the hospitalisation rate for RACF residents declined by 2.9% annually (95%CI: -4.3 to -1.5). Hospital treatment cost for hip fractures was $958.5 million. Compared to older people living in the community, a higher proportion of RACF residents were aged ≥90 years (36.1% vs 17.2%), were female (75.3% vs 71.8%), had >1 Charlson comorbidity (37.6% vs 35.6%), and had dementia (58.2% vs 14.4%). RACF residents had fewer in-hospital rehabilitation episodes (18.7% vs 60.9%) and a higher proportion of unplanned readmissions (10.6% vs 9.1%) and in-hospital mortality (5.9% vs 3.3%) compared to older people living in the community.
Conclusions
RACF residents are a vulnerable cohort of older people who experience worse health outcomes and survival post-hip fracture than older people living in the community. Whether access to individualised hip fracture rehabilitation for RACF residents could improve health outcomes should be examined.
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O'Brien MDC, Wand APF, Draper B. The use of opioids for chronic non-cancer pain in older Australians. Australas J Ageing 2019; 38:224-227. [PMID: 30843317 DOI: 10.1111/ajag.12645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/12/2019] [Accepted: 02/18/2019] [Indexed: 01/23/2023]
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Andriessen K, Hadzi-Pavlovic D, Draper B, Dudley M, Mitchell PB. New adolescent grief scales open new research possibilities: A commentary. DEATH STUDIES 2019; 45:838-839. [PMID: 31762405 DOI: 10.1080/07481187.2019.1691362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this commentary, we highlight the availability of two newly developed instruments that measure grief in adolescents. We present similarities and differences regarding their content, factor structure, and characteristics of the validated populations. Given the small body of adolescent grief instruments, these two new scales will prove to be useful instruments to enhance our knowledge of grief and effectiveness of grief interventions in this population.
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Wilkinson A, Quinn B, Draper B, White S, Hellard M, Stoové M. Prevalence of daily tobacco smoking participation among HIV-positive and HIV-negative Australian gay, bisexual and other men who have sex with men. HIV Med 2019; 21:e3-e4. [PMID: 31603591 DOI: 10.1111/hiv.12802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mitchell R, Draper B, Close J, Harvey L, Brodaty H, Do V, Driscoll TR, Braithwaite J. Future hospital service utilisation in older adults living in long-term residential aged care or the community hospitalised with a fall-related injury. Osteoporos Int 2019; 30:1995-2008. [PMID: 31342137 DOI: 10.1007/s00198-019-05096-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED This study identified group-based trajectories of hospitalisation for older adults who were living in residential aged care facilities (RACF) or the community for up to 4 years after an index fall injury hospitalisation. Greater than 3 subsequent fall injury hospitalisations and time until move to a RACF were key predictors of RACF and community-living trajectory group memberships, respectively. INTRODUCTION To examine hospital service use trajectories of people aged ≥ 65 years who had a fall injury hospitalisation and were either living in a residential aged care facility (RACF) or the community at the time of the index fall and to identify factors predictive of their trajectory group membership. METHOD A group-based trajectory analysis of hospitalisations of people aged ≥ 65 years who had a fall injury hospitalisation during 2008-2009 in New South Wales, Australia, was conducted. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived based on number of subsequent hospital admissions following the index fall injury hospitalisation. Multinominal logistic regression examined predictors of trajectory group membership. RESULTS There were 24,729 fall injury hospitalisations; 78.8% of fallers were living in the community and 21.2% in a RACF. Five distinct trajectory groups were identified for community-living and four trajectory groups for RACF residents. Key predictors of trajectory group membership for both community-living and RACF residents were age group, number of comorbidities and dementia status. For RACF residents, depression, assistance with activities of daily living and number of subsequent fall injury admissions were also predictors of group membership, with time to move to a RACF a predictor of group membership for community living. CONCLUSIONS Identifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living individuals to remain as long as possible within their own residence.
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Kwan E, Draper B, Harvey SB, Endre ZH, Brown MA. Prevalence, detection and associations of depression in Australian dialysis patients. Australas Psychiatry 2019; 27:444-449. [PMID: 31287327 DOI: 10.1177/1039856219859281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Depression in dialysis patients is often undetected despite associations with poor outcomes. The aim was to determine the prevalence and associations of depressive symptoms and physician recognition of depression within a typical Australian dialysis population. METHOD A cross-sectional study examined haemodialysis and peritoneal dialysis patients of two hospitals in Sydney. Participants were screened for depression using the Hospital Anxiety and Depression Scale (HADS). RESULTS One hundred and ten patients completed the HADS. Subjects had a mean age of 63.7 years, 37% from a culturally and linguistically diverse background, and median dialysis duration of 2 years. Forty-one per cent of participants had significant depressive symptoms, of whom 42% had been diagnosed with depression by their clinicians. After adjustment for sociodemographic factors, having >10 medications prescribed, >3 hospitalisations in the last 12 months, and a history of depression were associated with depression. CONCLUSION Depressive symptoms are prevalent in Australian dialysis patients. Robust evidence is needed on the effectiveness of treatments for depression in changing outcomes in chronic kidney disease.
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Moyle W, Murfield J, Jones C, Beattie E, Draper B, Ownsworth T. Can lifelike baby dolls reduce symptoms of anxiety, agitation, or aggression for people with dementia in long-term care? Findings from a pilot randomised controlled trial. Aging Ment Health 2019; 23:1442-1450. [PMID: 30474401 DOI: 10.1080/13607863.2018.1498447] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objectives: To compare a lifelike baby doll intervention for reducing anxiety, agitation, and aggression in older people with dementia in long-term care (LTC), with usual facility care; and explore the perceptions of care staff about doll therapy. Method: Pilot, mixed-methods, parallel, randomised controlled trial, with follow-up semi-structured interviews. Thirty-five residents from five LTC facilities in Queensland, Australia were randomised to the lifelike baby doll intervention (three, 30-minute, individual, non-facilitated sessions per week) or usual care. Outcomes were changes in levels of anxiety, agitation, and aggression after the 3-week intervention, and short-term effects at week 1. Following intention-to-treat principles, repeated measure MANOVA was undertaken. Qualitative interviews involved five staff. Results: The doll intervention did not significantly reduce residents' anxiety, agitation, or aggression when compared to usual care at weeks 3 (primary outcome) and 1 (secondary outcome). However, there was a significant group-by-time interaction for the outcome of pleasure - the doll group showed a greater increase in displays of pleasure at week 3 compared to baseline than usual care (F(1,31) = 4.400, p = 0.044; Cohen's d = 0.74). Staff perceived benefits for residents included emotional comfort, a calming effect, and providing a purposeful activity. Perceived limitations were that doll therapy may only be suitable for some individuals, some of the time, and the potential for residents to care for the doll at the expense of their health. Conclusions: Doll therapy can provide some residents with enjoyment and purposeful engagement. Further research should focus on understanding the individual characteristics and circumstances in which residents most benefit.
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Mitchell R, Fajardo Pulido D, Ryder T, Norton G, Brodaty H, Draper B, Close J, Rapport F, Lystad R, Harris I, Harvey L, Sherrington C, Cameron ID, Braithwaite J. Access to rehabilitation services for older adults living with dementia or in a residential aged care facility following a hip fracture: healthcare professionals' views. Disabil Rehabil 2019; 43:834-845. [PMID: 31335212 DOI: 10.1080/09638288.2019.1643418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To enhance understanding of access to rehabilitation services in Australian and New Zealand acute care facilities for older adults living with dementia and/or living in residential aged care facilities (RACFs) following a hip fracture. METHODS Information on hip fracture rehabilitation was obtained from an online survey of 40 health professionals who were members of the Australian and New Zealand Hip Fracture Registry Network. This information was supplemented with key informant interviews with five geriatricians and five rehabilitation physicians. RESULTS Availability of hip fracture rehabilitation services differed by region and country. Around one in 10 respondents indicated that their facility had specific rehabilitation protocols for people living in RACFs or who were living with dementia. Barriers to providing hip fracture rehabilitation were commonly related to availability of resources. Rehabilitation pathways were determined according to individual patient characteristics and perceived potential benefit. Decision making was mainly informed by the patient's pre-fracture morbidity and residence. Three key themes and nine sub-themes emerged from the interviews. CONCLUSIONS The development of consistent decision criteria and pathways for access to hip fracture rehabilitation could provide a standard approach to access to rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.IMPLICATIONS FOR REHABILITATIONNeed to establish evidence-based criteria for patients who will benefit from hip fracture rehabilitation.Consistent decision criteria for access to hip fracture rehabilitation will assist in guiding a standard approach to providing rehabilitation, particularly for patients with cognitive impairment and/or who reside in RACFs.There is a need to ensure the availability of physiotherapy services in RACFs to assist with rehabilitation provision.Rehabilitation provided to patients with cognitive impairment and/or who are living in RACFs should be tailored to their physical and mental ability.
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