Ageing across the Tasman Sea: the demographics and health of older adults in Australia and New Zealand

Identification and nutritional management of malnutrition and frailty in the community: the process used to develop an Australian and New Zealand guide

Malnutrition and frailty affect up to one-third of community-dwelling older adults in Australia and New Zealand (ANZ), burdening individuals, health systems and the economy. As these conditions are often under-recognised and untreated in the community, there is an urgent need for healthcare professionals (HCPs) from all disciplines to be able to identify and manage malnutrition and frailty in this setting. This paper describes the systematic and iterative process by which a practical guide for identifying and managing malnutrition and frailty in the community, tailored to the ANZ context, was developed. The development of the guide was underpinned by the Knowledge-to-Action Framework and included the following research activities: (1) a comprehensive literature review; (2) a survey of ANZ dietitians' current practices and perceptions around malnutrition and frailty; (3) interviews with ANZ dietitians; and (4) a multidisciplinary expert panel. This resulted in the development of a guide tailored to the ANZ context that provides recommendations around how to identify and manage malnutrition and frailty in the community. It is now freely available online and can be used by all HCPs across several settings. The approach used to develop this guide might be applicable to other conditions or settings, and our description of the process might be informative to others who are developing such tools to guide practice in their healthcare environment.

Electronic Health Literacy Among Baby Boomers: A Typology

BACKGROUND

Forecasts suggest that older adults will place unprecedented demands on future health care systems. Electronic health (eHealth) resources can potentially mitigate some pressures, but to be effective patients need to be able to use them. The negative relationship between eHealth literacy and age usually results in older adults classified as one homogenous mass, which misses the opportunity to tailor interventions.

OBJECTIVE

This research examines similarities and differences within the baby boom cohort among a sample that uses the internet for health information.

METHODS

We used an electronic survey with random samples of baby boomers (N = 996) from the United States, the United Kingdom, and New Zealand.

KEY RESULTS

Four distinct subgroups, or segments, emerged. While not different from a socioeconomic perspective, these four groups have very different levels of eHealth literacy and corresponding health behaviors. Therefore, we contribute a more complex picture than is usually presented in eHealth studies.

CONCLUSIONS

Resulting insights offer a useful starting point for providers wishing to better tailor health products, services, and communications to this large cohort of future older individuals. [HLRP: Health Literacy Research and Practice. 2024;8(1):e3-e11.].

Malnutrition Risk: Four Year Outcomes from the Health, Work and Retirement Study 2014 to 2018

This study aimed to determine four-year outcomes of community-living older adults identified at ‘nutrition risk’ in the 2014 Health, Work and Retirement Study. Nutrition risk was assessed using the validated Seniors in the Community: Risk Evaluation for Eating and Nutrition, (SCREENII-AB) by postal survey. Other measures included demographic, social and health characteristics. Physical and mental functioning and overall health-related quality of life were assessed using the 12-item Short Form Health Survey (SF-12v2). Depression was assessed using the verified shortened 10 item Center for Epidemiologic Studies Depression Scale (CES-D-10). Social provisions were determined with the 24-item Social Provisions Scale. Alcohol intake was determined by using the Alcohol Use Disorders Identification Test (AUDIT-C). Among 471 adults aged 49–87 years, 33.9% were at nutrition risk (SCREEN II-AB score ≤ 38). The direct effects of nutrition risk showed that significant differences between at-risk and not-at-risk groups at baseline remained at follow up. Over time, physical health and alcohol use scores reduced. Mental health improved over time for not-at-risk and remained static for those at-risk. Time had non-significant interactions and small effects on all other indicators. Findings highlight the importance of nutrition screening in primary care as nutrition risk factors persist over time.

Ageing badly: indicators of old-age structure in Australia and New Zealand

INTRODUCTION Until 2050, Australia and New Zealand will experience continuing increase in the population aged >65 years. Studying differences in indicators of old-age structure between these countries can inform policymakers. AIM To calculate and analyse indicators of old-age structure for Australia and New Zealand. METHODS Five indicators of old-age structure were calculated: centenarian ratio (number of centenarians per 100,000 people), longevity index (proportion of people aged ≥90 and ≥65 years in the population), longevity level (proportion of 80+/60+ years population), ageing tendency (proportion of people aged ≥60 years in the population) and centenarity index (ratio between the centenarians and the total population ≥90 years). RESULTS All indicators of old-age structure demonstrated an advantageous ageing structure in Australia compared with New Zealand. In addition, the New Zealand Māori and Australian Aboriginal indicators of old-age structure demonstrated a significant disadvantage to these ethnic groups compared with the general population. DISCUSSION Public health policy needs to target ageing in New Zealand as a major goal in advancing the 'Ageing Well' policy advocated by the government.

Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review

Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.

Proactive primary care model for frail older people in New Zealand delays aged-residential care: A quasi-experiment

BACKGROUND/OBJECTIVES

To determine the effect of a proactive primary care program on acute hospitalization and aged-residential care placement for frail older people.

DESIGN

Controlled before and after, and controlled after only quasi-experimental studies, with a comparison group created via propensity score matching. One-year follow-up.

SETTING

Nine general practices in Auckland, New Zealand.

PARTICIPANTS

Community-dwelling people aged 75 and older identified as at increased risk of hospitalization. One thousand and eighty five patients are compared with 3750 comparison patients matched by propensity score based on known risks.

INTERVENTION

Primary healthcare based, registered nurse-led, comprehensive geriatric assessment, goal-setting, care planning, and regular follow-up. Patients were also provided self-management education, health and social care navigation, and transitional care for hospital discharges. Practices received program support, workforce development, and mentoring of primary healthcare nurses by gerontology nurse specialists.

MEASUREMENTS

Outcomes from routinely collected administrative data. Primary: aged-residential care placement.

SECONDARY OUTCOMES

acute hospitalization, mortality, and other health service utilization.

RESULTS

Aged-residential care placement (odds ratio [OR] 0.66, 95% confidence interval (CI) = 0.48-0.91) and mortality (OR 0.66, 95% CI = 0.49-0.88) were significantly lower over the first year in Kare patients compared with matched controls. There was no difference in acute hospitalization (+0.06 admissions per year, 95% CI = -0.01-0.13). Support service use (allied health therapists and assessment for social support) was increased, and emergency department use decreased.

CONCLUSION

The Kare participants had lower aged-residential care placement and mortality in the first year, but no decrease in acute hospitalization. Because the design is nonexperimental caution is required in interpreting these results.

"If they can do it, I can do it": experiences of older women who engage in powerlifting training

Older adults' participation in resistance training is low. Recent research suggests social aspects are important determinants of exercise engagement. In this study, 13 older women (50 years and older) were interviewed to examine their experiences of powerlifting training. Data were thematically analyzed revealing two main themes: Challenging Beliefs and Positive Social Influences. Peer advocates were essential for uptake, with social interactions in group resistance training, and having a skilled trainer, identified as important adherence factors. Strategies to improve resistance training uptake in older women could leverage off the experience of others and powerlifting training culture and practices.

Defining loneliness in older adults: protocol for a systematic review

BACKGROUND

Socialization is an important part of the healthy aging process, but natural changes in the lifestyle and health of older people increased risk of loneliness. However, loneliness is not well defined and might differ in different cultures and settings. The main objective of this systematic review is to summarize literature on the topic and propose a definition that might help aging research and practice in the future.

METHODS

Eight databases including PubMed, Scopus, CINAHL, Web of Science, EMBASE, PsycINFO, Proquest, and Age Line bibliographic will be run individually to retrieve relevant literature on loneliness among elderly population using subject headings and appropriate MeSH terms. Inclusion and exclusion criteria will be developed and refined by the research team. Two reviewers will participate in each search stage including abstract/title and full text screening, data extraction, and appraisal. We will restrict our search to articles published in the English language biomedical journal between 2000 and 2017. The protocol adheres to the standards recommended by the PRISMA-P.

DISCUSSION

The results of this systematic review can present a more accurate definition of loneliness for researchers who aim at conducting new primary and secondary studies on this subject.

SYSTEMATIC REVIEW REGISTRATION

CRD42017058729.