Measures of Population Ageing in Australia from 1950 to 2050

Examining emergency departments practices on advance care directives and medical treatment decision making using the victorian emergency minimum dataset

INTRODUCTION

Existence of Advance Care Planning (ACP) documents including contact details of Medical Treatment Decision Makers (MTDM), are essential patient care records that support Emergency Department (ED) clinicians in implementing treatment concordant with patients' expressed wishes. Based upon previous findings, we conducted a statewide study to evaluate the performance of Victorian public hospital emergency departments on reporting of availability of records for ACP.

METHOD

The study is a quantitative retrospective observational comparative design based upon ED tier levels as defined by the Australasian College for Emergency Medicine (ACEM) for the calendar year 2021.

RESULTS

Of 1.8 million total Victorian ED attendances, 15,222 patients had an ACP alert status recorded. Of these, 7296 were aged ≥ 65 years (study group). Of the thirty-one public EDs that submitted data, 65 % were accredited and assigned a level of service tier. The presence of ACP alerts positively correlated to location, tier level, age and gender (MANOVA wilk's; p < 0.001, value=.981, F = (12, 15,300), partial ƞ2 = .006, observed power = 1.0 = 95.919).

CONCLUSION

The identified rate of ACP reporting is low. Strategies to improve the result include synchronising ACP (generated at different points) electronically, staff education, training and further validation of the data at the sending and receiving agencies.

Incidence and trends of middle ear cholesteatoma surgery and mastoidectomy in Australia-A national hospital morbidity database analysis

OBJECTIVE

To investigate the incidence of middle ear cholesteatoma surgery and assess trends in mastoidectomy procedures in Australia.

STUDY DESIGN

Cross-sectional population-based study using data from the National Hospital Morbidity Database.

METHODS

Admitted care episodes containing the principal diagnosis of middle ear cholesteatoma were analyzed for two 12-month periods of 2007-2008 and 2017-2018. Surgical admissions involving mastoidectomy were identified by procedure codes. Incidence rate per 100,000 person-years were compared between study periods.

RESULTS

Of the 3855 middle ear cholesteatoma admissions, 3558 (92.3%) involved surgery, with the incidence rate for cholesteatoma surgical admissions estimated at 8.6 per 100,000 (95% CI: 8.2-9.0) and 8.1 per 100,000 (95% CI: 7.7-8.5) for 2017-2018 and 2007-2008, respectively. Population aged 10-19 years had the highest age-specific incidence rate at 12.5 per 100,000 (95% CI: 11.3-13.9) for 2017-2018. The 60 years and over age groups had the highest decennial percentage increase. Mastoidectomy procedures were consistently used in over half of all surgical admissions. An increase in the rate of canal wall up (CWU) mastoidectomy procedure related admissions was observed (rate ratio of 1.62 [95%CI: 1.41-1.86], P <.001) and was offset by a decreased rate of canal wall down (CWD) procedure associated admissions (0.69 [95% CI: 0.61-0.78], P <.001]).

CONCLUSIONS

The incidence rate of cholesteatoma surgery in Australia is estimated at 8.6 per 100,000. Mastoidectomy continues to play an essential role in cholesteatoma surgery with a trend favoring CWU over CWD mastoidectomy. Level of evidence: 4.

Accounting for diversity in older adults’ digital inclusion and literacy: the impact of a national intervention

In many parts of the world, older adults continue to face significant barriers to digital inclusion, but the source of that inequality is not well understood. However, we do not know enough about differences among older people seeking to improve their digital skills. Examining the impact of a national three-year digital inclusion programme reaching more than 580,000 older adults in Australia, this study explores factors that affect digital skills and literacy later in life. A mixed-methods approach involving a two time-point survey (N = 337) along with participant interviews (N = 30) examined the effectiveness of programme elements. A latent class analysis was applied to examine differences in the way older adults engage with digital technologies. Qualitative analysis helped to detail those differences. Programme outcomes were far from uniform, reflecting diverse motivations, lifecourse experiences, needs and capabilities among older adults, countering much existing research that tends to elide those differences. With reference to the concept of situated literacies, we highlight the importance of life experiences, needs and motivations to the outcomes of digital inclusion interventions. Our findings emphasise the need to disaggregate older adult internet users, and account for differences in life experiences, needs and motivations in the design and delivery of digital inclusion interventions at scale.

Unplanned blood use within 24 hours of emergency department presentation: A cohort study in an ageing population

OBJECTIVE

This research aims to elucidate drivers of blood use in an older population, with a focus on unplanned transfusions following ED presentation.

METHODS

In a retrospective cohort study we examined 2015 data for ED presentations and blood use in two hospitals serving a population containing a high proportion (21%) of adults aged ≥65 years. Unplanned blood use was defined as any transfusion ≤24 h of presentation. Data were analysed by age, sex, Major Diagnostic Category, triage category and time to transfusion.

RESULTS

A total of 5294 blood components were transfused, comprising red cells (n = 3784), fresh frozen plasma (n = 657), platelets (n = 563) and cryoprecipitate (n = 290). Men aged ≥65 years were the highest users (40%, 2107 components). Unplanned transfusions accounted for 28% (n = 1057) of annual red cell use. Of 85 014 ED presentations, 494 (0.6%) were associated with unplanned red cell transfusion. Four Major Diagnostic Categories accounted for 81% (n = 853) of unplanned red cell use: gastrointestinal (n = 375), haematology (n = 267), trauma (n = 144) and cardiovascular (n = 67). Over one-fifth of unplanned transfusions (21%, n = 222 of 1057) were associated with ICD-10 codes for anaemia as a reason for presentation within the Haematology Major Diagnostic Category. Adults aged ≥65 years accounted for 62% of overall red cell use and 61% of transfusions ≤24 h of presentation. Odds of unplanned red cell transfusion increased with age, peaking at odds ratio 28.5 (95% confidence interval 14.2-57.4) in those aged 85 years and above.

CONCLUSIONS

Unplanned blood use accounted for 28% of annual hospital blood consumption. Blood component use increased with age and was greatest in older men. A significant burden of anaemia treatment was identified by the ED.

Emotional Intelligence and Quality of Life in Elderly Diabetic Patients

BACKGROUND

Coordination of various physical and mental aspects of individuals, including the ability to control difficult conditions and situations has an effect in the prevention and development of various diseases, such as diabetes, and the improvement of the quality of life. Therefore, the purpose of this study was is to determine the effect of emotional intelligence on the quality of life of elderly diabetic patients.

METHODS

This study was conducted in 2018. The statistical population in this cross-sectional study consisted of elderly people referred to the health centers of Kermanshah province in western Iran, who were divided via available sampling into two groups with diabetes and without diabetes. Data gathering tools were a couple of LIPAD Quality of Life and Shrink Emotional Intelligence standard questionnaires. The Data was analysed using software SPSS, 23 th version. Tests were used (T-test, Chi-square, Anova and regression).

RESULTS

Most of them were male (52.72%) and the mean age of the patients was 65.01(±6.08) years old and married. The quality of life score in diabetics and non-diabetics was respectively 51.9 and 50.37 with a standard deviation of 17.73 and 20.54. The mean total score of emotional intelligence in the elderly with diabetes was 99.42 with a standard deviation of 10.37 and non-diabetic subjects were 97.18 with a standard deviation of 18.4.

CONCLUSION

There was no significant difference between the mean scores of quality of life (0.652) and emotional intelligence (0.421) in diabetic and non-diabetic individuals. But, the emotional intelligence has an effect on the quality of life of the elderly people.

Unravelling animal exposure profiles of human Q fever cases in Queensland, Australia, using natural language processing

Q fever, caused by the zoonotic bacterium Coxiella burnetii, is a globally distributed emerging infectious disease. Livestock are the most important zoonotic transmission sources, yet infection in people without livestock exposure is common. Identifying potential exposure pathways is necessary to design effective interventions and aid outbreak prevention. We used natural language processing and graphical network methods to provide insights into how Q fever notifications are associated with variation in patient occupations or lifestyles. Using an 18-year time-series of Q fever notifications in Queensland, Australia, we used topic models to test whether compositions of patient answers to follow-up exposure questionnaires varied between demographic groups or across geographical areas. To determine heterogeneity in possible zoonotic exposures, we explored patterns of livestock and game animal co-exposures using Markov Random Fields models. Finally, to identify possible correlates of Q fever case severity, we modelled patient probabilities of being hospitalized as a function of particular exposures. Different demographic groups consistently reported distinct sets of exposure terms and were concentrated in different areas of the state, suggesting the presence of multiple transmission pathways. Macropod exposure was commonly reported among Q fever cases, even when exposure to cattle, sheep or goats was absent. Males, older patients and those that reported macropod exposure were more likely to be hospitalized due to Q fever infection. Our study indicates that follow-up surveillance combined with text modelling is useful for unravelling exposure pathways in the battle to reduce Q fever incidence and associated morbidity.

Prospective measures of aging for Central and South America

By conventional measures, it is often remarked that Central and South America is one of the fastest aging geographic regions in the world. In recent years, however, scholars have sought to problematize the orthodox measures and concepts employed in the aging literature. By not taking dynamic changes in life expectancy into account, measures which hold chronological age constant (e.g. defining a boundary to old age at 60 or 65) represent a very narrow view of population aging. Furthermore, such constant measures may misrepresent differences between territories when performing a comparative analysis. Prospective measures based on the number of years until death present an alternative approach which can adapt to dynamic changes in life expectancy and differences over time and space. The objective of this paper, then, is to apply the new ‘prospective’ measures of aging to the territories of Central and South America. We calculate prospective median age; an alternative old-age threshold based on the age at which remaining life expectancy is 15 years, and calculate prospective old-age dependency ratio for 1950–2100 using estimated and projected life tables from the latest iteration of the UN’s World Population Prospects. These new measures present a very different view of aging in Central and South America. While there are significant differences across countries, the pace and scale of aging are considerably slower and diminished when compared to standard, orthodox measures based on fixed chronological ages. Applying these new measures can not only serve to present a more realistic view of aging which maps onto demographic reality but can also serve to reconceptualize and reframe the issue as something which is far more manageable (e.g. through institutional reform) than is often perceived to be.

Better way to measure ageing in Oceania that takes life expectancy into account

OBJECTIVE

The aim of the study was to improve the measurement of ageing in Oceania taking into account characteristics of populations and, in particular, changes in life expectancy.

METHOD

Using past and projected life tables, we calculated prospective old age dependency ratios (POADRs) to 2060, placing the boundary to old age at a moving point with a fixed remaining life expectancy (RLE) for thirteen territories of Oceania.

RESULTS

In some territories, POADRs grow less rapidly than old age dependency ratios (OADRs). For example, in Australia and Guam, the OADR is forecast to increase from 0.20 and 0.07 in 1980, respectively, to 0.45 and 0.39 in 2050-55, while the POADR is forecast to increase from 0.17 and 0.07 to 0.19 and 0.19, respectively, over the same period.

CONCLUSION

Policymakers may consider this more rational approach to measurement when considering holistic policy responses to both current issues relating to ageing and mitigating against future challenges.

Patterns of Medication Dispensation for Multiple Comorbidities among Older Adults in Australia

Background: The increasing burden of chronic (medical) conditions (CCs) is a major issue for healthcare systems across the world. We aimed to examine the changes in the rate of medication dispensation for multiple CCs among Australians aged ≥65 years. Methods: A repeated cross-sectional study was performed using the 2013⁻2016 Pharmaceutical Benefits Scheme (PBS) data on reimbursed prescriptions for a 10% random sample of the Australian population. Twenty-two CCs were identified via the RxRisk-V tool. The yearly changes in the proportion of older adults dispensed medications for ≥2 CCs were determined through Poisson regression modelling using 2013 as the reference year. The occurrence of CC dyads and triads for which medications were dispensed within a 180-day window were characterised, and the observed and expected rate of medication dispensation for each CC dyad or triad were calculated to identify the top 15 combinations. Results: The proportion of older adults dispensed medications for ≥2 CCs remained stable from 2013 to 2016, at >79% in each year. The proportion who were dispensed medications for multiple CCs increased with age. No gender differences in the dispensation of medications for multiple CCs were observed. Over 60% had medications dispensed for ≥3 CCs. The most frequent CC dyad and triad for which medications were dispensed were dyslipidaemia + hypertension (38.6%) and dyslipidaemia + gastroesophageal reflux disease + hypertension (18.7%), respectively. For the majority of CC dyads and all triads examined, the observed rate of medication dispensation exceeded that expected by chance. Conclusions: A high proportion of older Australians are dispensed medications for multiple CCs, suggestive of multimorbidity. The results reiterate the need for increased research into understanding the causal mechanisms of multimorbidity to inform the design of cost-effective interventions.