Self-assessed impact of oral health on the psychological well-being and depressive symptoms of older adults living in Melbourne

OBJECTIVES

This study aimed to investigate oral health-related factors affecting the self-assessed psychological well-being (PW) and depressive symptoms of independent-living Australians aged 79 years and over living in the community in metropolitan Melbourne.

METHODS

The Melbourne Longitudinal Studies on Healthy Aging (MELSHA) program was used as the data source in this study and includes data on the health and well-being of older participants. The MELSHA baseline data collection occurred in 1994, the current study used data from the 2008 data collection and included 201 participants, who remained in the study. Data were analyzed using multiple linear regression (MLR) analysis with a stepwise procedure to identify the variables that accounted for a significant proportion of the variance in the participants' PW scores.

RESULTS

Present findings indicate that oral health may play a significant mediating role in PW through maintaining a presentable and acceptable physical appearance. Some 16.4 percent of participants reported feeling concerned about their dental appearance, either "Sometimes," "Often," or "Very often." Multivariate analysis showed significantly influences on PW positive and negative affect scores (P < 0.0001); and depressive symptoms (P < 0.0001) by participants' dentition status, enjoyment of meals, self-reported feeling of concern about the appearance of the mouth, social activity and self-assessment of general health. Final models explained 17.8, 20.1, and 24.6 percent of the variance of PW positive, negative affect scores, and depressive symptoms, respectively.

CONCLUSIONS

Oral health, specifically the appearance of the mouth and dentition, plays a significant role in the PW of older Melbournians. Future cross-sectional and longitudinal studies are indicated to raise awareness on the changes required to improve the quality of life of the older population.

Perceived availability of future care and depressive symptoms among older adults in China: evidence from CHARLS

BACKGROUND

Major concerns have arisen about the challenges facing China in providing sufficient care to its older population in light of rapid population ageing, changing family structure, and considerable rates of internal migration. At the family level, these societal changes may produce care uncertainty which may adversely influence the psychological wellbeing of older individuals. This paper applies social support and control theories to examine the relationship between perceived availability of future care and psychological wellbeing of older adults in China, and how this relationship is moderated by economic insufficiency, health vulnerability, and urban/rural context.

METHODS

Analyses are based on data from the China Health and Retirement Longitudinal Study, a multi-panel nationally representative household survey of the Chinese population aged 45 years and older. Data are taken from 2013 and 2011 waves of the study, with an initial sample size around 17,000, in which around 11,000-14,000 respondents are used for our final regression model. The score of depressive symptoms was measured in both waves with the Center for Epidemiologic Studies Depression Scale (CES-D10), and perceived availability of future care was measured in 2013 by asking respondents the question "Suppose that in the future, you need help with basic daily activities like eating or dressing, do you have relatives or friends (besides your spouse/partner) who would be willing and able to help you over a long period of time (yes/no)?"

RESULTS

Multivariate regression analysis revealed that uncertainty regarding future care support was associated with greater depressive symptoms even after controlling for factors confounded with care uncertainty such as family structure, socio- economic status, and a lagged measure of depression. Further, older adults without an anticipated source of care faced double jeopardy in their depressive symptoms if they also experienced functional limitations.

CONCLUSIONS

Considering rapid aging of the Chinese population, anticipated increases in chronic disease burden, and possible attenuation of filial care, this analysis suggests that older adults in China may increasingly face health and social conditions detrimental to their mental health. Polices that remedy these concerns should be discussed, developed and implemented.

Patterns of home and community care use among older participants in the Australian Longitudinal Study of Women's Health

The aims of this study were to investigate patterns of home and community care (HACC) use and to identify factors influencing first HACC use among older Australian women. Our analysis included 11,133 participants from the Australian Longitudinal Study of Women's Health (1921-1926 birth cohort) linked with HACC use and mortality data from 2001 to 2011. Patterns of HACC use were analysed using a k-median cluster approach. A multivariable competing risk analysis was used to estimate the risk of first HACC use. Approximately 54% of clients used a minimum volume and number of HACC services; 25% belonged to three complex care use clusters (referring to higher volume and number of services), while the remainder were intermediate users. The initiation of HACC use was significantly associated with (1) living in remote/inner/regional areas, (2) being widowed or divorced, (3) having difficulty in managing income, (4) not receiving Veterans' Affairs benefits, (5) having chronic conditions, (6) reporting lower scores on the SF-36 health-related quality of life, and (7) poor/fair self-rated health. Our findings highlight the importance of providing a range of services to meet the diverse care needs of older women, especially in the community setting.

Factors associated with length of stay in hospital for men and women aged 85 and over: A quantile regression approach

OBJECTIVES

Explore characteristics of hospital use for adults aged 85 and over in their last year of life and examine factors associated with cumulative overnight length of stay (LOS).

DATA SOURCE/STUDY SETTING

NSW 45 and Up Study linked with hospital data.

STUDY DESIGN

Longitudinal cohort study.

METHODS

Quantile regression models were performed for men and women (N = 3145) to examine heterogeneity in predictors of overnight hospital admissions. Coefficients were estimated at the 25th, 50th, 75th and 90th percentiles of the LOS distribution.

PRINCIPAL FINDINGS

86% had at least one hospitalisation in their last year of life, with 60% dying in hospital. For men, first admission for organ failure was associated with a 26 day increase at the 90th LOS percentile, and a 0.22 day increase at the 10th percentile compared to men with cancer. Women admitted with influenza had decreased LOS of 20.5 days at the 75th percentile and 6 to 8 fewer days at the lower percentiles compared to those women with cancer.

CONCLUSIONS

Poor health behaviours were a major driver of highest LOS among older men, pointing to opportunities to achieve health care savings through prevention. For older women, influenza was associated with shorter LOS, which could be an indicator of the high and rapid mortality rates at older ages, and may be easily prevented. Other factors associated with LOS among women, included where they lived before they were admitted, and discharge destination.

Geographical variations in self-rated health and functional limitations among older Chinese in eight WHO-SAGE provinces

BACKGROUND

The proportion of population ageing in China will grow significantly in the next few decades but the pace of population ageing and social change vary considerably across regions. Notably, Eastern coastal areas are economically more advanced compared to the Western region. These economic disparities could result in differing adverse health outcomes.

METHODS

We investigate geographical variations in self-rated overall health and functional limitations in a national representative sample of Chinese aged 50 years and older (n = 13,175) using the WHO Study on global AGEing and adult health (WHO SAGE). We used multivariable logistic regression to investigate urban-rural inequalities across regions, adjusting for sociodemographic and health covariates. Two main outcomes were self-rated overall health and functional limitations based on the WHO Disability Assessment Schedule 2.0 for a range of daily activities.

RESULTS

The largest urban-rural differences in adverse health outcomes were in Shandong (AORs for urban versus rural of 6.32 [95% Confidence Interval 4.53-8.82] for poor or very poor self-rated overall health and 5.14 [CI 3.55-7.44] for functional limitations), followed by Jilin (AORs 2.71 [CI 2.04-3.61] and 4.72 [CI 3.43-6.49]), and Hubei (AORs 2.36 [CI 1.82-3.07] and 4.11 [CI 2.80-6.04]), respectively. Covariates significantly associated with both adverse health outcomes were older age, poor income, no health insurance, and increasing number of chronic diseases.

CONCLUSION

Our study reveals substantial disparities between urban and rural areas observed in both the well-developed areas (eg Shandong) and also the lower end of the economic spectrum (eg Hubei and Jilin). Targeted economic development policy and systematic health prevention and healthcare policies could be beneficial in improving health in later life whilst minimising geographical inequalities.

'Millennials': Perceived generational opportunities and intergenerational conflict in Australia

OBJECTIVE

To investigate the perceptions of intergenerational conflict and lifelong opportunities of the Millennial cohort.

METHODS

Data were collected in the Attitudes to Ageing in Australia Study as part of the 2015-2017 national Australian Survey of Social Attitudes (n = 2049, aged 18 and older). Variations by age cohorts and individual characteristics were examined in descriptive analyses and binary logistic regressions.

RESULTS

Overall, the majority of people at all ages thought opportunities were worse for younger people than for baby boomers, but few perceived strong conflict between younger and older people. Millennials were the most likely to perceive strong conflict. People rendered 'disadvantaged' by their socio-economic positions were more likely to perceive better opportunities for younger people and strong intergenerational conflict.

CONCLUSION

Policymakers should address the barriers that Millennials and other socio-economically disadvantaged people face to improve their lifelong opportunities and address increasing social inequalities in Australia.

Carer Characteristics and Health, Wellbeing and Employment Outcomes of Older Australian Baby Boomers

Supporting caregivers and enabling continued workforce participation are central strategies in Australia's response to an ageing population, however these strategies have potential disadvantages for carers, particularly women, including reduced workforce participation and retirement income, and poorer health status. This paper explores the nexus between paid work and caregiving for Australia's baby boomer cohort as this group faces unprecedented pressures to manage paid work alongside caring longer and more intensively for family members, including grandchildren. A sample of 1261 men and women aged 60 to 64 completed the 2011-12 Life Histories and Health survey, a sub-study of the New South Wales 45 and Up Study. The survey collected data on sociodemographic, psychosocial, life history and health-related variables including caregiving and employment status. Around a third (32.5%) of the sample (52.2% female) were involved in some type of caregiving at the time. Compared to non-carers, carers reported lower workforce participation (45.8% versus 54.7% for non-carers) as well as poorer health, more mobility difficulties, lower quality of life and lower self-rated SES. Carers who also cared for grandchildren were more likely to be in part-time or no paid work compared to other carers. Working carers tended to be more highly educated, have fewer mobility difficulties, better self-rated health and higher SES than non-working carers. Male carers were more likely than female carers to be in full-time or no paid work. Results indicate that reduced workforce participation and health status of caregivers varies by gender and type of caregiving. Policy reforms are recommended to mitigate these adverse consequences on those providing care, their families, employers and the community.

Life course influences on later life health in China: Childhood health exposure and socioeconomic mediators during adulthood

China's unprecedented population aging and social and economic change raise important issues concerning life course determinants of advantage or disadvantage into later life. Data from the China Health and Retirement Longitudinal Study (CHARLS) 2013 were analysed to identify the influence of childhood health on later life health as indicated by self-rated health and how this influence could be mediated by social and economic positions (SEP) and resources later in the life span. CHARLS provides nationally representative data on 18, 000 individuals aged 45 years and above in approximately 150 districts and 450 villages. Both multivariate logit regression model and KHB method (Karlson/Holm/Breen method) were applied to examine and decompose the life span influences on later life health. The results show that the childhood health, accounts for approximately half of the effect directly and another half of the effect indirectly through social and economic variations during adulthood. Relative living standard, marital status and urban residence are the most significant and important social and economic mediators for men; For women, living standard and secondary schooling are most influential while marital status is not significant. Implications for social and economic policies to improve later life health are discussed.

Residential mobility in Australia and the United States: a retrospective study

Background: Levels of internal migration vary significantly between countries. Australia and the United States consistently record among the highest levels of migration anywhere in the world. Very little is known, however, about the factors underlying mobility differentials. We argue that this is because existing evidence is almost exclusively based on period measures applied to cross-sectional data. Aims: We seek to advance understanding of cross-national variations in levels of residential mobility by drawing on a newly proposed suite of cohort migration measures, coupled with the recent release of internationally comparable retrospective residential history data. Data and methods: Focusing on the early cohort of baby boomers born between 1947 and 1951, the paper examines residential mobility levels and patterns in early and mid-adulthood in Australia and the United States and compares them with 14 European countries. Differences in completed levels of residential mobility are assessed in terms of four components: the proportion of a cohort who moved at least once; mean age at first move; mean age at last move; and average interval between moves. Results: While cohort analysis confirms high levels of mobility in Australia and the United States, it does not support the notion of a common ‘new world’ mobility regime distinct from other advanced economies. Conclusion: A cohort perspective offers refined insights into population mobility. The increasing availability of retrospective survey data means that researchers can now apply cohort measures to a wide range of countries.

Impacts of voluntary and involuntary workforce transitions at mature ages: Longitudinal evidence from HILDA

OBJECTIVE

To assess the changes in health, well-being and welfare dependency associated with yearly workforce transitions from working to not working among people aged 45-64 years.

METHODS

Transition analysis of the nationally representative longitudinal data from the Household Incomes and Labour Dynamics in Australia survey 2002-2011.

RESULTS

People who voluntarily left paid work had reasonable control over their situations, and their satisfaction remained relatively stable even with deteriorating health and increasing welfare dependency. Those who involuntarily left paid work had less control and preparedness, and they experienced significant decreases in their satisfaction with life overall, finances and health; they were also more likely to be psychologically distressed, welfare dependent and had a higher probability to return to paid work.

CONCLUSION

Voluntary and involuntary workforce transitions have different impacts on health and well-being. Enabling mature aged workers to work longer can yield benefits for both individual well-being and government budgets.

Reorienting Health Services to People with Chronic Health Conditions: Diabetes and Stroke Services in Malaysia, Sri Lanka and Thailand

This paper explores whether middle-income Asian countries are reorienting their health services in response to non-communicable diseases (NCDs). Malaysia, Sri Lanka, and Thailand were selected as case studies of Asian societies experiencing rapid increases both in NCDs and an aging population. While NCD programs, especially those related to diabetes and stroke, are well-established in Thailand, health services struggle to respond to increasing numbers of people with chronic health problems. Health services at all levels must plan ahead for more patients with chronic and often multiple conditions who require better integrated health care.

Exploring Workforce Participation Patterns and Chronic Diseases Among Middle-Aged Australian Men and Women Over the Life Course

OBJECTIVE

This study identified associations between chronic diseases (diabetes, asthma, depression, and arthritis) and workforce participation patterns with a gendered perspective.

METHOD

We used data from 1,261 middle-aged participants of the Australian Life Histories and Health (LHH) Survey, aged 60 to 64 years in 2011. Latent class analysis identified dominant workforce patterns and associations between chronic diseases and these patterns were explored by multinomial regression models.

RESULTS

Diabetes, asthma, depression, and arthritis were less prevalent in men and women in class "mostly full-time work," compared with other workforce patterns. The odds of "mostly full-time work" were lower for men reporting depression or arthritis, whereas among women, depression was associated with "increasing part-time work" after adjusting early and adult life factors.

DISCUSSION

The results strengthen the importance of gender focused policies aimed to promote and preserve health of young and middle-aged workers, and creating supportive environment for those with chronic health issues over the life course.

Caregiving and mental health among workers: Longitudinal evidence from a large cohort of adults in Thailand

BACKGROUND

As people in middle and lower income countries live longer, more people become sick, disabled, and frail and the demand for family caregiving grows. Thailand faces such challenges. This study investigates the relationship between caregiving and mental health among workers drawn from a large longitudinal cohort of Thai adults.

METHODS

Participants were drawn from the Thai Health-Risk Transition Study, a cohort study since 2005 of distance-learning adult Open University students residing nationwide. Caregiving status and binary psychological distress outcome (score 19-30 on Kessler 6) were recorded in 2009 and 2013 among cohort members who were paid workers at both years (n=33,972). Multivariate logistic regression was used to estimate the relationship between four-year longitudinal caregiving status and psychological distress in 2013, adjusting for potential covariates.

RESULTS

Longitudinal analyses revealed the transitional nature of care with 25% exiting and 10% entering the caring role during the four-year follow-up. Based on multivariate logistic regression, 2009-2013 caregiving status was significantly associated with psychological distress. Cohort members transitioning into caregiving and those who were caregivers in both 2009 and 2013 had a higher risk for psychological distress than non-caregivers (Adjusted Odds Ratios 1.40 [1.02-1.96] and 1.64 [1.16-2.33], respectively).

CONCLUSION

Our findings provide evidence on caregiving and associated risk for psychological distress among working Thais. This adds to the limited existing literature in middle-income countries and highlights the potential pressure among caregivers in balancing work and care while preserving their own mental health.

Multimorbidity, health and aging in Canada and Australia: a tale of two countries

BACKGROUND

Multimorbidity has been recognized as a major public health issue, negatively affecting health-related quality of life, including physical, functional, mental, emotional, and social domains, as well as increasing health care utilization. This exploratory study examines selected health outcomes associated with multimorbidity across older age groups/cohorts and gender, comparing Canada and Australia.

METHODS

Data were drawn from the 2008/09 Canadian Community Health Survey and the 2009 Australian HILDA survey. Seven major chronic conditions were identical across the two data sets, and were combined into an additive measure of multimorbidity. OLS and logistic regression models were performed within age group (45-54, 55-64, 65-74, 75+) and gender to estimate associations between multimorbidity and several health-related outcomes, including: loneliness, life satisfaction, perceived health, mobility restriction, and hospital stays, adjusting for marital status, education and foreign born status.

RESULTS

Overall, country-level differences were identified for perceptions of loneliness, life satisfaction, and perceived health. Australians tended to experience a greater risk of loneliness and lower self-rated health in the face of multimorbidity than Canadians, especially among older men. Canadians tended to experience lower life satisfaction associated with multimorbidity than Australians. No country-level differences were identified for associations between multimorbidity and hospital stays or mobility limitations.

CONCLUSIONS

The associations between multimorbidity and health are similar between the two countries but are variable depending on population, age group/cohort, and gender. The strongest country-level associations are for indicators of health-related quality of life, rather than health care or mobility limitation outcomes.

End of life hospitalisations differ for older Australian women according to death trajectory: a longitudinal data linkage study

Background

Hospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users. Despite the apparent high use of hospitals at the end of life, limited evidence currently exists regarding reasons for hospitalisation. Understanding complex end of life care needs is required for future health care planning as the global population ages. This study aimed to investigate patterns of hospitalisation in the last year of life by cause of death (COD) as well as reasons for admission and short-term predictors of hospital use.

Methods

Survey data from 1,205 decedents from the 1921–1926 cohort of the Australian Longitudinal Study on Women’s Health were matched with the state-based hospital records and the National Death Index. Hospital patterns based on COD were graphically summarised and multivariate logistic regression models examined the impact of short-term predictors of length of stay (LOS).

Results

85 % of women had at least one admission in the last year of life; and 8 % had their first observed admission during this time. Reasons for hospitalisation, timing of admissions and LOS differed by COD. Women who died of cancer, diabetes and ‘other’ causes were admitted earlier than women who died of organ failure, dementia and influenza. Women who died of organ failure overall spent the longest time in hospital, and women with cancer had the highest median LOS. Longer LOS was associated with previous short- and medium-term- hospitalisations and type of hospital separation.

Conclusions

Reducing acute care admissions and LOS at the end of life is complex and requires a shift in perceptions and treatment regarding end of life care and chronic disease management.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1729-3) contains supplementary material, which is available to authorized users.

Recruitment for a Panel Study of Australian Retirees

Studies of change flowing from important life-course transitions such as retirement are best conducted using panel designs that allow change to be tracked at an individual level. However, for many life-course transitions, sample recruitment is especially difficult because no sampling frames exist for what are relatively rare and nonenumerated populations. This article outlines the difficulties encountered and strategies adopted in obtaining a sample of older Australian workers who were about to retire. It explores the fieldwork problems encountered and the effectiveness of alternative recruitment strategies in meeting core sampling goals. Recruitment strategies are evaluated in terms of their cost, efficiency, impact on data quality, and ability to recruit difficult-to-find subtypes of retirees. The experience of this research team is provided to offer guidance and information for other teams as they seek to recruit samples for retirement studies or for other studies of rare and nonenumerated populations.

Factors predicting health services use among older people in China: An analysis of the China Health and Retirement Longitudinal Study 2013

Background

Rapid population ageing in China is increasing the numbers of older people who are likely to require health services in response to higher levels of poor perceived health and chronic diseases. Understanding factors influencing health services use at late life will help to plan for increasing needs for health care, reducing inequalities in health services use and releasing severe pressures on a highly variable health care system that has constrained public resources and increasing reliance on health insurance and user payments.

Methods

Drawing on the nationally representative China Health and Retirement Longitudinal Study 2013 data, we apply the Andersen healthcare utilization conceptual model to binary logistic regression multivariate analyses to examine the joint predictors of physical examinations, outpatient and inpatient care among the middle-aged and elderly in China.

Results

The multivariate analyses find that both physical examinations and inpatient care rates increase significantly by age when health deteriorates. Females are less likely to use inpatient care. Significant socio-economic variations exist in healthcare utilization. Older people with higher education, communist party membership, urban residence, non-agricultural household registration, better financial situation are more likely to have physical examinations or inpatient care. Factors influencing all three types of health care utilization are household expenditure, losing a partner, having multiple chronic diseases or perceiving poor health. With activities of daily living limitations or pain increases the probability of seeing a doctor while with functional loss increases the rates of having physical examinations, but being the ethnic minorities, no social health insurance, with depression, fair or poor memory could be a barrier to having physical examinations or seeing a doctor, which might delay the early diagnose of severe health problems among these groups. Not drinking, not smoking and regular physical exercises are adaptations after having health problems.

Conclusions

As a rapidly ageing society, in order to address the increasing needs and inequalities in health care utilization, China is facing a massive challenge to reform the current health care system, improve equitable access to health insurance and financial affordability for the most disadvantaged, as well as to provide more health education and information to the general public.

Partner status and mental and physical health of independently living men aged 70 years and older

AIM

To describe and compare the mental health and physical functioning of community-dwelling men aged 70 years and over who live alone, and those who live with their partner/spouse.

METHOD

Data were obtained from the baseline survey of the New South Wales 45 and Up Study. Mental health was measured using the Kessler Psychological Distress Scale and physical health was measured using the Medical Outcome Short Form 36 physical functioning scale.

RESULTS

37 690 community-dwelling men aged 70 years or over were included in the analyses. Men living alone were more likely to have high psychological distress scores and lower physical functioning scores compared to men living with a spouse/partner within each age group, except those 85 and over.

CONCLUSIONS

Specific health and welfare programs targeted to the increasing number of older men living alone may be needed to address their higher levels of psychological distress and lower levels of physical functioning.

First incident hospitalisation for Australian women aged 70 and beyond: A 10 year examination using competing risks

There are increasing concerns regarding high hospital use among older adults and the capacity to manage the economic impact of the ageing population trend on healthcare systems. First hospitalisation in old age may act as a catalyst for ongoing intensification of health problems and acute care use. This study examined factors associated with first incident hospitalisation in women aged over 70, accounting for the health inequalities associated with geographic location. Survey data from 3780 women from the 1921 to 1926 cohort of the Australian Longitudinal Study on Women's Health were matched with the Admitted Patients Data Collection and National Death Index. Days to first event (hospitalisation or death) were modelled using competing risks methods. A total of 3065 (80.3%) women had at least one hospital admission. More than half of the top 15 reasons for first hospitalisation were related to cardiovascular disease, with atrial fibrillation the most common. Proportional subdistribution hazards models showed that first hospital admission was driven by enabling and need factors including asthma/bronchitis diagnosis (HR=1.16; p=0.047), private health insurance (HR=1.16; p=0.004) more than two prescribed medications in previous month (HR=1.31; p=0.001), more than four general practitioner visits in previous year (HR=1.50; p=0.034), lower physical functioning (HR=0.99; p<0.001) and living in an inner regional area (HR=1.17; p=0.003). First overnight hospitalisation was primarily related with potentially preventable and treatable chronic diseases. Primary and secondary strategies aimed at chronic disease generally, and better chronic disease management particularly for cardiovascular and respiratory diseases, may play a vital role in disease prevention or delay in readmissions among this population.

Health Expectancies in Adults Aged 50 Years or Older in China

OBJECTIVE

The purpose of this study is to understand the functional health of older adults in China and to assess the potential for advancing healthy and active aging.

METHOD

Data of 13,739 older adults aged 50 years and older from the China Health and Retirement Longitudinal Study in 2011 were analyzed. Life expectancy in good perceived health, chronic-disease-free life expectancy, active life expectancy, and severe impairment-free life expectancy were calculated using Sullivan's method.

RESULTS

At age 50 years, older adults had a life expectancy in good perceived health of 7.0 and 6.7 years in men and women, respectively. They would remain chronic-disease-free for 8.4 and 8.6 years, without activity limitation for 23.6 and 26.0 years, and severe impairment-free for 21.4 and 24.2 years.

DISCUSSION

The world's largest aging population was spending a substantial proportion of remaining life years in suboptimal health and well-being, while remaining largely independent in basic self-care without severe impairments.

Pathways to Well-Being in Later Life: Socioeconomic and Health Determinants Across the Life Course of Australian Baby Boomers

In many countries like Australia and the United States, baby boomers are referred to as the ‘lucky cohort’, yet there has been little research on the origins and extent of inequalities within this cohort. This study uses path analysis to investigate direct and indirect effects of childhood and adult socioeconomic status and health on two subjective well-being measures: quality of life and life satisfaction. Retrospective life course data were obtained for 1,261 people aged 60 to 64 in the 2011–12 Life Histories and Health survey, a sub-study of the Australian 45 and Up Study. Supporting an accumulation model, the number of negative childhood and adult exposures were inversely related to both types of well-being. Consistent with a critical period model, childhood exposures had small but significant effects on subjective well-being and were relatively more important for quality of life than for life satisfaction. However, these childhood effects were largely indirect and significantly mediated by more proximal adult exposures, providing support for a pathway model. A key implication of this research is that the critical period for later life well-being is significant in adulthood rather than childhood, suggesting that there may be key opportunities for improving individuals’ later life well-being far beyond the early, formative years. This research highlights the importance of understanding how earlier life exposures impact experiences in later life, and investing in health and socioeconomic opportunities to reduce inequalities across all stages of life.

Developing Age-Friendly Cities and Communities in Australia

Objective: The aim of the study is to present case studies and assess the impact of political, policy, consultative, and research processes used to implement Age Friendly Cities (AFC) initiatives in Australia. Method: A review and interpretation was conducted based on public documents, community consultations, survey analyses, and participant observation. Results: Governments in Australia have drawn on World Health Organization (WHO) concepts to establish AFC initiatives. In Melbourne, state political leadership established Positive Ageing plans that have reinforced local government actions. In Canberra, a baseline survey and an Older Persons Assembly were followed by modest positive ageing plans. In Sydney, a State Ageing Strategy developed a whole-of-government plan that has yet to be incorporated into budget processes. Discussion: AFC initiatives in Australia have had promising and varied starts with some aims to benefit disadvantaged older people. Notwithstanding the potential benefits, AFC influence on mainstream actions of government has been limited by uncertain political commitment and growing fiscal austerity.

Predictors of injurious falls and fear of falling differ: an 11-year longitudinal study of incident events in older people

OBJECTIVE

The objective of the study is to identify the intrinsic, psychosocial and lifestyle factors, which, over time, predict the incidence of having a fall requiring medical attention (injurious fall) or of acquiring a fear of falling (FOF).

METHOD

Data from 1,000 participants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA, 1994-2005) were analyzed using cox regressions and hazard ratios.

RESULTS

The predictors of injurious falls (n = 900, events = 200) were increasing age, slower gait speed, and being depressed. Main predictors of developing a FOF (n = 855, events =117) were increasing age, cognitive impairment, reduced social activity, and gender. A history of falls at baseline did not predict acquiring a FOF nor did FOF predict a future fall.

DISCUSSION

The profile of the person who will have an injurious fall differs from the profile of the person who develops a FOF and should be considered when designing interventions.

Health, lifestyle, and gender influences on aging well: an Australian longitudinal analysis to guide health promotion

A primary societal goal for aging is enabling older people to continue to live well as long as possible. The evidence base around aging well ("healthy," "active," and "successful" aging) has been constructed mainly from academic and professional conceptualizations of mortality, morbidity, functioning, and psychological well-being with some attention to lay views. Our study aims to inform action on health promotion to achieve aging well as conceptualized by qualitative research identifying what older Australians themselves value most: continuing to live as long as possible in the community with independence in daily living, and good self-rated health and psychological well-being. Multivariate survival analyses from the Melbourne longitudinal studies on healthy aging program found that important threats to aging well for the total sample over a 12-year period were chronological age, multi-morbidity, low perceived social support, low nutritional score, and being under-weight. For men, threats to aging well were low strain, perceived inadequacy of social activity, and being a current smoker. For women, urinary incontinence, low physical activity and being under-weight were threats to aging well. The findings indicate that healthy lifestyles can assist aging well, and suggest the value of taking gender into account in health promotion strategies.

Adapting data collection methods in the Australian Life Histories and Health Survey: a retrospective life course study

OBJECTIVE

Ideally, life course data are collected prospectively through an ongoing longitudinal study. We report adaptive multimethod fieldwork procedures that gathered life history data by mail survey and telephone interview, comparable with the face-to-face methods employed in the English Longitudinal Study on Ageing (ELSA).

DESIGN

The Australian Life Histories and Health (LHH) Survey was a substudy of the Australian 45 and Up Study, with data collection methods modified from the ELSA Study. A self-complete questionnaire and life history calendar were completed by the participants, followed by a computer-assisted telephone interview recording key life events.

RESULTS

The LHH survey developed and tested procedures and instruments that gathered rich life history data within an ongoing Australian longitudinal survey on ageing. Data collection proved to be economical. The use of a self-complete questionnaire in conjunction with a life history calendar and coordinated computer-assisted telephone interview was successful in collecting retrospective life course information, in terms of being thorough, practical and efficient. This study has a diverse collection of data covering the life course, starting with early life experiences and continuing with socioeconomic and health exposures and outcomes during adult life.

CONCLUSIONS

Mail and telephone methodology can accurately and economically add a life history dimension to an ongoing longitudinal survey. The method is particularly valuable for surveying widely dispersed populations. The results will facilitate understanding of the social determinants of health by gathering data on earlier life exposures as well as comparative data across geographical and societal contexts.

Housing type, location of residence and health status in Australian baby boomers: results from the Australian Baby Boomer (ABBA) Study

INTRODUCTION

Baby Boomers are working and living longer than their pre-war counterparts, and are more likely to live in high density urban housing. This paper examines the relationship between housing type, working status and location of residence on health status in Baby Boomers.

METHODS

We investigated location of residence and housing type in 1009 participants of the Ageing Baby Boomers in Australia (ABBA) Study to identify any predictors of, or correlations between, these variables and health status.

RESULTS

Current workers were less likely to report depression than retirees. We found a significantly higher rate of diabetes, obesity and hypertension in retirees than in current workers however rates of obesity, diabetes and hypertension were higher than predicted in current workers.

CONCLUSION

The rates of chronic disease are higher than previous estimates and provide evidence to inform health promotion programs designed to increase physical activity and improve eating habits in baby boomers.

The effectiveness of an aged care specific leadership and management program on workforce, work environment, and care quality outcomes: design of a cluster randomised controlled trial

Background

A plethora of observational evidence exists concerning the impact of management and leadership on workforce, work environment, and care quality. Yet, no randomised controlled trial has been conducted to test the effectiveness of leadership and management interventions in aged care. An innovative aged care clinical leadership program (Clinical Leadership in Aged Care − CLiAC) was developed to improve managers’ leadership capacities to support the delivery of quality care in Australia. This paper describes the study design of the cluster randomised controlled trial testing the effectiveness of the program.

Methods

Twenty-four residential and community aged care sites were recruited as managers at each site agreed in writing to participate in the study and ensure that leaders allocated to the control arm would not be offered the intervention program. Sites undergoing major managerial or structural changes were excluded. The 24 sites were randomly allocated to receive the CLiAC program (intervention) or usual care (control), stratified by type (residential vs. community, six each for each arm). Treatment allocation was masked to assessors and staff of all participating sites. The objective is to establish the effectiveness of the CLiAC program in improving work environment, workforce retention, as well as care safety and quality, when compared to usual care. The primary outcomes are measures of work environment, care quality and safety, and staff turnover rates. Secondary outcomes include manager leadership capacity, staff absenteeism, intention to leave, stress levels, and job satisfaction. Differences between intervention and control groups will be analysed by researchers blinded to treatment allocation using linear regression of individual results adjusted for stratification and clustering by site (primary analysis), and additionally for baseline values and potential confounders (secondary analysis). Outcomes measured at the site level will be compared by cluster-level analysis. The overall costs and benefits of the program will also be assessed.

Discussion

The outcomes of the trial have the potential to inform actions to enhance leadership and management capabilities of the aged care workforce, address pressing issues about workforce shortages, and increase the quality of aged care services.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN12611001070921)

Trajectories of older adults' hearing difficulties: examining the influence of health behaviors and social activity over 10 years

AIM

The aims of the present study were to describe the trajectories of self-reported hearing difficulties over time, and evaluate the impacts of age, sex, lifestyle factors and social activity, in explaining individual differences in patterns of change over time.

METHODS

As part of the Melbourne Longitudinal Studies on Healthy Aging (MELSHA) Program, the hearing status of 947 adults aged 65 years and older, across five measurement periods (over 10 years), were analyzed using Latent Growth Curve Modeling analysis. A multidimensional survey was also administered, which included questions relating to sociodemographic variables, self-reported hearing difficulties, nutrition, smoking habits and level of social activity.

RESULTS

Although there was a general increase in hearing difficulties over time, older age, poor nutrition, a lifetime of smoking and increased social activity predicted more rapid increases in hearing difficulty over time.

CONCLUSIONS

Findings support the importance of lifestyle factors in reducing the rate of perceived hearing difficulties in older people, and provide further evidence of the links between lifestyle and sensory loss in older people. Poor nutrition and smoking are areas that both clinicians and public health professionals should address in their work with older people.

A simple measure with complex determinants: investigation of the correlates of self-rated health in older men and women from three continents

Background

Self-rated health is commonly employed in research studies that seek to assess the health status of older individuals. Perceptions of health are, however, influenced by individual and societal level factors that may differ within and between countries. This study investigates levels of self-rated health (SRH) and correlates of SRH among older adults in Australia, United States of America (USA), Japan and South Korea.

Methods

Cross-sectional data were drawn from large surveys of older respondents (≥ 65 years) in Australia (n = 7,355), USA (n = 10,358), Japan (n = 3,541) and South Korea (n = 3,971), collected between 2000 and 2006. Harmonized variables were developed to represent socioeconomic, lifestyle and health indicators. We then assessed whether these variables, and their potentially different impact in different countries, could account for cross-national differences in levels of SRH.

Results

SRH differed significantly between countries, with older Koreans reporting much poorer health than those in the other three nations. This was not the result of biases in response patterns (for example central versus extreme tendency). Health-related correlates of SRH were similar across countries; those with more medical conditions, functional limitations or poor mental health gave poorer ratings. After accounting for the differential impact of determinants in different national contexts, Australians reported better SRH than other nations.

Conclusions

We conclude that when examining correlates of SRH, the similarities are greater than the differences between countries. There are however differences in levels of SRH which are not fully accounted for by the health correlates. Broad generalizations about styles of responding are not helpful for understanding these differences, which appear to be country, and possibly cohort specific. When using SRH to characterize the health status of older people, it is important to consider earlier life experiences of cohorts as well as national and individual factors in later life. Further research is required to understand the complex societal influences on perceptions of health.

Socioeconomic, psychological and demographic determinants of Australian baby boomers' financial planning for retirement

AIM

Research from around the Western World has shown that psychological, socioeconomic and demographic factors can influence levels of financial planning. This study aims to determine how these factors interrelate to predict planning outcomes.

METHOD

Data from the Ageing Baby Boomers in Australia Study were used to examine the effects of multiple factors on financial planning for 709 employed Australians nearing retirement.

RESULTS

The results showed that higher income, future time perspective (FTP) and financial knowledge independently predicted levels of retirement planning. The effects of FTP and financial knowledge on financial planning were consistent across levels of socioeconomic status.

CONCLUSIONS

While similar issues in financial planning appeared across socioeconomic status, a 'one size fits all' approach to retirement policy may not be effective. Instead, policy should be targeted towards the diverse needs of different groups. Raising public awareness of FTP and financial knowledge may provide a useful starting point.

Assessing patterns of home and community care service use and client profiles in Australia: a cluster analysis approach using linked data

The planning and delivery of care systems require knowledge on the ways in which individuals access available services that are funded by a range of health and community services. The aims of this study were to identify distinct groups of Home and Community Care (HACC) clients in New South Wales, Australia, based on patterns of actual service use, and to understand the health and social needs and resources of client groups that access different mixes of services. Multiple data sets linked at the individual level - including the 45 and Up Study community survey, the HACC Minimum Data Set and the Admitted Patient Data Collection for hospitals - provide an innovative basis to investigate the complexity of access to service use. Data were collected between 2006 and 2008. A cluster analysis based on clients' type and volume of community service use was conducted on the 4890 HACC clients in the linked dataset and nine distinct clusters of clients were identified. Three of these clusters were considered 'complex', in terms of the range of community and hospital assistance received, while the others comprised mainly of one or two dominant service types. The analytical approach and findings developed here provide a client-centred approach to monitor and evaluate access to local service systems that are being reformed to better integrate the delivery of health and community services currently funded and managed separately by national and state governments.

Worry in Older Community-Residing Adults

With rising longevity, increasing numbers of older people are experiencing changes in their everyday family and social life, changes in their financial status, and a greater number of chronic conditions affecting their health. We took the opportunity to explore these relationships with worry in a group of volunteer community-living elderly ( n = 310). Findings showed that that those people under 75 years of age had a higher risk of worrying (OR = 1.8, 95% CI = 1.0–3.1) compared to the older age groups. Women worried more than men and an important finding was that those with chronic health conditions such as arthritis of the hip and knee were more prone to worry than those who were healthy or had acute conditions (OR = 3.5, 95% CI = 1.4–8.9). This latter finding suggests the importance placed on the role of the hip and knee in maintaining functional capacity to perform life skills.