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Kwok WS, Khalatbari-Soltani S, Dolja-Gore X, Byles J, Oliveira JS, Pinheiro MB, Sherrington C. Differences in Falls and Physical Activity in Older Women From Two Generations. J Gerontol A Biol Sci Med Sci 2024; 79:glae033. [PMID: 38285003 PMCID: PMC10917443 DOI: 10.1093/gerona/glae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Falls and physical inactivity increase with age. However, physical activity, falls and their associations in older people born at different times are unclear. METHODS Women born 1921-26 and 1946-51 who completed follow-up questionnaires in 1999 (n = 8 403, mean (SD) age: 75 (1) years) and 2019 (n = 7 555; 71 (1) years) in the Australian Longitudinal Study on Women's Health. Self-reported noninjurious and injurious falls in the previous 12 months and weekly amounts and types of physical activity (brisk walking, moderate- and vigorous-intensity) were compared between the cohorts using Chi-square tests. Associations between physical activity, and noninjurious and injurious falls were estimated using multinomial logistic regressions informed by a directed acyclic graph. RESULTS A greater proportion of the later (1946-51) cohort (59%) reached 150-300 minutes of weekly physical activity, as recommended by the World Health Organization, compared to the earlier (1921-26) cohort (43%, p < .001). A greater proportion of the later cohort reported noninjurious falls (14% vs 8%). Both cohorts reported similar proportions of injurious falls (1946-51:15%, 1921-26:14%). In both cohorts, participation in 150-300 minutes of physical activity was associated with lower odds of noninjurious falls (adjusted Odds Ratio, 95% CI: 1921-26: 0.66, 0.52-0.84; 1946-51: 0.78, 0.63-0.97) and injurious falls (1921-26: 0.72, 0.60-0.87; 1946-51: 0.78, 0.64-0.96). CONCLUSIONS Participation in recommended levels of physical activity was associated with reduced falls in both cohorts. However, generational differences were found with more falls and more physical activities in the women born later. Future studies could examine the reasons contributing to the generational differences.
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Affiliation(s)
- Wing S Kwok
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Saman Khalatbari-Soltani
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, New South Wales, Australia
| | - Xenia Dolja-Gore
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Julie Byles
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Juliana S Oliveira
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marina B Pinheiro
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, Institute for Musculoskeletal Health, University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Dolja-Gore X, Depczynski J, Byles J, Loxton D. Mental health service use and cost by Australian women in metropolitan and rural areas. Aust J Rural Health 2024; 32:162-178. [PMID: 38088230 DOI: 10.1111/ajr.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 11/07/2023] [Accepted: 11/29/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION The use and costs of mental health services by rural and remote Australian women are poorly understood. OBJECTIVE To examine the use of the Better Access Scheme (BAS) mental health services across geographical areas. DESIGN Observational epidemiology cohort study using a nationally representative sample of 14 247 women from the Australian Longitudinal Study on Women's Health born 1973-1978, linked to the Medical Benefits Schedule dataset for use of BAS services from 2006 to 2015. The number and cost of BAS services were compared across metropolitan and regional/remote areas for women using the mental health services. FINDINGS 31% of women accessed a BAS mental health service, 12% in rural populations. Overall, 90% of women with estimated high service need had contact with professional services (83% rural vs 92% metropolitan regions). Mean mental health scores were lower for women accessing a BAS service in remote areas compared with metropolitan, inner and outer regional areas (61.9 vs 65.7 vs 64.8 vs 64.2, respectively). Higher proportion of women in remote areas who were smokers, low/risky drinkers and underweight were more likely to seek treatment. Compared with metropolitan areas, women in inner, outer regional and remote areas accessed a lower mean number of services in the first year of diagnosis (6.0 vs 5.0 vs 4.1 vs 4.2, respectively). Actual mean overall annual costs of services in the first year of diagnosis were higher for women in metropolitan areas compared with inner, outer regional or remote areas ($733.56 vs $542.17 vs $444.00 vs $459.85, respectively). DISCUSSION Women in rural/remote areas not accessing services need to be identified, especially among those with the highest levels of distress. In remote areas, women had greater needs when accessing services, although a substantial proportion of women who sought help through the BAS services lived in metropolitan areas. CONCLUSION Regardless of lower cost to services in rural/remote areas, geographic and economic barriers may still be major obstacles to accessing services.
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Affiliation(s)
- Xenia Dolja-Gore
- University of Newcastle School of Medicine and Public Health, Newcastle, New South Wales, Australia
| | - Julie Depczynski
- University of Newcastle Department of Rural Health, Moree, New South Wales, Australia
| | - Julie Byles
- University of Newcastle School of Medicine and Public Health, Newcastle, New South Wales, Australia
| | - Deborah Loxton
- University of Newcastle School of Medicine and Public Health, Newcastle, New South Wales, Australia
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Dingle SE, Bowe SJ, Bujtor M, Milte CM, Daly RM, Byles J, Cavenagh D, Torres SJ. Data-driven lifestyle patterns and risk of dementia in older Australian women. Alzheimers Dement 2024; 20:798-808. [PMID: 37777990 PMCID: PMC10916984 DOI: 10.1002/alz.13467] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Many lifestyle factors have been associated with dementia, but there is limited evidence of how these group together. The aim of this study was to examine the clustering of lifestyle behaviors and associations with dementia. METHODS This population-based study included 9947 older Australian women. Latent class analysis was employed to identify distinct lifestyle classes, and Cox proportional hazard regression compared these with incident dementia over 17 years. RESULTS Three classes were identified: (1) "highly social and non-smokers" (54.9%), (2) "highly social, smokers, and drinkers" (25.1%), and (3) "inactive and low socializers" (20.0%). Women in Class 3 exhibited a higher risk of dementia compared to both Class 1 (hazard ratio [HR] = 1.19, 95% confidence interval [CI]: 1.08 to 1.30) and Class 2 (HR = 1.12, 95% CI: 1.00 to 1.25). DISCUSSION A lifestyle pattern characterized by physical inactivity and low social engagement may be particularly detrimental for dementia risk in older women and should be prioritized in preventive strategies. HIGHLIGHTS Latent class analysis was employed to identify distinct lifestyle clusters. Three lifestyle-related clusters were differentially associated with dementia risk. Inactive and low socializers exhibited the greatest risk of dementia. Targeting physical inactivity and low social engagement in prevention is vital.
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Affiliation(s)
- Sara E Dingle
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityVictoriaAustralia
| | - Steven J Bowe
- Biostatistics UnitFaculty of HealthDeakin UniversityVictoriaAustralia
- Faculty of HealthVictoria University of WellingtonWellingtonNew Zealand
| | - Melissa Bujtor
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityVictoriaAustralia
- StressPsychiatry and Immunology LaboratoryDepartment of Psychological MedicineInstitute of PsychiatryPsychology & Neuroscience, King's CollegeLondonUK
| | - Catherine M Milte
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityVictoriaAustralia
| | - Robin M Daly
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityVictoriaAustralia
| | - Julie Byles
- Centre for Women's Health ResearchThe University of NewcastleNew South WalesAustralia
| | - Dominic Cavenagh
- Centre for Women's Health ResearchThe University of NewcastleNew South WalesAustralia
| | - Susan J Torres
- Institute for Physical Activity and NutritionSchool of Exercise and Nutrition SciencesDeakin UniversityVictoriaAustralia
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Kwok WS, Khalatbari-Soltani S, Dolja-Gore X, Byles J, Tiedemann A, Pinheiro MB, Oliveira JS, Sherrington C. Leisure-Time Physical Activity and Falls With and Without Injuries Among Older Adult Women. JAMA Netw Open 2024; 7:e2354036. [PMID: 38294812 PMCID: PMC10831579 DOI: 10.1001/jamanetworkopen.2023.54036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/07/2023] [Indexed: 02/01/2024] Open
Abstract
Importance Falls and fall-related injuries are common among older adults. Older adults are recommended to undertake 150 to 300 minutes of physical activity per week for health benefits; however, the association between meeting the recommended level of physical activity and falls is unclear. Objectives To examine whether associations exist between leisure-time physical activity and noninjurious and injurious falls in older women. Design, Setting, and Participants This population-based cohort study used a retrospective analysis of the Australian Longitudinal Study on Women's Health (ALSWH). ALSWH participants born from 1946 to 1951 who completed follow-up questionnaires in 2016 (aged 65-70 years) and 2019 (aged 68-73 years) were included. Statistical analysis was performed from September 2022 to February 2023. Exposure Self-reported weekly amounts (0, 1 to <150, 150 to <300, ≥300 minutes) and types of leisure-time physical activity, including brisk walking and moderate- and vigorous-intensity physical activity, in the 2016 survey. Main outcome and measures Noninjurious and injurious falls in the previous 12 months reported in the 2019 survey. Associations between leisure-time physical activity and falls were quantified using directed acyclic graph-informed multinomial logistic regression and presented in odds ratios (ORs) and 95% CIs. Results This study included 7139 women (mean [SD] age, 67.7 [1.5] years). Participation in leisure-time physical activity at or above the level recommended by the World Health Organization (150 to <300 min/wk) was associated with reduced odds of noninjurious falls (150 to <300 min/wk: OR, 0.74 [95% CI, 0.59-0.92]; ≥300 min/wk: OR, 0.66 [95% CI, 0.54-0.80]) and injurious falls (150 to <300 min/wk: OR, 0.70 [95% CI, 0.56-0.88]; ≥300 min/wk: OR, 0.77 [95% CI, 0.63-0.93]). Compared with women who reported no leisure-time physical activity, those who reported brisk walking (OR, 0.83 [95% CI, 0.70-0.97]), moderate leisure-time physical activity (OR, 0.81 [95% CI, 0.70-0.93]), or moderate-vigorous leisure-time physical activity (OR, 0.84 [95% CI, 0.70-0.99]) had reduced odds of noninjurious falls. No statistically significant associations were found between the types of leisure-time physical activity and injurious falls. Conclusions and Relevance Participation in leisure-time physical activity at the recommended level or above was associated with lower odds of both noninjurious and injurious falls. Brisk walking and both moderate and moderate-vigorous leisure-time physical activity were associated with lower odds of noninjurious falls.
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Affiliation(s)
- Wing S. Kwok
- Sydney Musculoskeletal Health, The University of Sydney, Sydney Local Health District and Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Saman Khalatbari-Soltani
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), The University of Sydney, Sydney, New South Wales, Australia
| | - Xenia Dolja-Gore
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Julie Byles
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Anne Tiedemann
- Sydney Musculoskeletal Health, The University of Sydney, Sydney Local Health District and Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Marina B. Pinheiro
- Sydney Musculoskeletal Health, The University of Sydney, Sydney Local Health District and Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Juliana S. Oliveira
- Sydney Musculoskeletal Health, The University of Sydney, Sydney Local Health District and Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Catherine Sherrington
- Sydney Musculoskeletal Health, The University of Sydney, Sydney Local Health District and Northern Sydney Local Health District, Sydney, New South Wales, Australia
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
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Taylor R, Acharya S, Parsons M, Ranasinghe U, Fleming K, Harris ML, Kuzulugil D, Byles J, Philcox A, Tavener M, Attia J, Kuehn J, Hure A. Australian general practitioners' perspectives on integrating specialist diabetes care with primary care: qualitative study. BMC Health Serv Res 2023; 23:1264. [PMID: 37974197 PMCID: PMC10652609 DOI: 10.1186/s12913-023-10131-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Improving the coordination and integration of health services is recognised nationally and internationally as a key strategy for improving the quality of diabetes care. The Australian Diabetes Alliance Program (DAP) is an integrated care model implemented in the Hunter New England Local Health District (HNELHD), New South Wales (NSW), in which endocrinologists and diabetes educators collaborate with primary care teams via case-conferencing, practice performance review, and education sessions. The objective of this study was to report on general practitioners' (GPs) perspectives on DAP and whether the program impacts on their skills, knowledge, and approach in delivering care to adult patients with type 2 diabetes. METHODS Four primary care practices with high rates of monitoring haemoglobin A1c (HbA1c) levels (> 90% of patients annually) and five practices with low rates of monitoring HbA1c levels (< 80% of patients annually) from HNELHD, NSW provided the sampling frame. A total of nine GPs were interviewed. The transcripts from the interviews were reviewed and analysed to identify emergent patterns and themes. RESULTS Overall, GPs were supportive of DAP. They considered that DAP resulted in significant changes in their knowledge, skills, and approach and improved the quality of diabetes care. Taking a more holistic approach to care, including assessing patients with diabetes for co-morbidities and risk factors that may impact on their future health was also noted. DAP was noted to increase the confidence levels of GPs, which enabled active involvement in the provision of diabetes care rather than referring patients for tertiary specialist care. However, some indicated the program could be time consuming and greater flexibility was needed. CONCLUSIONS GPs reported DAP to benefit their knowledge, skills and approach for managing diabetes. Future research will need to investigate how to improve the intensity and flexibility of the program based on the workload of GPs to ensure long-term acceptability of the program.
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Affiliation(s)
- Rachael Taylor
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute , New Lambton Heights, NSW, 2305, Australia
| | - Shamasunder Acharya
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia.
| | - Martha Parsons
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia
| | - Ushank Ranasinghe
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia
| | - Kerry Fleming
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia
| | - Melissa L Harris
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute , New Lambton Heights, NSW, 2305, Australia
| | - Deniz Kuzulugil
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia
| | - Julie Byles
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute , New Lambton Heights, NSW, 2305, Australia
| | - Annalise Philcox
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia
| | - Meredith Tavener
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute , New Lambton Heights, NSW, 2305, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute , New Lambton Heights, NSW, 2305, Australia
| | - Johanna Kuehn
- Hunter New England Health District, John Hunter Hospital, NSW, Lookout Road, New Lambton Heights, 2305, Australia
| | - Alexis Hure
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute , New Lambton Heights, NSW, 2305, Australia
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Kowal P, Corso B, Anindya K, Andrade FCD, Giang TL, Guitierrez MTC, Pothisiri W, Quashie NT, Reina HAR, Rosenberg M, Towers A, Vicerra PMM, Minicuci N, Ng N, Byles J. Prevalence of unmet health care need in older adults in 83 countries: measuring progressing towards universal health coverage in the context of global population ageing. Popul Health Metr 2023; 21:15. [PMID: 37715182 PMCID: PMC10503154 DOI: 10.1186/s12963-023-00308-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/09/2023] [Indexed: 09/17/2023] Open
Abstract
Current measures for monitoring progress towards universal health coverage (UHC) do not adequately account for populations that do not have the same level of access to quality care services and/or financial protection to cover health expenses for when care is accessed. This gap in accounting for unmet health care needs may contribute to underutilization of needed services or widening inequalities. Asking people whether or not their needs for health care have been met, as part of a household survey, is a pragmatic way of capturing this information. This analysis examined responses to self-reported questions about unmet need asked as part of 17 health, social and economic surveys conducted between 2001 and 2019, representing 83 low-, middle- and high-income countries. Noting the large variation in questions and response categories, the results point to low levels (less than 2%) of unmet need reported in adults aged 60+ years in countries like Andorra, Qatar, Republic of Korea, Slovenia, Thailand and Viet Nam to rates of over 50% in Georgia, Haiti, Morocco, Rwanda, and Zimbabwe. While unique, these estimates are likely underestimates, and do not begin to address issues of poor quality of care as a barrier or contributing to unmet need in those who were able to access care. Monitoring progress towards UHC will need to incorporate estimates of unmet need if we are to reach universality and reduce health inequalities in older populations.
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Affiliation(s)
- Paul Kowal
- International Health Transitions, Canberra, Australia.
- Health Data Analytics Team, The Australian National University, Canberra, Australia.
| | - Barbara Corso
- Neuroscience Institute, National Research Council (CNR), Padua, Italy
| | - Kanya Anindya
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Flavia C D Andrade
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana-Champaign, USA
| | - Thanh Long Giang
- Faculty of Economics, National Economics University, Hanoi, Viet Nam
| | | | - Wiraporn Pothisiri
- College of Population Studies, Chulalongkorn University, Bangkok, Thailand
| | - Nekehia T Quashie
- Department of Health Studies, University of Rhode Island, Kingston, USA
| | | | | | - Andy Towers
- School of Health Sciences, Massey University, Palmerston North, New Zealand
| | | | - Nadia Minicuci
- Neuroscience Institute, National Research Council (CNR), Padua, Italy
| | - Nawi Ng
- Department of Public Health and Community Medicine, University of Gothenberg, Gothenburg, Sweden
| | - Julie Byles
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Shebeshi DS, Dolja-Gore X, Byles J. Validation of Frail Scale and comparison with hospital frailty risk score to predict hospital use in a cohort of older Australian women. Int J Health Plann Manage 2023; 38:1510-1519. [PMID: 37452472 DOI: 10.1002/hpm.3684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 05/01/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION With no standard frailty tool for clinical care, research and policymaking, identifying frail older people is a challenge. AIMS This study aimed to compare two validated scales, which are the Frail Scale and Hospital Frailty Risk Score (HFRS) for their ability in identifying frailty in older Australian women and predicting hospital use. METHODS This study included older Australian women aged 75-95 years, who had unplanned overnight hospital admission as an index admission between 2001 and 2016. Data from the Australian Longitudinal Study on Women's Health (ALSWH) were linked with administrative hospital data to calculate HFRS (using the International Statistical Classification of Diseases, Australia Modification (ICD-10-AM) diagnostic codes) and the Frail Scale (using the ALSWH self-reported survey). RESULTS The Frail Scale identified a higher proportion of older frail women (30.54%) compared to the HFRS (23.0%). Frail older women, classified by Frail Scale, were at higher risk of long hospital stay (adjusted odds ratio = 1.28, 95% CI = 1.02-1.60), repeated admission (adjusted hazard ratio [AHR] = 1.30, 95% CI = 1.03-1.41) and death (AHR = 1.70, 95% CI = 1.45-2.01). HFRS was associated with longer hospital stay and mortality. CONCLUSIONS The proportion of older women classified as frail by the Frail Scale tool was higher than women classified as frail by HFRS. The Frail Scale and HFRS were not significantly associated with each other. While both tools were associated with the risk of long hospital stay and mortality, only the Frail Scale predicted the risk of repeated admission.
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Affiliation(s)
- Dinberu S Shebeshi
- Australian Health Services Research Institute, Faculty of Business and Law, University of Wollongong, Wollongong, New South Wales, Australia
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Xenia Dolja-Gore
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Julie Byles
- College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
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Byles J, Cavenagh D, Bryant J, Carey M, Mazza D, Sanson‐Fisher R. Do health assessments affect time to permanent residential aged care admission for older women with and without dementia? Geriatr Gerontol Int 2023; 23:595-602. [PMID: 37385683 PMCID: PMC10947059 DOI: 10.1111/ggi.14631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/18/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
AIM To investigate the effect of health assessments on permanent residential aged care admission for older Australian women with and without dementia. METHODS A total of 1427 older Australian women who had a health assessment between March 2002 and December 2013 were matched with 1427 women who did not have a health assessment in the same period. Linked administrative datasets were used to identify health assessment use, admission to permanent residential aged care, and dementia status. Outcome was time to residential aged care admission from the matched date of health assessment. RESULTS Women who had health assessments were less likely to be admitted to residential aged care in the short term (100 days), irrespective of dementia status (subdistribution hazard ratio [SDHR] = 0.35, 95% CI = [0.21, 0.59] for women with dementia; SDHR = 0.39, 95% CI = [0.25, 0.61] for women without dementia). However, there were no significant differences at 500- and 1000-days follow-up. At 2000-days follow-up, women who had a health assessment were more likely to be admitted to residential aged care, regardless of dementia status (SDHR = 1.41, 95% CI = [1.12, 1.79] for women with dementia; SDHR = 1.55, 95% CI = [1.32, 1.82] for women without dementia). CONCLUSIONS Benefits from health assessments may depend on the recency of the assessment, with women less likely to be admitted to residential aged care in the short term after a health assessment. Our results add to a growing body of literature suggesting that health assessments may provide benefits to older people, including those with dementia. Geriatr Gerontol Int 2023; 23: 595-602.
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Affiliation(s)
- Julie Byles
- Centre for Women's Health ResearchUniversity of NewcastleNewcastleNew South WalesAustralia
- Women's Health Research ProgramHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Dominic Cavenagh
- Centre for Women's Health ResearchUniversity of NewcastleNewcastleNew South WalesAustralia
- Women's Health Research ProgramHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Jamie Bryant
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
- Equity in Health and Wellbeing ProgramHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Mariko Carey
- Centre for Women's Health ResearchUniversity of NewcastleNewcastleNew South WalesAustralia
- Women's Health Research ProgramHunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Danielle Mazza
- Department of General PracticeMonash UniversityMelbourneVictoriaAustralia
| | - Rob Sanson‐Fisher
- Health Behaviour Research CollaborativeUniversity of NewcastleNewcastleNew South WalesAustralia
- Hunter Medical Research InstituteUniversity of NewcastleNewcastleNew South WalesAustralia
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Kwok WS, Dolja-Gore X, Khalatbari-Soltani S, Byles J, Oliveira JS, Pinheiro MB, Naganathan V, Tiedemann A, Sherrington C. Physical activity and injurious falls in older Australian women: adjusted associations and modification by physical function limitation and frailty in the Australian Longitudinal Study on Women's Health. Age Ageing 2023; 52:afad108. [PMID: 37389559 DOI: 10.1093/ageing/afad108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/09/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVES To investigate associations between leisure-time physical activity (LPA) and injurious falls in older women and explore modification of associations by physical function and frailty. METHODS Women born during 1946-51 from the Australian Longitudinal Study on Women's Health, injurious falls (self-reported fall with injury and/or medical attention) and self-reported weekly LPA (duration and type). We undertook cross-sectional and prospective analyses using data from 2016 [n = 8,171, mean (SD) age 68 (1)] and 2019 surveys (n = 7,057). Associations were quantified using directed acyclic graph-informed logistic regression and effect modification examined using product terms. RESULTS Participation in LPA as recommended by World Health Organization (150-300 min/week) was associated with lower odds of injurious falls in cross-sectional (adjusted Odds Ratio (OR) 0.74, 95% CI 0.61-0.90) and prospective analyses (OR 0.75, 95% CI 0.60-0.94). Compared with those who reported no LPA, cross-sectionally, odds of injurious falls were lower in those who reported brisk walking (OR 0.77, 95% CI 0.67-0.89) and vigorous LPA (OR 0.86, 95% CI 0.75-1.00). No significant association was found between different types of LPA and injurious falls prospectively. Only cross-sectionally, physical function limitation and frailty modified the association between LPA and injurious falls, with tendencies for more injurious falls with more activity in those with physical limitation or frailty, and fewer injurious falls with more activity among those without physical function limitation or frailty. CONCLUSION Participation in recommended levels of LPA was associated with lower odds of injurious falls. Caution is required when promoting general physical activity among people with physical limitation or frailty.
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Affiliation(s)
- Wing S Kwok
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Xenia Dolja-Gore
- School of Medicine and Public Health, The University of Newcastle, Australia
| | - Saman Khalatbari-Soltani
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), The University of Sydney, Sydney, Australia
| | - Julie Byles
- School of Medicine and Public Health, The University of Newcastle, Australia
| | - Juliana S Oliveira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Marina B Pinheiro
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney, Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
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10
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Awuviry-Newton K, Amponsah M, Amoah D, Dintrans PV, Afram AA, Byles J, Mugumbate JR, Kowal P, Asiamah N. Physical activity and functional disability among older adults in Ghana: The moderating role of multi-morbidity. PLOS Glob Public Health 2023; 3:e0001014. [PMID: 36963038 PMCID: PMC10021534 DOI: 10.1371/journal.pgph.0001014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 02/08/2023] [Indexed: 03/26/2023]
Abstract
Knowledge about how physical activity levels relate to functional disability is essential for health promotion and planning older adults' care or rehabilitation. The risk of living with one or more chronic health conditions increases with increasing age in lower and higher income countries-many of which are associated with physical inactivity. We conducted a cross-sectional study to examine the moderating role of multimorbidity on physical activity and its measures on functional disability among older adults in Ghana. Data from WHO's Study on global AGEing and adult health Ghana Wave 2 with a sample of 4,446 people aged 50+ years was used for this study. Functional disability was assessed using the 12-item WHO Disability Assessment Schedule 2.0. Three categories of physical activity levels were used: vigorous intensity, moderate intensity, and walking. Past month diagnosis by a doctor was used to assess the presence of a chronic condition, and the presence of two or more conditions was used to define multi-morbidity. Logistic regressions with a post hoc interactional tests were used to examine the associations. Overall, physical activity had a significant association with functional disability (OR = 0.25, 95%CI; 0.12, 0.32). A similar relationship was found for vigorous-intensity (OR = 0.19, 95%CI: 0.12, 0.29), moderate-intensity (OR = 0.19, 95%CI: 0.15, 0.25) and walking (OR = 0.41, 95%CI: 0.33, 0.51). Older adults living with one condition and physically active were 47% less likely to experience functional disability compared with the less active counterparts living with at least two chronic conditions. Among the three measures of physical activity, multimorbidity moderated the relationship between walking and functional disability. Future strategies for meeting the health and long-term care needs of older adults, particularly those living with only one chronic condition in Ghana should consider encouraging walking. Policies, financial assistance, family, and community level interventions aimed to promote and sustain physical activity among older adults should be a priority for stakeholders in Ghana.
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Affiliation(s)
- Kofi Awuviry-Newton
- African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
- College of Health and Biomedicine, Victoria University, Victoria, Australia
| | - Mary Amponsah
- African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
- Centre for African Research, Engagement and Partnerships (CARE-P), The University of Newcastle, Newcastle, Australia
| | - Dinah Amoah
- African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
- School of Health Sciences, University of Tasmania, Hobart, Australia
| | - Pablo Villalobos Dintrans
- African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
- Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santiago, Chile
- Millennium Institute for Caregiving Research (MICARE), Chile
| | | | - Julie Byles
- African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
- Centre for Women's Health Research, Hunter Medical Research Institutes, The University of Newcastle, Newcastle, Australia
| | - Jacob Rugare Mugumbate
- African Health and Ageing Research Centre (AHaARC), Winneba, Ghana
- School of Health and Society, University of Wollongong, Wollongong, Australia
| | - Paul Kowal
- International Health Transitions, Canberra, Australia
| | - Nestor Asiamah
- Division of Interdisciplinary Research and Practice, School of Health and Social Care, University of Essex, Essex, United Kingdom
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11
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Byles J. The 45 and Up Study: an investment in healthy ageing. Public Health Res Pract 2022; 32:3242231. [PMID: 36509686 DOI: 10.17061/phrp3242231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives and importance of the study: To identify the value and contribution of the 45 and Up Study toward understanding and advancing healthy ageing. STUDY TYPE Narrative review Methods: A review of the purpose, process, and output of the 45 and Up Study in relation to the World Health Organization's Healthy Ageing Framework. RESULTS The Sax Institute's 45 and Up Study (the Study) is Australia's largest longitudinal study of healthy ageing, with participants aged from 45 years to over 100 years followed over time through surveys and linked health and aged care data. The study is a powerful resource for understanding healthy ageing for the Australian population, identifying the factors that enable people to age well, widening inequities as people age, and prospects for healthy ageing for current and subsequent generations. To date, the participants have been followed for more than 15 years, providing information on the foundations of health in mid and later-life, factors affecting work, impacts of retirement, and the importance of housing, care, and aged services in improving the lives of people as they age. Moreover, since the Study cohort covers a wide age range, it is possible to divide the cohort into sequences, allowing comparisons of people in their 80s now (for example) with people who were aged in their 80s five, 10 or 15 years ago. Adding genetic and other biological and clinical data for some participants will further enhance the value of the project as a comprehensive study of healthy ageing. CONCLUSIONS The Study provides a clear view of factors affecting healthy ageing within population, healthcare, environmental and policy contexts. Over time, the Study will increase in value with the capacity to inform health services, policy, and aged care and to contribute to an ongoing cycle of evaluation and reform to continue to meet the needs of successive generations of people in the later stages of their lives.
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Affiliation(s)
- Julie Byles
- College of Health, Medicine and Wellbeing, University of Newcastle, NSW, Australia;
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12
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Tolhurst T, Princehorn E, Loxton D, Mishra G, Mate K, Byles J. Changes in the food and drink consumption patterns of Australian women during the COVID-19 pandemic. Aust N Z J Public Health 2022; 46:704-709. [PMID: 36047855 PMCID: PMC9539230 DOI: 10.1111/1753-6405.13295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/01/2022] [Accepted: 07/01/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This paper uses data from the seventh fortnightly Coronavirus (COVID-19) Survey sent to women in the Australian Longitudinal Study on Women's Health to investigate the relationship between the COVID-19 pandemic and the food and drink consumption of women born in 1946-51, 1973-78 and 1989-95. METHODS A survey about changes in fruit, vegetable, discretionary food, takeaway and sugary drink consumption during the pandemic was emailed on 22 July 2020 to 28,709 women in three cohorts of the Australian Longitudinal Study on Women's Health. Thematic qualitative analysis was conducted on comments about changes in consumption, and basic quantitative analysis was included for context. RESULTS There were significant associations between age and all categories of food and drink consumption. Women wrote of lifestyle changes and choices during lockdowns, comfort and emotional eating, and access to food and drink changing their consumption behaviours. CONCLUSIONS The COVID-19 pandemic and interventions had both positive and negative impacts on the food and drink consumption behaviours of Australian women. IMPLICATIONS FOR PUBLIC HEALTH These findings can be used to directly influence practice around healthy food and drink consumption, highlighting enablers, including being at home, and barriers, including mental health, that should be considered.
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Affiliation(s)
- Tara Tolhurst
- Centre for Women's Health Research, The University of Newcastle,Correspondence to: Tara Tolhurst, Centre for Women's Health Research, Level 4 HMRI Building, The University of Newcastle, University Drive, Callaghan, NSW 2308
| | | | - Deb Loxton
- Centre for Women's Health Research, The University of Newcastle
| | - Gita Mishra
- School of Public Health, The University of Queensland
| | - Karen Mate
- School of Biomedical Sciences and Pharmacy, The University of Newcastle
| | - Julie Byles
- Centre for Women's Health Research, The University of Newcastle
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13
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Rahman MM, Jagger C, Leigh L, Holliday E, Princehorn E, Loxton D, Kowal P, Beard J, Byles J. The Impact of Education and Lifestyle Factors on Disability-Free Life Expectancy From Mid-Life to Older Age: A Multi-Cohort Study. Int J Public Health 2022; 67:1605045. [PMID: 36046258 PMCID: PMC9421499 DOI: 10.3389/ijph.2022.1605045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: Low education and unhealthy lifestyle factors such as obesity, smoking, and no exercise are modifiable risk factors for disability and premature mortality. We aimed to estimate the individual and joint impact of these factors on disability-free life expectancy (DFLE) and total life expectancy (TLE). Methods: Data (n = 22,304) were from two birth cohorts (1921–26 and 1946–51) of the Australian Longitudinal Study on Women’s Health and linked National Death Index between 1996 and 2016. Discrete-time multi-state Markov models were used to assess the impact on DFLE and TLE. Results: Compared to the most favourable combination of education and lifestyle factors, the least favourable combination (low education, obesity, current/past smoker, and no exercise) was associated with a loss of 5.0 years TLE, 95% confidence interval (95%CI): 3.2–6.8 and 6.4 years DFLE (95%CI: 4.8–7.8) at age 70 in the 1921–26 cohort. Corresponding losses in the 1946–51 cohort almost doubled (TLE: 11.0 years and DFLE: 13.0 years). Conclusion: Individual or co-ocurrance of lifestyle risk factors were associated with a significant loss of DFLE, with a greater loss in low-educated women and those in the 1946–51 cohort.
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Affiliation(s)
- Md Mijanur Rahman
- The Daffodil Centre, The University of Sydney and Cancer Council NSW, Sydney, NSW, Australia
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lucy Leigh
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Emily Princehorn
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Deb Loxton
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Paul Kowal
- World Health Organization (Switzerland), Geneva, Switzerland
| | - John Beard
- ARC Centre of Excellence in Population Ageing Research, University of New South Wales, Kensington, NSW, Australia
| | - Julie Byles
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
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14
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Thomas S, Bolsewicz K, Latta R, Hewitt J, Byles J, Durrheim D. The Impact of Public Health Restrictions in Residential Aged Care on Residents, Families, and Staff During COVID-19: Getting the Balance Right. J Aging Soc Policy 2022:1-20. [PMID: 35946918 DOI: 10.1080/08959420.2022.2110802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/15/2022] [Indexed: 10/15/2022]
Abstract
Outbreaks of COVID-19 in a small number of aged care facilities in Australia had devastating mortality ratios. Strict infection control measures were implemented with little time to adapt. This study explored the views and experiences of residents, families, and care providers about the preparation for COVID-19 and identified areas for improvement. Twenty-one individual interviews were conducted. Using interpretative phenomenological analysis, we found rapid changes to visiting and activities, with physical and emotional impact. Some participants coped using personal resources. Family and residents valued the empathy and quality care provided, despite the overburdened workforce. Good leadership supported implementation of public health advice, but the severity of measures should be proportionate to local risk. Better pandemic planning that includes clear responsibilities, training, and evaluation is important. Consultation with residents, family, and health workers throughout a pandemic will help identify those most at risk of social isolation and physical decline and develop strategies to minimize their impact. The rights and welfare of residents must be respected at all times.
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Affiliation(s)
- Susan Thomas
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Health Protection, Hunter New England Local Health District, Population Health, Wallsend, New South Wales, Australia
| | - Katarzyna Bolsewicz
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Social Science Research Fellow, National Centre for Immunisation Research and Surveillance, Westmead, New South Wales, Australia
- Health Protection, c/o Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Rachel Latta
- Health Protection, Hunter New England Local Health District, Population Health, Wallsend, New South Wales, Australia
| | - Jacquie Hewitt
- Hunter New England and Central Coast Primary Health Network, Newcastle, New South Wales, Australia
| | - Julie Byles
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - David Durrheim
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Health Protection, Hunter New England Local Health District, Population Health, Wallsend, New South Wales, Australia
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15
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White J, Byles J, Williams T, Untaru R, Ngo DTM, Sverdlov AL. Early access to a cardio-oncology clinic in an Australian context: a qualitative exploration of patient experiences. Cardio-Oncology 2022; 8:14. [PMID: 35945637 PMCID: PMC9364611 DOI: 10.1186/s40959-022-00140-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022]
Abstract
Background Dedicated cardio-oncology services are emerging rapidly around the world in order to provide cardiovascular care (CV) for cancer patients. The perspectives of patients regarding their experience of cardiac surveillance during their cancer journey has not been qualitatively evaluated. Methods An interpretative qualitative study. Fifteen, in-depth qualitative interviews were conducted with a diverse range of community dwelling patients who attended a newly established cardio-oncology clinic in a large regional city in Australia. Data were analysed using an inductive thematic approach. Results Key themes were identified: (1) Access to a cardio-oncology clinic promotes information and understanding, (2) The experience of early CV intervention, (3) Factors promoting integrated care, (4) Balancing cancer treatment and CV symptoms and (5) Managing past and emerging CV risk factors. Conclusion As cardio oncology clinics continue to emerge, this study confirms the benefit of early access to a cardiologist for management of existing or emerging CV risk factors and diseases in the context of cancer treatment. Participants valued the opportunity for regular monitoring and management of CV issues that enabled them to continue cancer treatment. However, we identified gaps in education and support towards making positive lifestyle changes that reduce the risk of CV diseases in cancer patients.
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16
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White J, Cavenagh D, Byles J, Mishra G, Tooth L, Loxton D. The experience of delayed health care access during the COVID 19 pandemic in Australian women: A mixed methods exploration. Health Soc Care Community 2022; 30:e1384-e1395. [PMID: 34423499 PMCID: PMC8653352 DOI: 10.1111/hsc.13546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
Delayed health care access is a potential collateral effect of pandemic conditions, health rationing strategies and social distancing responses. We investigated experiences of delayed health care access in Australian women during COVID-19. A mixed methods study used quantitative and free-text data from the Australian Longitudinal Study on Women's Health COVID-19 survey 4 (health care access or delay). Logistic regression models were used to estimate factors associated with delaying access to general practitioners (GPs), specialists and allied health services. Free-text comments were analysed thematically, employing a process of constant comparison. COVID-19 survey 4 was completed by 8,200 women and 2,727 provided free-text comments. Of the women who needed the health service, 25% (1,268/5,071) delayed seeing their GP, 23.6% (570/1,695) delayed seeing a specialist and 45% (791/1,757) delayed use of an allied health service. Younger age was most significantly associated with delaying attendance. Women born 1989-95 were significantly more likely to delay compared to women born 1946-51 (OR (95% CI): GP = 0.28 (0.22, 0.35)); Specialist = 0.65 (0.45, 0.92; Allied Health = 0.59 (0.42, 0.82)). Women born 1973-78 were also likely to delay GP visits (0.69, (0.58, 0.83)). Four qualitative themes emerged including: (1) Challenges negotiating care during a pandemic; (2) Ongoing uncertainty towards accessing health care when a specialist delays an appointment; (3) Accessing health care (or not) using Telehealth and (4) Managing complex care needs. COVID-19 has had a significant effect on access to health care. Women delayed seeking help for cancer screening, mental health, and other health conditions involving chronic and complex needs for health and social care. While there is a need to rationalise and optimise health access during a pandemic, our outcomes suggest a need for public health campaigns that clarify how to access care, engage with telehealth and respond to missed appointments.
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Affiliation(s)
- Jennifer White
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
| | - Dominic Cavenagh
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
| | - Julie Byles
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
| | - Gita Mishra
- School of Public HealthFaculty of MedicineThe University of QueenslandHerstonAustralia
| | - Leigh Tooth
- School of Public HealthFaculty of MedicineThe University of QueenslandHerstonAustralia
| | - Deborah Loxton
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
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17
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Freak-Poli R, Ryan J, Tran T, Owen A, McHugh Power J, Berk M, Stocks N, Gonzalez-Chica D, Lowthian JA, Fisher J, Byles J. Social isolation, social support and loneliness as independent concepts, and their relationship with health-related quality of life among older women. Aging Ment Health 2022; 26:1335-1344. [PMID: 34219569 DOI: 10.1080/13607863.2021.1940097] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: To assess whether social isolation, social support, and loneliness are independently associated with health-related quality of life (HRQoL).Method: Retrospective analysis including 10,517 women aged 70-75 years from the Australian Longitudinal Study on Women's Health (ALSWH). Social isolation, social support (Duke Social Support Index), and loneliness (single item) were investigated for their association with standardised HRQoL (physical [PCS] and mental [MCS] components of the SF-36® questionnaire). Analyses were adjusted for sociodemographic variables and number of medical conditions.Results: Only 3% reported being socially isolated, having low social support and being lonely, and 34% reported being not socially isolated, high social support and not being lonely. Each construct was independently associated with HRQoL, with loneliness having the strongest inverse association (PCS: isolation -0.98, low support -2.01, loneliness -2.03; MCS: isolation -1.97, low support -4.79, loneliness -10.20; p-value < 0.001 for each). Women who were not isolated or lonely and with high social support had the greatest HRQoL (compared to isolated, low social support and lonely; MCS: 17 to 18 points higher, PCS: 5 to 8 points higher). Other combinations of social isolation, social support and loneliness varied in their associations with HRQoL.Conclusion: Ageing populations face the challenge of supporting older people to maintain longer, healthy, meaningful and community-dwelling lives. Among older women, social isolation, low social support and loneliness are distinct, partially overlapping yet interconnected concepts that coexist and are each adversely associated with HRQoL. Findings should be replicated in other cohorts to ensure generalisability across other age groups and men.
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Affiliation(s)
- Rosanne Freak-Poli
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Thach Tran
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Michael Berk
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, the Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | - Nigel Stocks
- Discipline of General Practice, The University of Adelaide, Adelaide, Australia
| | - David Gonzalez-Chica
- Discipline of General Practice, The University of Adelaide, Adelaide, Australia.,Adelaide Rural Clinical School, The University of Adelaide, Adelaide, Australia
| | - Judy A Lowthian
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia.,Bolton Clarke Research Institute, Bolton Clarke, Melbourne, Australia.,Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia
| | - Jane Fisher
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Julie Byles
- Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, Australia
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18
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White J, Hambisa MT, Cavenagh D, Dolja-Gore X, Byles J. Understanding the relationship between eye disease and driving in very old Australian women: a longitudinal thematic evaluation. BMC Ophthalmol 2022; 22:277. [PMID: 35751055 PMCID: PMC9233390 DOI: 10.1186/s12886-022-02506-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background Over recent decades an increasing number of adults will retain their driver’s licenses well into their later years. The aim of this study was to understand and explore the experience of driving and driving cessation in very old Australian women with self-reported eye disease. Methods An interpretative qualitative study. Participants were from the Australian Longitudinal Study on Women’s Health (cohort born in 1921–26), a sample broadly representative of similarly aged Australian women. Responses to open-ended questions were analysed using an inductive thematic approach, employing a process of constant comparison. Results Qualitative data were from 216 older women with eye disease who made 2199 comments about driving, aged between 70 and 90 years depending on the timing of their comments. Themes included: (1) Access to treatment for eye disease promotes driving independence and quality of life; (2) Driving with restrictions for eye disease enables community engagement and (3) Driving cessation due to poor vision leads to significant lifestyle changes. Conclusions Key findings highlighted driving cessation, or reduction, is often attributed to deterioration in vision. The consequence is dependence on others for transport, typically children and friends. Access to successful treatment for eye disease allowed older women to continue driving. We posit that occupational therapists can play an essential role in promote driving confidence and ability as women age. Trial registration: Not applicable.
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Affiliation(s)
- Jennifer White
- Centre for Women's Health Research, College of Health Medicine and Wellbeing, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.
| | - Mitiku Teshome Hambisa
- Centre for Women's Health Research, College of Health Medicine and Wellbeing, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Dominic Cavenagh
- Centre for Women's Health Research, College of Health Medicine and Wellbeing, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Xenia Dolja-Gore
- Centre for Women's Health Research, College of Health Medicine and Wellbeing, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
| | - Julie Byles
- Centre for Women's Health Research, College of Health Medicine and Wellbeing, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia
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19
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Awuviry-Newton K, Tavener M, Wales K, Byles J. Using ethics of care as the theoretical lens to understand lived experiences of caregivers of older adults experiencing functional difficulties. PLoS One 2022; 17:e0267658. [PMID: 35511930 PMCID: PMC9071116 DOI: 10.1371/journal.pone.0267658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
The lived experiences of caregivers of older adults in Ghana are not well understood. The purpose of this study was to explore and discuss the lived experiences of these caregivers using the Ethics of Care as a theoretical lens and Interpretative phenomenological analysis as the methodological approach. Ten caregivers in receipt of social welfare services on behalf of older adults were recruited from the Social Welfare Unit at the Komfo Anokye Teaching Hospital (KATH) in southern Ghana. The analysis identified five interrelated themes: 1) committing the Self to caregiving; 2) caregiving impacting the Self; 3) motivating factors to caregiving; 4) caregiving burdens, and 5) thinking about personal affairs. Their experiences demonstrate that caregivers value the caregiving relationship, as posited by Ethics of Care, and tend to care for their health and well-being. Caregivers’ expression of commitment to caring for older adults is mainly influenced by reciprocity, despite internal and external stressors, and desire to fulfil unmet personal needs. Ethics of care offers an understanding of the lived experiences of caregivers of older adults in Ghana. The findings draw attention to the state to develop specific programs to ensure the health, social and financial well-being of older adults’ caregivers.
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Affiliation(s)
- Kofi Awuviry-Newton
- Centre for Women’s Health Research, The University of Newcastle, Australia
- African Health and Ageing Research Centre, New Castle, Australia
- * E-mail:
| | - Meredith Tavener
- Centre for Women’s Health Research, The University of Newcastle, Australia
- African Health and Ageing Research Centre, New Castle, Australia
| | - Kylie Wales
- Centre for Women’s Health Research, The University of Newcastle, Australia
- Lecturer, School of Health Sciences, The University of Newcastle, Newcastle, Australia
| | - Julie Byles
- Centre for Women’s Health Research, The University of Newcastle, Australia
- African Health and Ageing Research Centre, New Castle, Australia
- Global Innovation Chair in Responsive Transitions in Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Impact of medication reviews on potentially inappropriate medications and associated costs among older women in aged care. Res Social Adm Pharm 2022; 18:3758-3765. [DOI: 10.1016/j.sapharm.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 03/04/2022] [Accepted: 05/07/2022] [Indexed: 12/01/2022]
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Engel RM, de Luca K, Graham PL, Kaboli Farshchi M, Vemulpad S, Byles J. Predictors of chronic obstructive pulmonary disease in women who never smoked: A cohort study. ERJ Open Res 2022; 8:00532-2021. [PMID: 35586447 PMCID: PMC9108965 DOI: 10.1183/23120541.00532-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Abstract
COPD is responsible for an increasing number of deaths worldwide. Smoking is the most reliable predictor for developing COPD later in life. However, women make up the majority of patients with COPD who have never smoked. There is therefore a need to identify other factors that can predict COPD in women. The aim of this study is to identify factors associated with increasing the risk of developing COPD later in life in women who have never smoked. Data from the Australian Longitudinal Study on Women's Health (ALSWH) cohort born between 1946 and 1951 were used to investigate potential predictors of COPD. Retrospective analyses were performed on data from two of the ALSWH surveys: wave 1 (1996) and wave 9 (2019). There were 3584 women who self-reported as being never-smokers (at waves 1 and 9) and did not have COPD at baseline, of which 109 had developed COPD at wave 9. Logistic regression showed a significant relationship between COPD at wave 9 and baseline breathing difficulties (p<0.001), asthma (p<0.001) and allergies (p=0.026), though significance of asthma and allergies disappeared when included together in a single model, implying that women with these symptoms earlier in life were more likely to be diagnosed with COPD later in life compared to women without these symptoms. Our study supports the inclusion of lung function testing in primary care settings for women over the age of 45 years who have never smoked and have a history of breathing difficulties, asthma or allergies. A history of breathing difficulties, asthma, allergies, hay fever and sinusitis are associated with an increased risk of developing COPD later in life in women who have never smoked. Lung function testing should be considered for these women.https://bit.ly/3jDX9Mp
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22
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Cations M, Keage HAD, Laver KE, Byles J, Loxton D. Intimate Partner Violence and Risk for Mortality and Incident Dementia in Older Women. J Interpers Violence 2022; 37:NP2605-NP2625. [PMID: 32713246 DOI: 10.1177/0886260520943712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to assess the long-term risk for mortality and incident dementia associated with exposure to intimate partner violence (IPV) at any time over the life course. Data were taken from the Australian Longitudinal Study of Women's Health, a population-based cohort study initiated in 1996. Analysis is based on 12,085 community-dwelling women aged 70 to 75 years at baseline from all states and territories. Self-reported exposure to violence was separated into historical (any time before baseline), current (past 12 months), or both. Date of death was obtained from the National Death Index, and dementia status was self-reported or obtained from administrative data. We modeled mortality risk using Cox regression, and risk for incident dementia using Fine-Gray proportional hazards modeling with death as a competing risk. Follow up continued to December 2017. At baseline, 728 women (6.0%) reported historical IPV, 121 (1.0%) reported current violence, and 38 reported both (0.3%). Historical IPV increased 20-year mortality risk after controlling for demographic, socioeconomic, and lifestyle variables (hazard ratio 1.10, 95% confidence interval = [1.00, 1.20]). There was no relationship between current violence and mortality (hazard ratio 1.04, 95% confidence interval = [0.85, 1.29]). There was also no association between IPV and risk for incident dementia (hazard ratio 1.02, 95% confidence interval = [0.89, 1.17]). Older women who self-report exposure to IPV over the lifespan die significantly earlier than women who do not. Further research that considers the mediating role of psychological trauma is needed to examine the relationship between IPV and dementia.
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Affiliation(s)
- Monica Cations
- Flinders University, Adelaide, South Australia, Australia
- University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | | | - Kate E Laver
- Flinders University, Adelaide, South Australia, Australia
| | - Julie Byles
- The University of Newcastle, Callaghan, New South Wales, Australia
| | - Deborah Loxton
- The University of Newcastle, Callaghan, New South Wales, Australia
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Awuviry-Newton K, Amoah D, Tavener M, Afram AA, Dintrans PV, Byles J, Kowal P. Food Insecurity and Functional Disability Among Older Adults in Ghana: The Role of Sex and Physical Activity. J Am Med Dir Assoc 2022; 23:1432.e1-1432.e7. [PMID: 35218730 DOI: 10.1016/j.jamda.2022.01.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/15/2022] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES We examined the associations between food insecurity and functional disability among older adults in Ghana and, the roles of sex and physical activity on the relationship. DESIGN A cross-sectional study design was employed. SETTING AND PARTICIPANTS A total of 4446 older adults (50+ years of age) from the Study on Global Aging and Adult Health Ghana Wave 2, a countrywide study, was completed in 2015. METHODS Logistic regression models were used to examine the associations between measures of food insecurity and functional disability using data from Study on Global Aging and Adult Health Ghana Wave 2. Functional disability was assessed using World Health Organization Disability Assessment Schedule 2.0 composed of 12 items in 6 domains of cognition, mobility, self-care, getting along, life activities, and participation in society. Food insecurity was assessed from 12-month food sufficiency and experience of hunger over the last 12 months. RESULTS Approximately 11% were identified as having functional disability. The prevalence of food insecurity was 23.8% for insufficient food intake and 18.3% for hunger. Adjusting for all variables, older adults who reported consuming insufficient food (OR 2.27; 95% CI 1.57, 3.28), and those who experienced hunger (OR 2.35; 95% CI 1.59, 3.46) had higher odds of functional disability, compared with those not reporting these issues. Sex differences modified the association between hunger and functional disability. Physical activity served as a protective factor (OR 0.60; 95% CI 0.38, 0.95) on the association implying that older adults who engaged in physical activity were 40% less likely to experience food insecurity-induced functional disability. CONCLUSIONS AND IMPLICATIONS Food insecurity is associated with functional disability among older adults. Results highlight the usefulness of tackling the social determinants of health and promoting financial/social security in older age in a changing Ghanaian society.
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Affiliation(s)
| | - Dinah Amoah
- African Health and Aging Research Center (AHaARC), Winneba, Ghana; School of Health Sciences, University of Tasmania, Hobart, Australia
| | - Meredith Tavener
- African Health and Aging Research Center (AHaARC), Winneba, Ghana; Center for Women's Health Research, Hunter Medical Research Institutes, The University of Newcastle, Callaghan, Australia
| | - Adjeiwa Akosua Afram
- African Health and Aging Research Center (AHaARC), Winneba, Ghana; Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana
| | - Pablo Villalobos Dintrans
- African Health and Aging Research Center (AHaARC), Winneba, Ghana; Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santago, Chile; Millennium Institute for Caregiving Research (MICARE), Santiago, Chile
| | - Julie Byles
- African Health and Aging Research Center (AHaARC), Winneba, Ghana; Center for Women's Health Research, Hunter Medical Research Institutes, The University of Newcastle, Callaghan, Australia
| | - Paul Kowal
- Center for Women's Health Research, Hunter Medical Research Institutes, The University of Newcastle, Callaghan, Australia
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Hambisa MT, Dolja-Gore X, Byles J. Application of Andersen-Newman model to assess cataract surgery uptake among older Australian women: findings from the Australian Longitudinal Study on Women's Health (ALSWH). Aging Clin Exp Res 2022; 34:1673-1685. [PMID: 35184260 PMCID: PMC9246771 DOI: 10.1007/s40520-022-02091-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although Cataract Surgery Rate is increasing, the availability of surgery is outstripped by the increasing number of cataract cases as populations age. AIM The study aimed to identify factors associated with cataract surgery uptake in terms of predisposing, enabling, and need factors in very old Australian women. METHOD This study used ALSWH data included 6229 women aged 79-84 to 85-90 years. Women were asked whether they had undergone eye surgery (including cataracts) three years prior to each survey. Generalised estimating equation modelling was used to determine factors associated with these surgeries. RESULT At baseline (2005), more than half of the participants either had undergone surgery (43.5%) or had unoperated cataracts (7.6%). Increasing age (AOR = 1.11, 95% CI = 1.07, 1.15) and being current or ex-smokers (AOR = 1.15, 95% CI = 1.03, 1.29) were associated with higher odds of cataract surgery (predisposing factors). Women who had private health insurance had 27% higher odds of having surgery (AOR = 1.27, 95% CI = 1.16, 1.39) (enabling factor). Need factors of more General Practitioner visits (AOR = 1.16, 95% CI = 1.09, 1.25) and skin cancer (AOR = 1.09, 95% CI = 1.01, 1.17) also increased the odds of cataract surgery. Women who had no difficulty seeing newspaper print were more likely to have had cataract surgery (AOR = 1.35, 95% CI = 1.23, 1.48). CONCLUSION Need factors are the major drivers of cataract surgery; however, predisposing and enabling factors also play a role, including access to private health insurance. This finding indicates some inequity regarding access to cataract surgery in the Australian setting.
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Affiliation(s)
- Mitiku Teshome Hambisa
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, NSW, 2308, Australia.
- School of Public Health, Haramaya University College of Health and Medical Sciences, P. O. Box 235, Harar, Ethiopia.
| | - Xenia Dolja-Gore
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Julie Byles
- Centre for Women's Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Callaghan, NSW, 2308, Australia
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White J, Byles J, Walley T. The patient experience of telehealth access and clinical encounters in Australian health care during COVID-19: implications for enhancing integrated care. JICA 2022. [DOI: 10.1108/jica-05-2021-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeTelehealth consultations are likely to continue while living with COVID-19 and the risk of other pandemics. Greater understanding of patient perceptions is important in order to inform future integrated care models involving telehealth.Design/methodology/approachAn interpretative qualitative study. Fifteen, in-depth qualitative interviews were conducted with diverse range of community dwelling patients who attended outpatient clinics at The John Hunter Hospital, Newcastle. Data were analysed using an inductive thematic approach.FindingsKey themes were identified: (1) telehealth is valuable in a pandemic; (2) telehealth accessibility can be challenging; (3) there are variations in care experiences, especially when visual feedback is lacking; (4) telehealth for acute and complex care needs may lead to gaps and (5) considerations towards the future of telehealth, beyond a pandemic.Research limitations/implicationsThere is a shortfall in evidence of the patient experience of integrated care within a telehealth framework. The results provided practical insights into how telehealth services can play a greater role in integrated care.Practical implicationsApart from the need for affordable access to high-speed data for basic Internet access, the author posit the need for patient and clinician training towards promoting communication that is underpinned by choice, trust and shared decision-making.Originality/valueTelehealth is important towards keeping patients safe during COVID-19. Key findings extend knowledge of the practical implications need to promote integrated telehealth systems. While there is a benefit in extending telehealth to more preventative activities, there is also a need for greater service coordination and sharing of information between treating clinicians. Overall the results highlight telehealth consultations to be an effective means of treating well-known conditions and for follow-up rather than for acute conditions.
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White J, Byles J, Walley T. The qualitative experience of telehealth access and clinical encounters in Australian healthcare during COVID-19: implications for policy. Health Res Policy Syst 2022; 20:9. [PMID: 35033107 PMCID: PMC8760598 DOI: 10.1186/s12961-021-00812-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 12/21/2021] [Indexed: 11/20/2022] Open
Abstract
Background Adaptive models of healthcare delivery, such as telehealth consultations, have rapidly been adopted to ensure ongoing delivery of essential healthcare services during the COVID-19 pandemic. However, there remain gaps in our understanding of how clinicians have adapted to telehealth. This study aims to explore the telehealth experiences of specialists, based at a tertiary hospital in the Hunter Region, and general practitioners (GP), including barriers, enablers and opportunities. Methods An interpretative qualitative study involving in-depth interviews explored the telehealth experiences of specialists, based at a tertiary hospital in the Hunter Region of Australia, and GPs, including barriers, enablers and opportunities. Data were analysed using an inductive thematic approach with constant comparison. Results Individual interviews were conducted with 10 specialists and five GPs. Key themes were identified: (1) transition to telehealth has been valuable but challenging; (2) persisting telehealth process barriers need to be addressed; (3) establishing when face-to-face consults are essential; (4) changes in workload pressures and potential for double-up; (5) essential modification of work practices; and (6) exploring what is needed going forward. Conclusions While there is a need to rationalize and optimize health access during a pandemic, we suggest that more needs to be done to improve telehealth going forward. Our results have important policy implications. Specifically, there is a need to effectively train clinicians to competently utilize and be confident using this telehealth and to educate patients on necessary skills and etiquette.
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Affiliation(s)
- Jennifer White
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Locked Bag 1000, New Lambton, NSW, 2305, Australia.
| | - Julie Byles
- Centre for Women's Health Research, College of Health, Medicine and Wellbeing, University of Newcastle, Locked Bag 1000, New Lambton, NSW, 2305, Australia
| | - Tom Walley
- Hunter Medical Research Institute, Newcastle, NSW, Australia
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Shebeshi DS, Dolja-Gore X, Byles J. Charlson Comorbidity Index as a predictor of repeated hospital admission and mortality among older women diagnosed with cardiovascular disease. Aging Clin Exp Res 2021; 33:2873-2878. [PMID: 33591545 DOI: 10.1007/s40520-021-01805-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/23/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Comorbidity can complicate cardiovascular diseases (CVDs), increasing the risk of adverse events including hospitalisation and death. This study aimed to assess the Charlson Comorbidity Index (CCI) as a predictor of repeated hospital admission and mortality in older CVD patients. METHODS This study linked data from the Australian longitudinal study on women's health (ALSWH) with hospital and National Death Index datasets to identify dates for hospital admission, discharge, and death for women born 1921-26. CCI was calculated using the International Statistical Classification of Diseases, Australia Modification (ICD-10-AM) diagnostic codes. RESULTS Women with a higher CCI on index admission had increased risk of repeated hospital admission (AHR = 1.29, 95% CI 1.06, 1.58) and mortality (AHR = 3.05, 95% CI 2.15, 4.31). Older age and hypertension were also significantly associated with a higher risk of repeated hospital admission and mortality. Living in a remote area was associated with a higher risk of mortality. CONCLUSIONS The Charlson Comorbidity Index predicts repeated hospital admission and mortality incidences among older women with CVD. Improving management of comorbidities for older CVD patients should be considered as part of a strategy to mitigate subsequent repeated hospitalisation and delay mortality.
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Affiliation(s)
- Dinberu S Shebeshi
- Research Centre for Generational Health and Ageing (RCGHA), Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia.
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, 2308, Australia.
- Research Assets Division, SAX Institute, Level 3, 30C Wentworth Street, Glebe, NSW, 2037, Australia.
| | - Xenia Dolja-Gore
- Research Centre for Generational Health and Ageing (RCGHA), Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
- Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, 2308, Australia
- Research Assets Division, SAX Institute, Level 3, 30C Wentworth Street, Glebe, NSW, 2037, Australia
| | - Julie Byles
- Research Centre for Generational Health and Ageing (RCGHA), Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
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Cations M, Keage HAD, Laver KE, Byles J, Loxton D. Impact of Historical Intimate Partner Violence on Wellbeing and Risk for Elder Abuse in Older Women. Am J Geriatr Psychiatry 2021; 29:930-940. [PMID: 33431284 DOI: 10.1016/j.jagp.2020.12.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the psychological impacts and risk for elder abuse associated with historical intimate partner violence (IPV) in older women. DESIGN Prospective cohort study SETTING: All Australian states and territories. PARTICIPANTS A total of 12,259 women aged 70-75 years at baseline participating in the Australian Longitudinal Study of Women's Health. MEASUREMENTS Women were asked at baseline whether they had ever been in a violent relationship with a partner, and completed a comprehensive survey about their physical and psychological health every 3 years (15 years follow-up) including the Short Form-36 Mental Health subscale (SF-MH) and Vulnerability to Abuse Screening Scale (VASS). Linear mixed effects modelling with maximum likelihood estimation assessed the impact of IPV over time on the SF-MH and VASS. Risk for incident depression and experiencing physical or sexual violence over follow-up was examined using logistic regression models. RESULTS The 782 (6.4%) women who reported historical IPV recorded significantly poorer psychological wellbeing at all timepoints compared to those who did not report historical IPV, and were at higher risk for incident depression over follow up (adjusted odds ratio [aOR] = 1.36, 95% confidence interval [CI]:1.11-1.67). There was no significant relationship between historical IPV and self-reported exposure to physical or sexual violence in late life (aOR = 0.87, 95%CI: 0.53-1.43), but women who reported historical IPV recorded higher rates of vulnerability to abuse on the VASS. DISCUSSION Women who have experienced a violent relationship continue to experience negative effects into older age, highlighting the importance of clinical monitoring and ongoing support for survivors as they age.
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Affiliation(s)
- Monica Cations
- College of Education, Social Work and Psychology (MC), Flinders University, South Australia, Australia; Justice and Society (MC, HADK), The University of South Australia, South Australia, Australia.
| | - Hannah A D Keage
- Justice and Society (MC, HADK), The University of South Australia, South Australia, Australia
| | - Kate E Laver
- College of Medicine and Public Health (KEL), Flinders University, South Australia, Australia
| | - Julie Byles
- Faculty of Health and Medicine (JB), The University of Newcastle, New South Wales, Australia
| | - Deborah Loxton
- Faculty of Health and Medicine (JB), The University of Newcastle, New South Wales, Australia
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Harris ML, Kuzulugil D, Parsons M, Byles J, Acharya S. "They were all together … discussing the best options for me": Integrating specialist diabetes care with primary care in Australia. Health Soc Care Community 2021; 29:e135-e143. [PMID: 33316851 DOI: 10.1111/hsc.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/20/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
Over one-third of diabetes-related encounters with healthcare providers in Australia fail to meet clinical guidelines. Evidence is mounting that care provision within an integrated framework may facilitate greater adherence to clinical guidelines and improved outcomes for patients. The Diabetes Alliance Program was implemented across a large healthcare district to enhance diabetes care capacity at the primary care level through intensive case-conferencing involving the primary care team, patients and visiting specialist team, whole practice performance review and regular diabetes education for practitioners. Here, we provide an in-depth patient assessment of the case-conferencing process and impact on diabetes management. Two practices with high pre-intervention HbA1c monitoring and three practices with low HbA1c monitoring provided the sampling frame. Patients were selected according to their score on the Patient Activation MeasureTM to achieve maximum variation, with up to two patients with high scores and three with low scores, selected from each practice. Patients were sampled until data saturation was achieved and then subjected to thematic content analysis (n = 19). Patients mostly described the model of care as a positive experience, reporting a boost in confidence in diabetes self-management (particularly around nutrition). The program was also seen to be helpful in providing an opportunity to refocus when "life gets in the way". Other valued aspects of the program included the holistic approach to healthcare, reduced travel time, familiarity in environment and clinical care, top-down knowledge transfer as well as mutual learning by the patient and their primary care team. Despite this, difficulties in coping with diabetes and adherence to treatment recommendations remained for a minority of patients. Integrating specialist teams within primary care has the ability to provide efficient healthcare delivery, better patient experience and health outcomes. Investment in such approaches will be critical to navigating healthcare provision in order to meet the demands of an ageing population.
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Affiliation(s)
- Melissa L Harris
- Faculty of Health and Medicine, Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, NSW, Australia
| | - Deniz Kuzulugil
- Hunter New England Health District, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Martha Parsons
- Hunter New England Health District, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Julie Byles
- Faculty of Health and Medicine, Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, NSW, Australia
| | - Shamasunder Acharya
- Hunter New England Health District, John Hunter Hospital, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
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Freak-Poli R, Ryan J, Tran T, Owen A, Power JM, Berk M, Stocks N, Gonzalez-Chica D, Lowthian JA, Fisher J, Byles J. 372Social Isolation, Social Support and Loneliness as independent interconnected concepts. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Social isolation, lack of social support and loneliness have historically been assessed as overlapping or even interchangeable terms. We aimed to assess whether these three social constructs are independently associated with health-related quality of life (HRQoL).
Methods
This analysis included 10,517 women aged 70-75 years from the Australian Longitudinal Study on Women's Health (ALSWH). Social isolation (Duke Social Support Index: DSSI), social support (DSSI), and loneliness (one-item) were investigated for their association with HRQoL (physical [PCS] and mental [MCS] component scores of the SF-36® questionnaire). Multivariable analyses adjusted for age, demographics, socio-economic position and medical conditions.
Results
Social isolation, social support and loneliness were not strongly correlated with one another. However, all were independently associated with HRQoL (PCS: isolation -0.97, low support -2.24, loneliness -2.70; MCS: isolation -1.96, low support -4.78, loneliness -10.31; p-value<0.001 for each). Compared to those with low social isolation, high social support and lack of loneliness, women highly isolated, with low social support and lonely reported the lowest HRQoL (MCS: -18 to -17; PCS: -8 to -6). Other combinations of isolation, support and loneliness varied in their associations with HRQoL.
Conclusions
Social isolation, social support and loneliness are distinct, yet interconnected concepts that may coexist and are each adversely associated with HRQoL.
Key messages
Ageing populations present the challenge of supporting older people to maintain a longer, healthy, meaningful and community-dwelling lives. Social isolation, low social support and loneliness have adverse associations with HRQoL.
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Affiliation(s)
- Rosanne Freak-Poli
- Monash University, Melbourne, Australia
- Erasmus MC, Rotterdam, The Netherlands
| | | | | | | | | | - Michael Berk
- Deakin University, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | | | | | - Judy A Lowthian
- Bolton Clarke, Melbourne, Australia
- University of Queensland, Brisbane, Australia
| | | | - Julie Byles
- University of Newcastle, Newcastle, Australia
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Abbas SS, Majeed T, Nair BR, Forder PM, Weaver N, Byles J. 699Are we treating our older generations appropriately? Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
This study aims to understand the disease burden of Atrial Fibrillation (AF) and how it is treated among older Australian women.
Methods
Data from the oldest cohort (born 1921-26) of the Australian Longitudinal Study of Women’s Health were linked to state based hospital data to identify AF and to Pharmaceutical Benefit Scheme data for medication details. Yearly prevalence and incidence of AF was calculated, followed by calculation of proportions for different medications received.
Results
A total of 6671 women were eligible for the analysis. About 1827 women from were identified as having AF between 2000-2015. Despite steady incidence, prevalence of AF increased from 2.7% (95%CI=1.6%-3.8%) when women were aged 74-79 years to 24.8% (95%CI=23.2%-26.4%) in 2015 when women were 89-94 years. About 10% of women with AF did not receive any treatment for AF and another 60% did not receive any prophylaxis for thromboembolism within 3 years of AF onset. More than three quarters of women with AF received a combination of medications. Rate control with Vitamin K Inhibitors and Rate control with Platelet Aggregation Inhibitors were the most common combinations.
Conclusions
Older women have high prevalence of AF. These women are undertreated for the prevention of the most common and disabling complication of AF, stroke.
Key messages
Prevalence of AF is increasing and women receive inadequate treatment rendering them at risk of serious complications like stroke. This results in reduced quality of life for patients as well as burdens the health care system.
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Frailty and potentially inappropriate medications using the 2019 Beers Criteria: findings from the Australian Longitudinal Study on Women's Health (ALSWH). Aging Clin Exp Res 2021; 33:2499-2509. [PMID: 33449339 DOI: 10.1007/s40520-020-01772-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/03/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Frailty is an essential consideration with potentially inappropriate medications (PIMs), especially among older women. AIMS This study determined the use of potentially inappropriate medications according to frailty status using the Beers Criteria 2019, identified medications that should be flagged as potentially inappropriate and harmful depending on individual health factors, and determined the association between frailty and PIMs, adjusted for characteristics associated with PIMs. METHODS This prospective longitudinal study included 9355 participants aged 77-82 years at baseline (2003). Frailty was measured using the FRAIL (fatigue, resistance, ambulation, illness and loss of weight) scale. Generalised estimating equations using log-binomial regressions determined the association between frailty and risk of using PIMs. RESULTS Among participants who were frail and non-frail at baseline, the majority used ≥ 3 PIMs (74.2% and 58.5%, respectively). At 2017, the proportion using ≥ 3 PIMs remained constant in the frail group (72.0%) but increased in the non-frail group (66.0%). Commonly prescribed medications that may be potentially inappropriate in both groups included benzodiazepines, proton-pump inhibitors and non-steroidal anti-inflammatory drugs, and risperidone was an additional contributor in the non-frail group. When adjusted for other characteristics, frail women had a 2% higher risk of using PIMs (RR 1.02; 95% CI 1.01, 1.03). CONCLUSION Given that the majority of frail women were using medications that may have been potentially inappropriate, it is important to consider both frailty and PIMs as indicators of health outcomes, and to review the need for PIMs for women aged 77-96 years who are frail.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
- International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Nicholas Egan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Home Medicines Review and frailty among community-dwelling older women. Int J Pharm Pract 2021; 29:548-555. [PMID: 34463322 DOI: 10.1093/ijpp/riab054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Home Medicines Reviews (HMRs) can optimize medications for frail older adults. This study aimed to determine the use of HMRs according to frailty status and the association between frailty and use of HMRs. METHODS The study included 9139 female participants enrolled in the Australian Longitudinal Study on Women's Health from 2003 (aged 77-82 years) to 2017 (aged 91-96 years). Generalized estimating equations (GEEs) using log-binomial regressions were used to determine associations using repeated measures on individuals over time. KEY FINDINGS The majority of participants in the study remained non-frail and did not receive HMRs from 2003 [7116 (77.86%)] to 2017 [1240 (71.31%)]. The use of HMRs was low in both groups with 33 (1.68%; 95% CI, 1.16 to 2.36) frail and 64 (0.89%; 95% CI, 0.69 to 1.14) non-frail participants receiving HMRs in 2003; by 2017, 19 (4.19%; 95% CI, 2.54 to 6.46) frail and 45 (3.50%; 95% CI, 2.57 to 4.66) non-frail participants received HMRs. Frailty was not associated with receiving a HMR (RR 1.06; 95% CI, 0.95 to 1.20), although for every 1-year increase, participants were 10% more likely to receive a HMR (RR 1.10; 95% CI, 1.09 to 1.11). Participants with continuous polypharmacy, ≥4 chronic diseases, >4 general practitioner visits and Department of Veterans Affairs coverage were more likely to receive a HMR. CONCLUSIONS Despite the proven value of HMRs for frail older people, HMRs were not used for most frail and non-frail community-dwelling women in this study. Reasons for low use of the service should be explored, with interventions to raise awareness of the benefits of the service.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, Callaghan, NSW, Australia.,School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Julie Byles
- University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Syed Shahzad Hasan
- University of Newcastle, Callaghan, NSW, Australia.,Department of Pharmacy, University of Huddersfield, Queensgate, Huddersfield, UK
| | - Nicholas Egan
- University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Therese Kairuz
- University of Newcastle, Callaghan, NSW, Australia.,School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
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Byles J, Cavenagh D, Bryant J, Mazza D, Browning C, O'Loughlin S, Sanson-Fisher R. Use of medical services by older Australian women with dementia: a longitudinal cohort study. Aust N Z J Public Health 2021; 45:497-503. [PMID: 34309976 DOI: 10.1111/1753-6405.13146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/01/2021] [Accepted: 06/01/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the use of Medicare-subsidised health services by women with and without dementia. METHODS Data from women of the 1921-26 birth cohort of the Australian Longitudinal Study on Women's Health were linked to various administrative datasets to ascertain dementia diagnosis. The use of subsidised general practitioner (GP) services (75+ health assessments [HAs], chronic disease management meetings [CDMs], multidisciplinary case conferences [MCCs]) and specialist and allied health services between 2000 and 2013 for these women was analysed using longitudinal GEE models. RESULTS A total of 9,683 women were included with 1,444 (15%) women identified as having dementia. Compared to women with no dementia indication, women with dementia had more yearly non-emergency GP attendances (short [<30 minutes] IRR=1.11 [1.07, 1.13]; long [>30 minutes] IRR=1.11 [1.04, 1.19]) and fewer specialist attendances (IRR=0.91 [0.85, 0.97]) and were more likely to have an emergency GP attendance (OR=2.29 [2.05, 2.57]). There were no significant differences in the odds of having either a HA or CDM or using allied health services for women with and without dementia indicators. CONCLUSIONS The overall use of services designed to improve the prevention and coordination of the care of older people with chronic conditions was low. Women with dementia were no more likely to access these services. Implications for public health: There is underuse of some primary and allied healthcare services designed for people with complex chronic conditions. These could be better used by women with dementia to improve the management of complex comorbidities (e.g. CDMs), to prevent the onset of disability (e.g. physiotherapy), and enhance needs assessment and service access (e.g. HAs).
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Affiliation(s)
- Julie Byles
- Centre for Women's Health Research, The University of Newcastle, New South Wales
| | - Dominic Cavenagh
- Centre for Women's Health Research, The University of Newcastle, New South Wales
| | - Jamie Bryant
- Health Behaviour Research Group, The University of Newcastle, New South Wales
| | - Danielle Mazza
- Department of General Practice, Monash University, Victoria
| | | | | | - Rob Sanson-Fisher
- Health Behaviour Research Group, The University of Newcastle, New South Wales
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Thiruchelvam K, Byles J, Hasan SS, Kairuz T. Innovating medication reviews through a technology-enabled process. Res Social Adm Pharm 2021; 18:2700-2705. [PMID: 34326004 PMCID: PMC8847068 DOI: 10.1016/j.sapharm.2021.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/06/2021] [Accepted: 07/20/2021] [Indexed: 10/31/2022]
Abstract
Medication reviews are effective in improving the quality of medication use among older people. However, they are conducted to various standards resulting in a wide range of outcomes which limit generalisability of findings arising from research studies. There also appear to be funding and time constraints, lack of data storage for quality improvement purposes, and non-standardised reporting of outcomes, especially clinically relevant outcomes. Furthermore, the coronavirus disease-19 (COVID-19) pandemic has restricted many face-to-face activities, including medication reviews. This article introduces a technology-enabled approach to medication reviews that may overcome some limitations with current medication review processes, and also make it possible to conduct medication reviews during the COVID-19 pandemic by providing an alternate platform. The possible advantages of this technology-enabled approach, legislative considerations and possible implementation in practice are discussed.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, United Kingdom.
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, New South Wales, 2308, Australia; International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Cavenagh D, Kairuz T. Common combinations of medications used among oldest-old women: a population-based study over 15 years. Aging Clin Exp Res 2021; 33:1919-1928. [PMID: 32909246 DOI: 10.1007/s40520-020-01693-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/19/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Older people use many medications, but combinations of medications used among the oldest old (≥ 80 years) are not commonly reported. AIMS This study aimed to determine common combinations of medications used among women aged 77-96 years and to describe characteristics associated with these combinations. METHODS A cohort study of older women enroled in the Australian Longitudinal Study on Women's Health over a 15-year period was used to determine combinations of medications using latent class analysis. Multinomial logistic regression was used to determine characteristics associated with these combinations. RESULTS The highest medication users during the study were for the cardiovascular (2003: 80.28%; 2017: 85.63%) and nervous (2003: 66.03%; 2017: 75.41%) systems. A 3-class latent model described medication use combinations: class 1: 'Cardiovascular & neurology anatomical group' (27.25%) included participants using medications of the cardiovascular and nervous systems in their later years; class 2: 'Multiple anatomical group' (16.49%) and class 3: 'Antiinfectives & multiple anatomical group' (56.27%). When compared to the reference class (class 1), the risk of participants being in class 3 was slightly higher than being in class 2 if they had > 4 general practitioner visits (RRR 2.37; 95% CI 2.08, 2.71), Department of Veterans Affairs' coverage (RRR 1.59; 95% CI 1.36, 1.86), ≥ 4 chronic diseases (RRR 3.16; 95% CI 2.56, 3.90) and were frail (RRR 1.47; 95% CI 1.27, 1.69). CONCLUSION Identification of combinations of medication use may provide opportunities to develop multimorbidity guidelines and target medication reviews, and may help reduce medication load for older individuals.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
- International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Nicholas Egan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Dominic Cavenagh
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
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Awuviry-Newton K, Tavener M, Wales K, Byles J. The roles and capacities of social workers in the lives of older adults seeking healthcare and their caregivers in Ghana. Health Soc Care Community 2021; 29:877-888. [PMID: 33249647 DOI: 10.1111/hsc.13121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/08/2020] [Accepted: 07/10/2020] [Indexed: 06/12/2023]
Abstract
As Ghana's older population increases in number and proportion, the social and healthcare needs of older adults and their caregivers become more critical highlighting the relevance of social workers' contribution in assisting older adults and their caregivers. The purpose of this study was to explore social workers' contributions, discussed against the International Federation of Social Workers (IFSW) Policy on Ageing and Older Person framework. The study employed a descriptive qualitative approach making use of semi-structured interviews to collect information from eight social workers at the Social Welfare Unit in Komfo Anokye Teaching Hospital in Ghana. Themes and codes were developed from the interviews using thematic analysis, employing In-vivo and descriptive coding, and N-Vivo v12 as a management tool. Analysis of interviews revealed three interrelated themes; (a) "We provide it accordingly": Talking about their contributions as systematic, (b) "I think we can do more": Talking about their contributions as insufficient, and (c) "Our efforts are being hampered": Complaints of inadequate resources for working with older adults and their caregivers. The study offers areas of opportunities for social workers per the IFSW policy framework to reflect and examine their current knowledge and skill to address the challenges population ageing presents in Ghana. While social workers contribute towards helping older adults seeking healthcare and their caregivers, their needs cannot be ignored. The findings draw attention to effective policies and programs that can provide social workers with the needed resources to be independent and be able to devise novel approaches unique to older adults and their caregivers.
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Affiliation(s)
- Kofi Awuviry-Newton
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Meredith Tavener
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Kylie Wales
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
| | - Julie Byles
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Global Innovation Chair in Responsive Transitions in Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Awuviry-Newton K, Tavener M, Wales K, Byles J. Interpretative Phenomenological Analysis of the Lived Experiences of Older Adults Regarding Their Functional Activities in Ghana. J Prim Care Community Health 2021; 11:2150132720931110. [PMID: 32584195 PMCID: PMC7318820 DOI: 10.1177/2150132720931110] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction: Research on disability largely draws on epidemiological data, often conducted in more developed countries. To date, there is little research related to older adults in Ghana, Africa. The purpose of this study was to strengthen understanding of how older adults in Ghana perform functional activities, referenced against the World Health Organization’s International Classification of Functioning, Disability and Health (WHO-ICF) framework. Methods: Interpretative phenomenological analysis (IPA) of semistructured interview data was employed as the methodological approach. Using purposive criterion sampling, 8 older adults admitted to Komfo Anokye Teaching Hospital in Ghana, presenting with any identified health condition and/or frailty were recruited. Results: Analysis of interview data identified 5 interrelated themes: (1) feeling anxious, (2) feeling restricted, (3) understanding and admitting difficulty, (4) striving to be healthy and being productive, and (5) managing functional difficulty. These concerns were classified and related to the WHO-ICF, particularly the contextual factors. Discussion: This study examined in detail experiences of older adults performing functional activities. Our study highlights the relevance of the WHO-ICF framework for understanding the health needs of older adults, emphasizing the functional, social, and environmental factors influencing the functional status of older adults. The findings offer unique insight into the health needs of older adults, drawing attention to the implications for policy and care.
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Affiliation(s)
- Kofi Awuviry-Newton
- The Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Meredith Tavener
- The Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Kylie Wales
- The Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Julie Byles
- The Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Callaghan, New South Wales, Australia
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Residential Medication Management Reviews and continuous polypharmacy among older Australian women. Int J Clin Pharm 2021; 43:1619-1629. [PMID: 34091857 DOI: 10.1007/s11096-021-01294-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Background Polypharmacy is an important consideration for the provision of Residential Medication Management Reviews (RMMRs) among older women given their enhanced risk of medication-related problems and admission to residential aged care (RAC). Objectives To determine the prevalence of the use of RMMRs among older women in RAC, and the association between RMMRs and polypharmacy, medications, and costs. Setting Older Australian women aged 79-84 years in 2005 who had at least one Medicare Benefits Schedule and Pharmaceutical Benefits Scheme record, received a service in aged care, and consented to data linkage. Methods Generalised estimating equations were used to determine the association between polypharmacy and RMMRs, while adjusting for confounding variables. Main outcome measures Prevalence of the use of RMMRs among older women in RAC, association between RMMRs and polypharmacy, medications, and costs. Results Most participants did not have continuous polypharmacy and did not receive RMMRs from 2005 [451 (67.4%)] until 2017 [666 (66.6%)]. Participants with continuous polypharmacy were 17% more likely to receive a RMMR (risk ratio 1.17; 95% confidence interval 1.11, 1.25). Participants in their final year of life and residing in outer regional/remote/very remote Australia were less likely to receive RMMRs. Out-of-pocket medication costs increased over time, and alendronate and aspirin were common contributors to polypharmacy among participants who received RMMRs. Conclusion Polypharmacy was associated with receiving RMMRs and around two-thirds of women who are entitled to a RMMR never received one. There is potential to improve the use of medicines by increasing awareness of the service among eligible individuals, their carers and health care professionals.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Nicholas Egan
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
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Thiruchelvam K, Byles J, Hasan SS, Egan N, Kairuz T. Prevalence and association of continuous polypharmacy and frailty among older women: A longitudinal analysis over 15 years. Maturitas 2021; 146:18-25. [PMID: 33722360 DOI: 10.1016/j.maturitas.2021.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/01/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to determine the prevalence of continuous polypharmacy and hyperpolypharmacy, determine medications that contribute to continuous polypharmacy, and examine the association between frailty and continuous polypharmacy. STUDY DESIGN A prospective study using data from the Australian Longitudinal Study on Women's Health. Women aged 77-82 years in 2003, and 91-96 years in 2017 were analysed, linking the Pharmaceutical Benefits Scheme data to participants' survey data. MAIN OUTCOME MEASURES The association between frailty and continuous polypharmacy was determined using generalised estimating equations for log binomial regressions, controlling for confounding variables. Descriptive statistics were used to determine the proportion of women with polypharmacy, and medications that contributed to polypharmacy. RESULTS The proportion of women with continuous polypharmacy increased over time as they aged. Among participants who were frail (n = 833) in 2017, 35.9 % had continuous polypharmacy and 1.32 % had hyperpolypharmacy. Among those who were non-frail (n = 1966), 28.2 % had continuous polypharmacy, and 1.42 % had hyperpolypharmacy. Analgesics (e.g. paracetamol) and cardiovascular medications (e.g. furosemide and statins) commonly contributed to continuous polypharmacy among frail and non-frail women. Accounting for time and other characteristics, frail women had an 8% increased risk of continuous polypharmacy (RR 1.08; 95 % CI 1.05, 1.11) compared to non-frail women. CONCLUSIONS Combined, polypharmacy and frailty are key clinical and public health challenges. Given that one-third of women had continuous polypharmacy, monitoring and review of medication use among older women are important, and particularly among women who are frail.
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Affiliation(s)
- Kaeshaelya Thiruchelvam
- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia.
| | - Julie Byles
- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia.
| | - Syed Shahzad Hasan
- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; University of Huddersfield, Queensgate, Huddersfield HD1 3DH, United Kingdom.
| | - Nicholas Egan
- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia.
| | - Therese Kairuz
- University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; International Medical University, 126 Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia.
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Shebeshi DS, Dolja-Gore X, Byles J. Validation of hospital frailty risk score to predict hospital use in older people: Evidence from the Australian Longitudinal Study on Women’s Health. Arch Gerontol Geriatr 2021; 92:104282. [DOI: 10.1016/j.archger.2020.104282] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/18/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022]
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Dobson A, Anderson A, Cavenagh D, Egan N, Fitzgerald D, Forder P, Hockey R, Loos C, Loxton D, Waller M, Xu Z, Mishra G, Byles J. Tracking the Development of Multimorbidity In the Australian Longitudinal Study on Women’s Health. Int J Popul Data Sci 2020. [DOI: 10.23889/ijpds.v5i5.1456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
IntroductionWith population ageing the prevalence of multi-morbidity (the co-occurrence of two or more chronic medical conditions) is increasing.
Objectives and ApproachOur goal was to use data linkage to obtain clinically validated data on the incidence of a range of common chronic conditions developed by participants in the Australian Longitudinal Study on Women’s Health (57,000 women) and hence to track the cumulative incidence of multi-morbidity over time.
ResultsThe major data sources differed for different conditions, e.g. the Pharmaceutical Benefits Scheme was important for identifying musculoskeletal conditions, whereas hospital admission data was crucial for identifying stroke. The most common combinations of conditions differed for women at different ages, e.g., mental health, musculoskeletal and respiratory conditions were most common for women born in 1989-95, whereas heart disease was a prominent part of multi-morbidity for women born in 1921-26. Among these older women about 50% had 3 or more chronic conditions in 2002 (when they were aged 76-81) and this increased to over 80% by 2015 (when they were 89-93). For comparison, among women born in 1973-78 fewer than 5% had 2 or more chronic conditions in 2002 (when they were aged 24-29) and this increased to about 15% in 2016 (when they were 38-43).
Conclusion / ImplicationsRecord linkage from multiple data sources, repeated over a long time span, is a powerful method for studying the development of multi-morbidity patterns in cohorts.
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Kingston A, Byles J, Kiely K, Anstey KJ, Jagger C. The Impact of Smoking and Obesity on Disability-Free Life Expectancy in Older Australians. J Gerontol A Biol Sci Med Sci 2020; 76:1265-1272. [PMID: 33249489 PMCID: PMC8202145 DOI: 10.1093/gerona/glaa290] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Smoking and obesity are 2 modifiable risk factors for disability. We examine the impact of smoking and obesity on disability-free life expectancy (DFLE) at older ages, using 2 levels of disability. METHOD We used the DYNOPTA dataset, derived by harmonizing and pooling risk factors and disability outcomes from 5 Australian longitudinal aging studies. We defined mobility disability as inability to walk 1 km, and more severe (activities of daily living [ADL]) disability by the inability to dress or bathe. Mortality data for the analytic sample (N = 20 401; 81.2% women) were obtained from Government Records via data linkage. We estimated sex-specific total life expectancy, DFLE, and years spent with disability by Interpolated Markov Chain (IMaCh) software for each combination of smoking (never vs ever), obesity (body mass index ≥30 vs 18.5 to <30), and education (left school age 14 or younger vs age 15 or older). RESULTS Compared to those without either risk factor, high educated nonobese smokers at age 65 lived shorter lives (men and women: 2.5 years) and fewer years free of mobility disability (men: 2.1 years; women: 2.0 years), with similar results for ADL disability. Obesity had the largest effect on mobility disability in women; high educated obese nonsmoking women lived 1.3 years less than nonsmoking, not obese women but had 5.1 years fewer free of mobility disability and 3.2 fewer free of ADL disability. Differences between risk factor groups were similar for the low educated. CONCLUSIONS Our findings suggest eliminating obesity would lead to an absolute reduction of disability, particularly in women.
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Affiliation(s)
- Andrew Kingston
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Julie Byles
- Research Centre for Generational Health and Ageing, University of Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Kim Kiely
- School of Psychology, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Anderson AE, Cavenagh D, Forder P, Loxton D, Byles J. Alcohol-related risk from pre-loading and heavy episodic drinking (HED) among a cohort of young Australian women: a cross-sectional analysis. Aust N Z J Public Health 2020; 44:382-389. [PMID: 32776670 DOI: 10.1111/1753-6405.13018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/01/2020] [Accepted: 06/01/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To cross-sectionally examine heavy episodic drinking (HED) and pre-loading with alcohol among young Australian women in relation to the alcohol-induced adverse outcomes of memory loss, vomiting and injury. METHODS A total of 7,800 participants, aged 20-25 years, from the 1989-95 cohort of the Australian Longitudinal Study on Women's Health answered all questions on alcohol use, reported drinking alcohol in the previous year and were not pregnant at the third survey in 2015. Log-binomial models were used to estimate prevalence ratios for adverse outcomes associated with increased frequency of HED and pre-loading. RESULTS The majority of participants reported HED (83.4%) and/or pre-loading (65.6%), which had a moderate correlation (r=0.646). Just over half (55.2%) of participants experienced at least one adverse event, with vomiting being most common. As the frequency of HED or pre-loading increased, so did the risk of an adverse outcome. CONCLUSIONS Both HED and pre-loading pose a risk to young Australian women, and that risk rises with increased frequency. Implications for public health: Although HED has been a target of public health policy and interventions, pre-loading has received limited attention. In addition to addressing HED, there is a need to consider the risk posed by pre-loading, a related, yet unique risky drinking behaviour.
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Affiliation(s)
- Amy E Anderson
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, The University of Newcastle, New South Wales
| | - Dominic Cavenagh
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, The University of Newcastle, New South Wales
| | - Peta Forder
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, The University of Newcastle, New South Wales
| | - Deborah Loxton
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, The University of Newcastle, New South Wales
| | - Julie Byles
- Research Centre for Generational Health and Ageing, School of Medicine and Public Health, The University of Newcastle, New South Wales
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Shebeshi DS, Dolja‐Gore X, Byles J. Estimating unplanned and planned hospitalization incidents among older Australian women aged 75 years and over: The presence of death as a competing risk. Int J Health Plann Manage 2020; 35:1219-1231. [DOI: 10.1002/hpm.3030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/21/2019] [Accepted: 06/24/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Dinberu S. Shebeshi
- Research Centre for Generational Health and Ageing (RCGHA), Faculty of Health and Medicine The University of Newcastle Callaghan NSW Australia
- Centre for Clinical Epidemiology and Biostatistics University of Newcastle Newcastle Australia
- Research Assets Division SAX Institute, Level 3, 30C Wentworth Street Glebe NSW Australia
| | - Xenia Dolja‐Gore
- Research Centre for Generational Health and Ageing (RCGHA), Faculty of Health and Medicine The University of Newcastle Callaghan NSW Australia
| | - Julie Byles
- Research Centre for Generational Health and Ageing (RCGHA), Faculty of Health and Medicine The University of Newcastle Callaghan NSW Australia
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Majeed T, Tavener M, Dolja-Gore X, Nair B, Chojenta C, Byles J. Patterns of geriatric health assessment use among community dwelling older Australian women over a 14-year period. J Health Serv Res Policy 2020; 24:100-107. [PMID: 30971194 DOI: 10.1177/1355819618814561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess which older Australian women had Medicare subsidized health assessments between 1999 and 2013. METHODS This study used prospective, longitudinal survey data from the 1921 to 1926 birth cohort of Australian Longitudinal Study on Women's Health (ALSWH) linked with Medicare Australia data on health services use. Over 11,000 Australian women were included in the study. Latent class analysis was used to identify assessment patterns over time, accounting for death, and based on three categories ('no assessment'; 'assessment; 'deceased') for each year between 1999 and 2013. Further analysis explored the impact of health and sociodemographic characteristics on class membership. RESULTS Of the women included in the latent class analysis, 37% never had any assessment and the remainder had had at least one assessment. After a steady uptake from 1999 to 2003, there was decline in uptake from 2003 onwards. A six-class model with sufficient homogeneity and reliable estimation was selected to represent assessment patterns and mortality risk, labelled as: 'high mortality' rate with little chance for assessment (12.4%), 'intermediate mortality, low assessment' (14.1%), 'later mortality/low assessment' (13.1%), 'later mortality, high assessment' (7.0%), 'low mortality, low assessment' (31.8%), 'low mortality, high assessment' (21.6%). Older women with certain conditions (such as diabetes, depression, heart disease) were more likely to be in the low assessment groups, and women with difficulty managing on income were more likely to be in low assessment groups. CONCLUSION Distinct assessment and mortality patterns were seen, with many women not having assessment, in particular those who had certain health conditions, were taking 3+ medications, had difficulty in managing on income, needed help or were in respite care, and had caring responsibilities. The findings point to a need to promote these assessments among older women, and to reduce financial barriers, even within the context of a heavily subsidized health care system.
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Affiliation(s)
- Tazeen Majeed
- 1 Lecturer, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Meredith Tavener
- 2 Research Fellow, Priority Research Centre for Generational Health and Ageing, University of Newcastle, Australia
| | - Xenia Dolja-Gore
- 2 Research Fellow, Priority Research Centre for Generational Health and Ageing, University of Newcastle, Australia
| | - Balakrishnan Nair
- 3 Professor of Medicine, Priority Research Centre for Generational Health and Ageing, University of Newcastle, Australia
| | - Catherine Chojenta
- 2 Research Fellow, Priority Research Centre for Generational Health and Ageing, University of Newcastle, Australia
| | - Julie Byles
- 4 Professor, Priority Research Centre for Generational Health and Ageing, University of Newcastle, Australia
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Awuviry-Newton K, Wales K, Tavener M, Byles J. Do factors across the World Health Organisation's International Classification of Functioning, Disability and Health framework relate to caregiver availability for community-dwelling older adults in Ghana? PLoS One 2020; 15:e0233541. [PMID: 32469915 PMCID: PMC7259767 DOI: 10.1371/journal.pone.0233541] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/25/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction In Ghana, the care needs of older adults in the later years has become a critical issue given population ageing and increased proportions of older adults with difficulties with functional abilities. However, factors related to caregiver availability is unknown. The purpose of this study was to examine how the World Health Organisation’s International Classification of Functioning, Disability and Health (WHO-ICF) framework relates to caregiver availability for community-dwelling older adults in Ghana. This evidence will strengthen our understanding of the perceived unmet care needs of older adults in Ghana in Africa. Materials and methods A hospital-based survey was conducted among 400 consecutively recruited older adult in-patients using a questionnaire at Komfo Anokye Teaching Hospital in southern Ghana. Multivariate logistic regression tested associations between caregiver availability and other factors as related to the WHO-ICF conceptual framework. Results Eighty-six per cent of the participants reported having an available caregiver. In the final parsimonious model, the environmental factors were highly related to caregiver availability, seconded by personal factors, and then health conditions. Body function and structure, activity, and participation variables were not statistically significant. Overall, the variables that were associated with caregiver availability were age, being a widow, having a single chronic condition, being hardly understood by friends and family, receiving no neighbourhood support, and having 2–4 children. Interaction existed between being a widow and living as a couple in relation to caregiver availability. Conclusions Caregiver availability is associated with variables under the personal, health and environmental components of the WHO-ICF. Increased effort to strengthen the current and future welfare programs, including the health of older adults and their caregivers is relevant.
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Affiliation(s)
- Kofi Awuviry-Newton
- Priority Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- * E-mail:
| | - Kylie Wales
- Priority Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
| | - Meredith Tavener
- Priority Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Julie Byles
- Priority Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
- Global Innovation Chair in Responsive Transitions in Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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Byles J. Advanced age geriatric care: A comprehensive guide. Australas J Ageing 2020; 39:83. [DOI: 10.1111/ajag.12778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Julie Byles
- University of Newcastle Newcastle NSW Australia
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Awuviry-Newton K, Tavener M, Wales K, Kowal P, Byles J. ACTIVITIES OF DAILY LIVING DIFFICULTIES AND TOILETING AMONG OLDER GHANAIANS: AN APPLICATION OF WHO-ICF FRAMEWORK. Innov Aging 2019. [PMCID: PMC6841545 DOI: 10.1093/geroni/igz038.1916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of the study was to analyze the prevalence of activities of daily living (ADL) difficulties among older Ghanaians and specifically how one ADL, toileting difficulty, predicts care and supports needs using the World Health Organization International Classification of Disability and Health framework (WHO-ICF). Toileting difficulty requiring upper extremity strength is among ADLs that can lead to functional loss of independence among older people globally. A sample of n=5,096 adults aged 50 years and older from the WHO Study on global AGEing and adult health (SAGE) Ghana Wave 1 was used to analyze difficulties with ADLs and toileting. Level of difficulty was assessed against 22 other functioning items from the interview. Out of the 22 functioning items, climbing one flight of stairs without resting was the most difficult activity to be completed by older Ghanaians, and difficulty eating being the least endorsed item. Toileting was ranked the 16th in terms of reported difficulty and was related to other ADLs. Logistics multivariate regression was used to analyze data. Including significant variables from the univariate analysis in parsimonious model based on WHO-ICF framework, age, self-report health, memory, bodily pain, short distance vision, stroke, neighborhood trust, toilet facility type, and religious meeting attendance, were significantly independently associated with toileting difficulty. Gender was significant at the univariate level but became insignificant after adjusting for body function and structural variables. Toileting difficulty was associated with factors across different components in the WHO-ICF making the WHO-ICF an appropriate tool for understanding health and disability.
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Affiliation(s)
- Kofi Awuviry-Newton
- Priority Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia, Australia
| | - Meredith Tavener
- Priority Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Kylie Wales
- School of Health Sciences, The University of Newcastle, Newcastle, NSW, Australia
| | - Paul Kowal
- The University of Newcastle, School of Medicine and Public Health, Faculty of Health and Medicine, Australia
| | - Julie Byles
- Priority Research Center for generational Health and Ageing, Newcastle, NSW, Australia
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Abstract
This article presents a broad narrative review of the epidemiological evidence on how and why the mental health of older adults varies by gender. We draw upon international research literatures spanning gerontology and population mental health, as well as major reports from global health agencies. Compared with older men, older women are more likely to experience common mental disorders such as depression and anxiety, although the gender gap is smaller than it is at younger ages. In contrast, the mortality-related impacts of poor mental health, including suicide, are more severe for older men. These gendered patterns vary by country and other social contexts. Factors proposed to account for these findings include cultural and social norms, differentiation of gender roles, disadvantage and (dis)empowerment across the life course, and the coping styles of older men. However, little research has explicitly tested these explanations. Research to date has overwhelmingly focused on identifying differences in the mental health of older men and women. Notably, most studies have been restricted to binary comparisons, lacking the data to disentangle sex and gender dynamics, and few studies have examined the mental health of minority gendered adults in later life. Finally, there remains a need for high-quality population-based research into the mental health of those aged over 80 that includes coverage of people living in residential aged care settings.
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Affiliation(s)
- Kim M Kiely
- Neuroscience Research Australia (NeuRA), Sydney, Australia; School of Psychology, University of New South Wales, Sydney, Australia; UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia.
| | - Brooke Brady
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia; ARC Centre for Excellence in Population Ageing Research, University of New South Wales, Sydney, Australia
| | - Julie Byles
- Priority Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, Australia
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