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Wizgier D, Meng Y, Das A, Naganathan V, Blyth F, Le Couteur DG, Handelsman DJ, Waite LM, Ribeiro RV, Shivappa N, Hébert JR, Hirani V. The association of dietary antioxidants and the inflammatory potential of the diet with poor physical function and disability in older Australian men: the Concord Health and Ageing in Men Project. Br J Nutr 2024; 131:1528-1539. [PMID: 38220224 PMCID: PMC11043910 DOI: 10.1017/s0007114524000126] [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: 06/07/2023] [Revised: 12/18/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
Our objective was to evaluate the association of antioxidant intake and the inflammatory potential of the diet with functional decline in older men. A diet history questionnaire was used to collect dietary intake data from men aged ≥ 75 years (n 794) participating in the Concord Health and Aging in Men Project cohort study. Intake of vitamins A, C, E and Zn were compared with the Australian Nutrient Reference Values to determine adequacy. The Energy-adjusted Dietary Inflammatory Index (E-DIITM) was used to assess the inflammatory potential of the diet. Physical performance data were collected via handgrip strength and walking speed tests, and activities of daily living (ADL) and instrumental activities of daily living (IADL) questionnaires, at baseline and 3-year follow-up (n 616). Logistic regression analysis was used to identify associations between diet and incident poor physical function and disability. Both poor antioxidant intake and high E-DII scores at baseline were significantly associated with poor grip strength and ADL disability at 3-year follow-up. No significant associations with walking speed or IADL disability were observed. Individual micronutrient analysis revealed a significant association between the lowest two quartiles of vitamin C intake and poor grip strength. The lowest quartiles of intake for vitamins A, C, E and Zn were significantly associated with incident ADL disability. The study observed that poor antioxidant and anti-inflammatory food intake were associated with odds of developing disability and declining muscle strength in older men. Further interventional research is necessary to clarify the causality of these associations.
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Affiliation(s)
- Daniela Wizgier
- Discipline of Nutrition and Dietetics, Sydney School of Nursing, FMH, University of Sydney, Sydney, NSW2006, Australia
| | - Ying Meng
- Discipline of Nutrition and Dietetics, Sydney School of Nursing, FMH, University of Sydney, Sydney, NSW2006, Australia
| | - Arpita Das
- Discipline of Nutrition and Dietetics, Sydney School of Nursing, FMH, University of Sydney, Sydney, NSW2006, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation Hospital, University of Sydney, Sydney, NSW2139, Australia
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW2006, Australia
| | - Fiona Blyth
- School of Public Health, University of Sydney, Sydney, NSW2006, Australia
| | - David G. Le Couteur
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation Hospital, University of Sydney, Sydney, NSW2139, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW2006, Australia
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, NSW, Australia
| | - David J. Handelsman
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, NSW, Australia
| | - Louise M. Waite
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation Hospital, University of Sydney, Sydney, NSW2139, Australia
| | - Rosilene V. Ribeiro
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation Hospital, University of Sydney, Sydney, NSW2139, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW2006, Australia
- School of Life and Environmental Science (SoLES), University of Sydney, Sydney, NSW, Australia
| | - Nitin Shivappa
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC29208, USA
| | - James R. Hébert
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC29208, USA
| | - Vasant Hirani
- Discipline of Nutrition and Dietetics, Sydney School of Nursing, FMH, University of Sydney, Sydney, NSW2006, Australia
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation Hospital, University of Sydney, Sydney, NSW2139, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW2006, Australia
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, NSW, Australia
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Milledge K, Cumming RG, Wright FAC, Naganathan V, Blyth FM, Le Couteur DG, Waite LM, Handelsman DJ, Hirani V. Title: Cross-sectional associations between nutrient intake and tooth decay in older Australian men: The Concord Health and Ageing in Men Project. Caries Res 2024:000531454. [PMID: 38740005 DOI: 10.1159/000531454] [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] [Received: 11/15/2020] [Accepted: 05/12/2023] [Indexed: 05/16/2024] Open
Abstract
Poor nutrition is a risk factor for dental decay in younger people. However, except for sugar it is unclear if this is true in older age groups. The aim of this study was to analyze the possible associations between overall dietary intake of nutrients and diet quality and presence of dental decay in community dwelling older men. A cross-sectional analysis of a longitudinal study with a standardized validated diet history assessment and comprehensive oral health examination in 520 community dwelling men (mean age: 84 years) participating in the Concord Health and Ageing in Men Project. Nutrient Reference Values (NRVs) were used to determine if individual micronutrients and macronutrients were meeting recommendations. Acceptable Macronutrient Distribution Ranges (AMDR) were attained for fat and carbohydrate intakes and were incorporated into a dichotomous variable to determine if the participants were consuming a high fat and low carbohydrate diet. Diagnosis of coronal caries was based on visual criteria and inspection and was completed on each of the five coronal surfaces. Root surface caries was textual changes across four root surfaces. This diagnosis was used to categorize participants by presence and severity of coronal and root caries. Adjusted logistic regression showed not meeting the recommended intakes for thiamin (odds ratio (OR): 2.32 95% confidence interval (CI) 1.15 - 4.67), and zinc (OR: 3.33, 95% CI 1.71 - 6.48) were associated with presence of severe root decay. Adjusted analysis also showed that participants who were outside the recommended AMDR for fat (OR: 0.61, 95% CI 0.38 - 0.98), and those who consumed a high fat and low carbohydrate diet (OR: 0.56, 95% CI 0.35 - 0.91) were less likely to have coronal tooth decay. Our study shows associations between micronutrients and macronutrients and coronal and root surface decay. Although this study cannot prescribe causality or be generalized to all older adults, diet has a possible association with dental decay in older men.
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Chu KY, Wright FAC, Naganathan V, Stanaway F, Tran J, Cockrell D. Provision of domiciliary dental service to residential aged care facilities: A 3-year descriptive summary. Spec Care Dentist 2024; 44:787-796. [PMID: 37550797 DOI: 10.1111/scd.12912] [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: 03/24/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/09/2023]
Abstract
AIM This cross-sectional descriptive study described the oral health status and types of domiciliary dental treatment received by residents living in residential care after an oral health assessment (OHAT). METHODS Twenty-one facilities were recruited where consenting participants received OHAT followed by a referral for further domiciliary dental treatments. Data were captured and stored as Reach-OHT database where 2017-2019 data were analyzed. RESULT Overall, 88% of residents consented. 69.1% were referred for treatment after completion of OHAT. More than half had one or more caries; 40% showed sign of periodontal disease; a higher proportion of dentate participants had an unsatisfactory level of oral cleanliness. Of those received domiciliary dental treatment, diagnostic and preventive service was the combination most frequently provided. These comprised an average of 71.9% of total treatment provided across the 3-year period. CONCLUSION This study contributes to the understanding and knowledge around the provision of domiciliary dental services in residential care. A large number of older people in residential care can be assessed and treated through a domiciliary service pathway. As the vast majority of services provided were diagnostic, preventive, and restorative care, the feasibility of utilizing the skillset of the entire dental team should be explored.
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Affiliation(s)
- Kuang-Yin Chu
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Australia
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Frederick Allan Clive Wright
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Australia
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Fiona Stanaway
- School of Public Health, University of Sydney, Sydney, Australia
| | - Juliette Tran
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Australia
| | - Deborah Cockrell
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Australia
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Marshall KH, Riddiford-Harland DL, Meller AE, Caplan GA, Naganathan V, Cullen J, Gonski P, Zwar NA, O’Keeffe JA, Krysinska K, Rhee JJ. Feasibility and Acceptability of Facilitated Advance Care Planning in Outpatient Clinics: A Qualitative Study of Patient and Caregivers Experiences. J Appl Gerontol 2024; 43:339-348. [PMID: 37949095 PMCID: PMC10875901 DOI: 10.1177/07334648231206742] [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: 05/10/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 11/12/2023] Open
Abstract
Guidelines recommend advance care planning (ACP) for people with advanced illness; however, evidence supporting ACP as a component of outpatient care is lacking. We sought to establish the feasibility and acceptability of a facilitated ACP intervention for people attending tertiary outpatient clinics. Data from 20 semi-structured interviews with patient (M = 79.3 ± 7.7, 60% male) and caregiver (M = 68.1 ± 11.0, 60% female) participants recruited as part of a pragmatic, randomized controlled trial (RCT) were analyzed using qualitative descriptive methodology. Patients were randomized to intervention (e.g., facilitated support) or control (e.g., standard care). Intervention patients expressed high satisfaction, reporting the facilitated ACP session was clear, straightforward, and suited to their needs. Intervention caregivers did not report any significant concerns with the facilitated ACP process. Control participants reported greater difficulty completing ACP compared to intervention participants. Embedding facilitated ACP into tertiary outpatient care appears feasible and acceptable for people with advanced illnesses.
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Affiliation(s)
- Kate H. Marshall
- UNSW Academic General Practice Network, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Anne E. Meller
- Advance Care Planning Services, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Gideon A. Caplan
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - John Cullen
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Peter Gonski
- Southcare Aged and Extended Community Care, Sutherland Hospital, Sydney, NSW, Australia
| | - Nicholas A. Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Julie-Ann O’Keeffe
- Aged, Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, NSW, Australia
| | - Karolina Krysinska
- Centre for Primary Health Care and Equity, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Joel J. Rhee
- UNSW Academic General Practice Network, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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Aitken SJ, James S, Lawrence A, Glover A, Pleass H, Thillianadesan J, Monaro S, Hitos K, Naganathan V. Codesign of health technology interventions to support best-practice perioperative care and surgical waitlist management. BMJ Health Care Inform 2024; 31:e100928. [PMID: 38471784 DOI: 10.1136/bmjhci-2023-100928] [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: 10/06/2023] [Accepted: 02/10/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES This project aimed to determine where health technology can support best-practice perioperative care for patients waiting for surgery. METHODS An exploratory codesign process used personas and journey mapping in three interprofessional workshops to identify key challenges in perioperative care across four health districts in Sydney, Australia. Through participatory methodology, the research inquiry directly involved perioperative clinicians. In three facilitated workshops, clinician and patient participants codesigned potential digital interventions to support perioperative pathways. Workshop output was coded and thematically analysed, using design principles. RESULTS Codesign workshops, involving 51 participants, were conducted October to November 2022. Participants designed seven patient personas, with consumer representatives confirming acceptability and diversity. Interprofessional team members and consumers mapped key clinical moments, feelings and barriers for each persona during a hypothetical perioperative journey. Six key themes were identified: 'preventative care', 'personalised care', 'integrated communication', 'shared decision-making', 'care transitions' and 'partnership'. Twenty potential solutions were proposed, with top priorities a digital dashboard and virtual care coordination. DISCUSSION Our findings emphasise the importance of interprofessional collaboration, patient and family engagement and supporting health technology infrastructure. Through user-based codesign, participants identified potential opportunities where health technology could improve system efficiencies and enhance care quality for patients waiting for surgical procedures. The codesign approach embedded users in the development of locally-driven, contextually oriented policies to address current perioperative service challenges, such as prolonged waiting times and care fragmentation. CONCLUSION Health technology innovation provides opportunities to improve perioperative care and integrate clinical information. Future research will prototype priority solutions for further implementation and evaluation.
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Affiliation(s)
- Sarah Joy Aitken
- Sydney Medical School, The University of Sydney Faculty of Medicine and Health, Camperdown, New South Wales, Australia
- Concord Institute of Academic Surgery, Sydney Local Health District, Concord West, New South Wales, Australia
| | - Sophie James
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Amy Lawrence
- Anaesthetics, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Anthony Glover
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Department of Surgery and Endocrinology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Henry Pleass
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Janani Thillianadesan
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Geriatrics, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Sue Monaro
- Clinical Excellence Commission, Sydney South, New South Wales, Australia
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Kerry Hitos
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
| | - Vasi Naganathan
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Tran MH, van Zwieten A, Kiely KM, Blyth FM, Naganathan V, Le Couteur DG, Handelsman DJ, Seibel MJ, Waite LM, Cumming RG, Khalatbari-Soltani S. Intra-generational social mobility and mortality among older men in the Concord Health and Ageing in Men Project: A cohort study. SSM Popul Health 2024; 25:101581. [PMID: 38264197 PMCID: PMC10803938 DOI: 10.1016/j.ssmph.2023.101581] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/16/2023] [Accepted: 12/06/2023] [Indexed: 01/25/2024] Open
Abstract
Objectives We examined associations between intra-generational social mobility (reflected in life-course socioeconomic trajectories) and mortality, among older men. Methods Data came from a prospective Australian community-based cohort of older men. Social mobility was defined by socioeconomic indicators from three points in the life-course: educational attainment (late adolescence-early adulthood), occupation (mid-life), and current sources of income (older age). We defined indicators of social mobility trajectory (6 categories; reflecting the direction of social mobility) and social mobility status (2 categories; mobile or non-mobile). We used Cox regression to examine associations with mortality, adjusting for age, country of birth, and living arrangement. Results We followed 1568 men (mean age 76.8, SD 5.4) for a mean duration of 9.1 years, with 797 deaths recorded. Moving upward was the predominant social mobility trajectory (36.0%), followed by mixed trajectories (25.1%), downward (15.1%), stable low (12.2%), stable high (7.6%), and stable middle (4.0%). Men with downward (Hazard ratio 1.58, 95% CI 1.13 to 2.19) and stable low socioeconomic trajectories (1.77, 1.25 to 2.50) had higher mortality risks than men with stable high socioeconomic trajectories, while men with upward trajectories had similar risks to those with stable high trajectories. 76.2% of the participants were classified as having mobile status; no associations were evident between binary social mobility status and mortality. Discussions These findings suggest cumulative and persistent exposure to disadvantaged socioeconomic conditions across the life-course, rather than social mobility, is associated with increased mortality. For each stage of the life-course, addressing socioeconomic disadvantage may reduce inequities in mortality.
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Affiliation(s)
- Minh-Hoang Tran
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- NTT Hi-Tech Institute, Nguyen Tat Thanh University, HCMC, Viet Nam
| | - Anita van Zwieten
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Kim M. Kiely
- Ageing Futures Institute, University of New South Wales (UNSW), Sydney, (NSW), Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, NSW, Australia
- School of Health and Society and School of Mathematics and Applied Statistics, University of Wollongong, Wollongong, (NSW), Australia
| | - Fiona M. Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, NSW, Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Concord, New South Wales, Australia
| | - David G. Le Couteur
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - David J. Handelsman
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia
| | - Markus J. Seibel
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia
| | - Louise M. Waite
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, NSW, Australia
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Concord, New South Wales, Australia
| | - Robert G. Cumming
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Saman Khalatbari-Soltani
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, NSW, Australia
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Okafor CE, Keramat SA, Comans T, Page AT, Potter K, Hilmer SN, Lindley RI, Mangin D, Naganathan V, Etherton-Beer C. Cost-Consequence Analysis of Deprescribing to Optimize Health Outcomes for Frail Older People: A Within-Trial Analysis. J Am Med Dir Assoc 2024; 25:539-544.e2. [PMID: 38307120 DOI: 10.1016/j.jamda.2023.12.016] [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: 08/31/2023] [Revised: 12/13/2023] [Accepted: 12/26/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVES The structured, clinically supervised withdrawal of medicines, known as deprescribing, is one strategy to address inappropriate polypharmacy. This study aimed to evaluate the costs and consequences of deprescribing in frail older people living in residential aged care facilities (RACFs) in Australia. DESIGN A within-trial cost-consequence analysis of a deprescribing intervention-Opti-Med. The Opti-Med double-blind randomized controlled trial of deprescribing included 3 groups: blinded control, blinded intervention, and an open intervention group. SETTING AND PARTICIPANTS Seventeen RACFs in Western Australia and New South Wales. Participants were 303 older people living in participating RACFs from March 2014 to February 2019. METHODS Analysis was conducted from the health sector perspective. Health economic outcomes assessed include cost saved from deprescribed medicines and the incremental quality-adjusted life-years. Costs were presented in 2022 Australian dollars. RESULTS The total cost of the Opti-Med intervention was $239.13 per participant. The costs saved through deprescribed medicines over 12 months after adjusting for mortality within the trial period was $328.90 per participant in the blinded intervention group and $164.00 per participant in the open intervention group. On average, the cost of the intervention was more than offset by the cost saved from deprescribed medicines. Extrapolating these findings to the Australian population suggests a potential net cost saving of about $1 to $16 million per annum for the health system nationally. The incremental quality-adjusted life-years were very similar across the 3 groups within the trial period. CONCLUSIONS AND IMPLICATIONS Deprescribing for frail older people living in RACFs can be a cost-saving intervention without reducing the quality of life. Systemwide implementation of deprescribing across RACFs in Australia has the potential to improve health care delivery through the cost savings, which could be reapplied to further optimize care within RACFs.
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Affiliation(s)
- Charles E Okafor
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
| | - Syed Afroz Keramat
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Amy T Page
- Western Australia Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
| | | | - Sarah N Hilmer
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; Kolling Institute, Northern Sydney Local Health District and The University of Sydney, St Leonards, New South Wales, Australia
| | - Richard I Lindley
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; The George Institute for Global Health, Barangaroo, Sydney, New South Wales, Australia
| | - Dee Mangin
- McMaster University, Hamilton, Ontario, Canada; University of Otago, Christchurch Central City, Christchurch, New Zealand
| | - Vasi Naganathan
- Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia; Department of Geriatric Medicine, Centre of Education and Research in Ageing, Concord Repatriation Hospital, New South Wales, Australia
| | - Christopher Etherton-Beer
- Western Australia Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia
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Smith J, Cvejic E, Houssami N, Schonberg MA, Vincent W, Naganathan V, Jansen J, Dodd RH, Wallis K, McCaffery KJ. Randomized Trial of Information for Older Women About Cessation of Breast Cancer Screening Invitations. J Gen Intern Med 2024:10.1007/s11606-024-08656-3. [PMID: 38409512 DOI: 10.1007/s11606-024-08656-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Older women receive no information about why Australia's breast screening program (BreastScreen) invitations cease after 74 years. We tested how providing older women with the rationale for breast screening cessation impacted informed choice (adequate knowledge; screening attitudes aligned with intention). METHODS In a three-arm online randomized trial, eligible participants were females aged 70-74 years who had recently participated in breast screening (within 5 years), without personal breast cancer history, recruited through Qualtrics. Participants read a hypothetical scenario in which they received a BreastScreen letter reporting no abnormalities on their mammogram. They were randomized to receive the letter: (1) without any rationale for screening cessation (control); (2) with screening cessation rationale in printed-text form (e.g., downsides of screening outweigh the benefits after age 74); or (3) with screening cessation rationale presented in an animation video form. The primary outcome was informed choice about continuing/stopping breast screening beyond 74 years. RESULTS A total of 376 participant responses were analyzed. Compared to controls (n = 122), intervention arm participants (text [n = 132] or animation [n = 122]) were more likely to make an informed choice (control 18.0%; text 32.6%, p = .010; animation 40.5%, p < .001). Intervention arm participants had more adequate knowledge (control 23.8%; text 59.8%, p < .001; animation 68.9%, p < .001), lower screening intentions (control 17.2%; text 36.4%, p < .001; animation 49.2%, p < .001), and fewer positive screening attitudes regarding screening for themselves in the animation arm, but not in the text arm (control 65.6%; text 51.5%, p = .023; animation 40.2%, p < .001). CONCLUSIONS Providing information to older women about the rationale for breast cancer screening cessation increased informed decision-making in a hypothetical scenario. This study is an important first step in improving messaging provided by national cancer screening providers direct to older adults. Further research is needed to assess the impact of different elements of the intervention and the impact of providing this information in clinical practice, with more diverse samples. TRIAL REGISTRATION ANZCTRN12623000033640.
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Affiliation(s)
- Jenna Smith
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a joint venture with the Cancer Council NSW, Sydney, NSW, Australia
| | - Mara A Schonberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Wendy Vincent
- BreastScreen NSW, Sydney Local Health District, Sydney, NSW, Australia
| | - Vasi Naganathan
- Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, Australia
- Department of Geriatric Medicine, Centre for Education and Research On Ageing, Concord Hospital, Concord, NSW, Australia
| | - Jesse Jansen
- Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Rachael H Dodd
- The Daffodil Centre, The University of Sydney, a joint venture with the Cancer Council NSW, Sydney, NSW, Australia
| | - Katharine Wallis
- General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, QLD, Australia
| | - Kirsten J McCaffery
- Edward Ford Building (A27), The University of Sydney, Sydney, NSW, Australia.
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Luong R, Ribeiro R, Naganathan V, Blyth F, Waite LM, Handelsman DJ, Le Couteur DG, Seibel MJ, Hirani V. Empirically derived dietary patterns are associated with major adverse cardiovascular events, all-cause mortality, and congestive cardiac failure in older men: The Concord Health and Ageing in Men Project. J Nutr Health Aging 2024; 28:100020. [PMID: 38388114 DOI: 10.1016/j.jnha.2023.100020] [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: 07/31/2023] [Accepted: 10/10/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Diet is associated with major adverse cardiovascular events (MACE). OBJECTIVE We evaluated the associations between empirically derived dietary patterns and MACE. DESIGN Prospective cohort study. SETTING The Concord Health and Ageing in Men Project, Sydney, Australia. PARTICIPANTS 539 community-dwelling older Australian men aged 75 years and older. METHODS Men underwent dietary assessment using a validated dietitian-administered diet history questionnaire. Cox regression analyses were conducted between MACE and the three dietary patterns identified from factor analysis. Five-point MACE comprised of all-cause mortality, myocardial infarction (MI), congestive cardiac failure (CCF), coronary revascularisation, and/or ischaemic stroke. Four-point MACE included the four endpoints of MI, CCF, coronary revascularisation, and/or ischaemic stroke, and excluded all-cause mortality. RESULTS At a median of 5.3 (IQR 4.6-6.3) years of follow-up, the incidences were: five-point MACE 31.2% (n = 168); four-point MACE excluding all-cause mortality 17.8% (n = 96); all-cause mortality 20.1% (n = 111); CCF 11.3% (n = 61); MI 3.7% (n = 20); stroke 3.2% (n = 17); and coronary revascularisation 3.1% (n = 15). In fully adjusted analyses, compared to the bottom tertile, the middle tertile of 'vegetables-legumes-seafood' dietary pattern was associated with reduced five-point MACE (HR 0.67 [95% CI: 0.45, 0.99, P = .047]), and CCF (HR 0.31 [95% CI: 0.15, 0.65, P = .002]), whilst the middle tertile of 'wholegrains-milk-other fruits' dietary pattern was associated with increased five-point MACE (HR 1.78 [95% CI: 1.17, 2.70, P = .007]), four-point MACE (HR 1.92 [95% CI: 1.12, 3.30, P = .018]), and CCF (HR 2.33 [95% CI: 1.17, 4.65, P = .016]). For the 'discretionary-starchy vegetables-processed meats' dietary pattern, a higher score was associated with increased five-point MACE (HR 1.33 [95% CI: 1.09, 1.62, P = .004]), and all-cause mortality (HR 1.63 [95% CI: 1.26, 2.12, P < .001]), and compared to the bottom tertile, the top tertile was associated with increased all-cause mortality (HR 2.26 [95% CI: 1.27, 4.00, P = .005]). CONCLUSION Older men may benefit from consuming a 'vegetables-legumes-seafood' dietary pattern rather than 'discretionary-starchy vegetables-processed meats' and 'wholegrains-milk-other fruits' dietary patterns for the prevention of MACE.
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Affiliation(s)
- Rebecca Luong
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia.
| | - Rosilene Ribeiro
- Charles Perkins Centre, The University of Sydney, NSW, Australia; School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - Fiona Blyth
- ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; School of Public Health, The University of Sydney, NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - David J Handelsman
- ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia; Andrology Department, Concord Hospital, Concord, NSW, Australia
| | - David G Le Couteur
- Charles Perkins Centre, The University of Sydney, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
| | - Markus J Seibel
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
| | - Vasant Hirani
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia; Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
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Nguyen TX, Nguyen AHP, Nguyen HTT, Nguyen TTH, Nguyen HL, Goldberg RJ, Thillainadesan J, Naganathan V, Vu HTT, Tran LV, Nguyen AT. Health-Related Quality of Life among Older Adults with Dementia Living in Vietnamese Nursing Homes. Int J Environ Res Public Health 2024; 21:135. [PMID: 38397626 PMCID: PMC10888023 DOI: 10.3390/ijerph21020135] [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] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/25/2024]
Abstract
Better understanding of the quality of life among nursing home residents with dementia is important for developing interventions. The objectives of this cross-sectional study were to examine factors associated with poor health-related quality of life in older people with dementia living in nursing homes in Hanoi, Vietnam. In-person interviews were conducted with 140 adults who were 60 years and older with dementia, and information about their quality of life was obtained using the Quality of Life in Alzheimer's Disease (QOL-AD) scale. The sociodemographic and clinical factors associated with poor health-related quality of life (lowest quartile) were assessed through the results of physical tests, interviews with nursing home staff, and review of medical records. The average age of the study sample was 78.3 years, 65% were women, and their average QOL-AD total score was 27.3 (SD = 4.4). Malnutrition, total dependence in activities of daily living, and urinary incontinence were associated with poor quality of life after controlling for multiple potentially confounding factors. Our findings show that Vietnamese nursing home residents with dementia have a moderate total quality of life score, and interventions based on comprehensive geriatric assessment remain needed to modify risk factors related to poor health-related quality of life.
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Affiliation(s)
- Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam; (H.T.T.N.); (T.T.H.N.); (H.T.T.V.); (A.T.N.)
- National Geriatric Hospital, Hanoi 100000, Vietnam;
| | - Anh Huynh Phuong Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam; (H.T.T.N.); (T.T.H.N.); (H.T.T.V.); (A.T.N.)
- National Geriatric Hospital, Hanoi 100000, Vietnam;
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam; (H.T.T.N.); (T.T.H.N.); (H.T.T.V.); (A.T.N.)
- National Geriatric Hospital, Hanoi 100000, Vietnam;
| | - Hoa Lan Nguyen
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA; (H.L.N.); (R.J.G.)
| | - Robert Joel Goldberg
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA; (H.L.N.); (R.J.G.)
| | - Janani Thillainadesan
- Department of Geriatric Medicine, Centre for Education and Research on Ageing (CERA), Concord Hospital, Sydney, NSW 2139, Australia; (J.T.); (V.N.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Vasi Naganathan
- Department of Geriatric Medicine, Centre for Education and Research on Ageing (CERA), Concord Hospital, Sydney, NSW 2139, Australia; (J.T.); (V.N.)
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam; (H.T.T.N.); (T.T.H.N.); (H.T.T.V.); (A.T.N.)
- National Geriatric Hospital, Hanoi 100000, Vietnam;
| | - Luc Viet Tran
- National Geriatric Hospital, Hanoi 100000, Vietnam;
- Neurology Department, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi 100000, Vietnam; (H.T.T.N.); (T.T.H.N.); (H.T.T.V.); (A.T.N.)
- National Geriatric Hospital, Hanoi 100000, Vietnam;
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11
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Marshall KH, Riddiford-Harland DL, Meller AE, Kruger V, Kirsebom M, Tran M, Caplan GA, Naganathan V, Cullen J, Gonski P, Zwar N, O'Keeffe JA, Krysinska K, Rhee JJ. Feasibility and acceptability of facilitated advance care planning in outpatient clinics: A qualitative study of health-care professionals experience. Australas J Ageing 2024. [PMID: 38258915 DOI: 10.1111/ajag.13272] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/15/2023] [Accepted: 11/24/2023] [Indexed: 01/24/2024]
Abstract
OBJECTIVE This study sought to determine the feasibility and acceptability of a facilitated advance care planning (ACP) intervention implemented in outpatient clinics, as perceived by health-care professionals (HCPs). METHODS Data from seven focus groups (n = 27) and nine semi-structured interviews with HCPs recruited as part of a pragmatic, randomised controlled trial (RCT) were analysed using qualitative descriptive methodology. Components of the intervention included HCP education and training, tools to assist HCPs with patient selection, hardcopy information, and ACP documentation, and specialised nurse-facilitators to support HCPs to complete ACP conversations and documentation with patients and caregivers. RESULTS Health-care professionals working in tertiary outpatient clinics perceived the facilitated ACP intervention as feasible and acceptable. Health-care professionals reported a high level of satisfaction with key elements of the intervention, including the specialised education and training, screening and assessment procedures and ongoing support from the nurse-facilitators. Health-care professionals reported this training and support increased their confidence and ACP knowledge, leading to more frequent ACP discussions with patients and their families. Health-care professionals noted their ability to conduct ACP screening and assessment in clinic was impeded by large clinical caseloads and patient-related factors (e.g., dementia diagnoses, and emotional distress). Additional barriers to ACP implementation identified by HCPs included poor collaboration, constrained time and clinical space, undefined roles and standardised recording procedures for HCPs. CONCLUSIONS Facilitated ACP intervention in outpatient clinics is perceived by HCPs as feasible and acceptable. Addressing barriers and tailoring implementation strategies may improve the delivery of ACP as part of tertiary outpatient care.
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Affiliation(s)
- Kate H Marshall
- Faculty of Medicine & Health, UNSW Academic General Practice Network, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Anne E Meller
- Advance Care Planning Services, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Vanessa Kruger
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Marie Kirsebom
- Section of Caring Sciences, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Michael Tran
- Faculty of Medicine & Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Gideon A Caplan
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Faculty of Medicine and Health, Centre for Education and Research on Ageing, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - John Cullen
- Faculty of Medicine and Health, Centre for Education and Research on Ageing, Concord Clinical School, University of Sydney, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Peter Gonski
- Southcare Aged and Extended Community Care, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Julie-Ann O'Keeffe
- Aged, Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Karolina Krysinska
- Centre for Primary Health Care and Equity, Faculty of Medicine & Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Joel J Rhee
- Faculty of Medicine & Health, UNSW Academic General Practice Network, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine & Health, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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12
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Weng V, Wiles N, Jenkins D, Amanatidis S, Kidd JC, Walsh JA, Baillie AJ, Naganathan V. The effectiveness of a home-based dietetic intervention for community-dwelling older adults. Australas J Ageing 2024. [PMID: 38217875 DOI: 10.1111/ajag.13264] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES The aim of this study was to describe the characteristics of clients receiving home-based dietetic intervention and to evaluate the effectiveness of these interventions in improving nutritional status, functional status, and quality of life in a culturally and socioeconomically diverse client group. METHODS Participants referred to a home-based dietetic service were recruited to this prospective cohort study. Dietetic interventions were recommended at baseline and reviewed at 3-month follow-up. Assessment of nutritional, functional and quality of life markers was measured using the Mini Nutritional Assessment (MNA), Timed Up and Go (TUG) and EQ-5D-5L, respectively, at baseline and after home-based dietetic intervention. RESULTS Participants (n = 99) were recruited from consecutive referrals. Participant's weight, body mass index (BMI), total daily energy and protein intake, MNA total score, and TUG significantly improved after a 3-month nutrition intervention (effect sizes 0.257, 0.257, 0.580, 0.533, 0.577 and 0.281, respectively). The most common interventions dietitians utilised were nutrition education, use of oral nutritional supplements (ONS) and meal fortification. In total, 339 dietetic interventions were recommended to participants at baseline with 197 (58.11%) implemented at 3 months, with meal planning and referral to other relevant allied health or Commonwealth Home Support Program (CHSP) services the most implemented interventions. CONCLUSIONS Home-based dietetic intervention improves nutritional status, functional status and quality of life in community-dwelling older adults referred for dietetic input. Improvements observed in nutritional and functional status were consistent with benchmarks of change from published literature.
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Affiliation(s)
- Vicky Weng
- Community Nutrition, Primary and Community Health, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nicole Wiles
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Deanna Jenkins
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sue Amanatidis
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Joanna C Kidd
- Department of Speech Pathology, Campbelltown Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jessica A Walsh
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Andrew J Baillie
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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13
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Luong R, Ribeiro R, Naganathan V, Blyth F, Waite LM, Handelsman DJ, Le Couteur DG, Seibel MJ, Hirani V. Cross-sectional and longitudinal associations between empirically derived dietary patterns and frailty among older men: The Concord Health and Ageing in Men Project. J Nutr Health Aging 2024; 28:100021. [PMID: 38267155 DOI: 10.1016/j.jnha.2023.100021] [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: 07/31/2023] [Accepted: 11/30/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Diet may be associated with frailty. OBJECTIVE We aimed to evaluate the associations between empirically derived dietary patterns and frailty in older men. DESIGN Prospective cohort study. SETTING The Concord Health and Ageing in Men Project, Sydney, Australia. PARTICIPANTS 785 community-dwelling older Australian men aged 75 years and older. METHODS Men underwent dietary assessment using a validated dietitian-administered diet history questionnaire. Factor analysis identified three dietary patterns. Multinomial logistic regression was conducted between frailty and dietary patterns for cross-sectional analyses and longitudinal analyses over a 3-year follow-up. Frailty was defined by the Fried frailty phenotype. RESULTS Of the 785 men, pre-frailty was prevalent in 47.1% (n = 370), and frailty in 8.3% (n = 65). In fully adjusted cross-sectional analyses, the top tertile and a higher 'vegetables-legumes-seafood' dietary pattern score were associated with reduced prevalence of frailty (OR 0.34 [95% CI: 0.12, 0.93, P = .036]) and OR 0.50 [95% CI: 0.30, 0.83, P = .007] respectively). The top tertile of the 'discretionary-starchy vegetables-processed meats' dietary pattern was also associated cross-sectionally with increased prevalence of pre-frailty (OR 1.75 [95% CI: 1.08, 2.83, P = .022]). Of the 296 robust men in fully adjusted longitudinal analyses, the incidence of pre-frailty was 52.4% (n = 155), and frailty was 5.4% (n = 16) over a 3-year follow-up. The middle tertile of the 'vegetables-legumes-seafood' dietary pattern had a non-significant trend towards reduced incident pre-frailty (OR 0.52 [95% CI: 0.27, 1.00, P = .050]). CONCLUSION Consumption of a 'vegetables-legumes-seafood' dietary pattern appears to be less favoured by frail older men.
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Affiliation(s)
- Rebecca Luong
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia.
| | - Rosilene Ribeiro
- Charles Perkins Centre, The University of Sydney, NSW, Australia; School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - Fiona Blyth
- ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; School of Public Health, The University of Sydney, NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - David J Handelsman
- ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia; Andrology Department, Concord Hospital, Concord, NSW, Australia
| | - David G Le Couteur
- Charles Perkins Centre, The University of Sydney, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
| | - Markus J Seibel
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
| | - Vasant Hirani
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia; Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
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Ssonko M, Hardy A, Naganathan V, Kalula S, Combrinck M. Dementia subtypes, cognitive decline and survival among older adults attending a memory clinic in Cape Town, South Africa: a retrospective study. BMC Geriatr 2023; 23:829. [PMID: 38071284 PMCID: PMC10709983 DOI: 10.1186/s12877-023-04536-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There are no published longitudinal studies from Africa of people with dementia seen in memory clinics. The aim of this study was to determine the proportions of the different dementia subtypes, rates of cognitive decline, and predictors of survival in patients diagnosed with dementia and seen in a memory clinic. METHODS Data were collected retrospectively from clinic records of patients aged ≥ 60 seen in the memory clinic at Groote Schuur Hospital, Cape Town, South Africa over a 10-year period. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were used to identify patients with Major Neurocognitive Disorders (dementia). Additional diagnostic criteria were used to determine the specific subtypes of dementia. Linear regression analysis was used to determine crude rates of cognitive decline, expressed as mini-mental state examination (MMSE) points lost per year. Changes in MMSE scores were derived using mixed effects modelling to curvilinear models of cognitive change, with time as the dependent variable. Multivariable cox survival analysis was used to determine factors at baseline that predicted mortality. RESULTS Of the 165 patients who met inclusion criteria, 117(70.9%) had Major Neurocognitive Disorder due to Alzheimer's disease (AD), 24(14.6%) Vascular Neurocognitive Disorder (VND), 6(3.6%) Dementia with Lewy Bodies (DLB), 5(3%) Parkinson disease-associated dementia (PDD), 3(1.8%) fronto-temporal dementia, 4(2.4%) mixed dementia and 6(3.6%) other types of dementia. The average annual decline in MMSE points was 2.2(DLB/PDD), 2.1(AD) and 1.3(VND). Cognitive scores at baseline were significantly lower in patients with 8 compared to 13 years of education and in those with VND compared with AD. Factors associated with shorter survival included age at onset greater than 65 (HR = 1.82, 95% C.I. 1.11, 2.99, p = 0.017), lower baseline MMSE (HR = 1.05, 95% C.I. 1.01, 1.10, p = 0.029), Charlson's comorbidity scores of 3 to 4 (HR = 1.88, 95% C.I. 1.14, 3.10, p = 0.014), scores of 5 or more (HR = 1.97, 95% C.I. 1.16, 3.34, p = 0.012) and DLB/PDD (HR = 3.07, 95% C.I. 1.50, 6.29, p = 0.002). Being female (HR = 0.59, 95% C.I.0.36, 0.95, p = 0.029) was associated with longer survival. CONCLUSIONS Knowledge of dementia subtypes, the rate and factors affecting cognitive decline and survival outcomes will help inform decisions about patient selection for potential future therapies and for planning dementia services in resource-poor settings.
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Affiliation(s)
- Michael Ssonko
- Division of Geriatric Medicine, Groote Schuur Hospital & Institute of Ageing in Africa, Cape Town, South Africa.
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | | | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Education and Research On Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Sebastiana Kalula
- Division of Geriatric Medicine, Groote Schuur Hospital & Institute of Ageing in Africa, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Marc Combrinck
- Division of Geriatric Medicine, Groote Schuur Hospital & Institute of Ageing in Africa, Cape Town, South Africa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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15
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Thillainadesan J, Naganathan V, Hilmer SN, Kerdic R, Aitken SJ. Microlearning for surgical residents enhances perioperative comprehensive geriatric assessment. J Am Geriatr Soc 2023; 71:E30-E33. [PMID: 37776048 PMCID: PMC10952399 DOI: 10.1111/jgs.18612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Janani Thillainadesan
- Department of Geriatric MedicineConcord HospitalConcord, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
- Centre for Education and Research on AgeingConcord HospitalSydneyNew South WalesAustralia
| | - Vasi Naganathan
- Department of Geriatric MedicineConcord HospitalConcord, SydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
- Centre for Education and Research on AgeingConcord HospitalSydneyNew South WalesAustralia
| | - Sarah N. Hilmer
- Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
- Kolling Institute of Medical ResearchThe University of Sydney and Northern Sydney Local Health DistrictSt Leonards, SydneyNew South WalesAustralia
| | - Richard Kerdic
- Department of Vascular SurgeryConcord HospitalConcord, SydneyNew South WalesAustralia
| | - Sarah J. Aitken
- Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
- Department of Vascular SurgeryConcord HospitalConcord, SydneyNew South WalesAustralia
- Concord Institute of Academic SurgeryConcord HospitalConcord, SydneyNew South WalesAustralia
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16
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Nguyen TN, Nguyen TN, Thillainadesan J, Nguyen AT, Nguyen HTT, Nguyen TTH, Nguyen HTT, Nguyen TX, Naganathan V, Vu HTT. Factors associated with frailty in geriatric patients with and without sarcopenia in Vietnam. Australas J Ageing 2023. [PMID: 37842735 DOI: 10.1111/ajag.13253] [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: 11/07/2022] [Revised: 08/15/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES This study aimed to investigate the relationship between sarcopenia and frailty and examine factors associated with frailty among older patients with and without sarcopenia. METHODS This cross-sectional study was conducted on older inpatients and outpatients in Vietnam. Participants aged 60 years or older were consecutively enrolled in the study. Sarcopenia was defined using the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Fried's frailty phenotype was applied to define frailty. Logistic regression models with frailty as the dependent variable were applied. RESULTS A total of 835 patients (mean age: 71.3 years, SD 8.4) were recruited. The overall prevalence of frailty was 17%. Among participants with and without frailty, 92% and 47% had sarcopenia, respectively. In unadjusted analysis, sarcopenia was significantly associated with increased frailty (OR 12.3, 95% CI 6.7-22.6) and remained significant after adjustment for sociodemographic factors (OR 6.3, 95% CI: 3.0-12.6) and for both sociodemographic and clinical factors (OR 5.4, 95% CI: 2.4-12.2). Among participants with sarcopenia, older age, inpatient status, having a high risk for falls, malnutrition and a history of hospitalisation in the last year were significantly associated with frailty. Among participants without sarcopenia, the factors associated with frailty were older age, inpatient status, low educational level, high risk of falls and malnutrition. CONCLUSIONS Our study results highlighted that sarcopenia and frailty are two related but distinct geriatric syndromes.
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Affiliation(s)
- Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Tu Ngoc Nguyen
- Faculty of Medicine and Health, Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Janani Thillainadesan
- Department of Geriatric Medicine and Centre for Education and Research on Ageing (CERA), Concord Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Huong Thi Thanh Nguyen
- Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam
- Physiology Department, Hanoi Medical University, Hanoi, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Vasi Naganathan
- Department of Geriatric Medicine and Centre for Education and Research on Ageing (CERA), Concord Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
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Smith J, Dodd RH, Naganathan V, Cvejic E, Jansen J, Wallis K, McCaffery KJ. Screening for cancer beyond recommended upper age limits: views and experiences of older people. Age Ageing 2023; 52:afad196. [PMID: 37930739 DOI: 10.1093/ageing/afad196] [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: 02/27/2023] [Revised: 08/21/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Internationally, screening programmes and clinical practice guidelines recommend when older adults should stop cancer screening using upper age limits, but it is unknown how older adults view these recommendations. OBJECTIVE To examine older adults' views and experiences about continuing or stopping cancer screening beyond the recommended upper age limit for breast, cervical, prostate and bowel cancer. DESIGN Qualitative, semi-structured interviews. SETTING Australia, telephone. SUBJECTS A total of 29 community-dwelling older adults (≥70-years); recruited from organisation newsletters, mailing lists and Facebook advertisements. METHODS Interviews were audio-recorded, transcribed and analysed thematically using Framework Analysis. RESULTS Firstly, older adults were on a spectrum between trusting recommendations and actively deciding about cancer screening, with some who were uncertain. Secondly, participants reported limited in-depth discussions with health professionals about cancer screening. In primary care, discussions were focused on checking they were up to date with screening or going over results. Discussions mostly only occurred if older adults initiated themselves. Finally, participants had a socially- and self-constructed understanding of screening recommendations and potential outcomes. Perceived reasons for upper age limits were cost, reduced cancer risk or ageism. Risks of screening were understood in relation to their own social experiences (e.g. shared stories about friends with adverse outcomes of cancer treatment or conversations with friends/family about controversy around prostate screening). CONCLUSIONS Direct-to-patient information and clinician support may help improve communication about the changing benefit to harm ratio of cancer screening with increasing age and increase understanding about the rationale for an upper age limit for cancer screening programmes.
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Affiliation(s)
- Jenna Smith
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachael H Dodd
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation Hospital, Sydney, NSW, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Katharine Wallis
- General Practice Clinical Unit, The University of Queensland, Queensland, QLD, Australia
| | - Kirsten J McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Wright FAC, Shu ECC, Cumming RG, Naganathan V, Blyth FM, Hirani V, Le Couteur DG, Handelsman DJ, Seibel MJ, Waite LM, Stanaway FF. Oral health-related quality of life of older Australian men. Community Dent Oral Epidemiol 2023; 51:767-777. [PMID: 35561045 DOI: 10.1111/cdoe.12754] [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: 05/07/2021] [Revised: 02/16/2022] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aims of this study were to assess oral health-related quality of life (OHRQoL) in a cohort of older Australian men and explore the association between their general health conditions, socio-demographic factors and OHRQoL. METHODS The Concord Health and Ageing in Men Project (CHAMP) is a cohort study of the health of a representative sample of Australian men, initiated in 2005-2006 with an initial sample of 1705 men 70 years or over. Participants completed a self-administered health and socio-demographic questionnaire and attended an interview and clinical assessment at baseline and each of three follow-up assessments. Information on oral health and responses to the Oral Health Impact Profile (OHIP-14) were collected in the 4th follow-up in which 778 men completed the OHIP-14 questionnaire and 614 men had a dental assessment. The prevalence of oral health impact was defined as a response of fairly often or very often to one or more of the OHIP-14 questions. Mean OHIP-14 scores were calculated for the 14 questions and used as the dependent variable in the regression analyses. Zero-inflated Poisson regression was used to estimate prevalence rate ratios (PRR). RESULTS Only 10% of men presented oral health impacts. In multivariate regression modelling, being born in Italy/Greece (PRR: 2.16, 95% CI: 1.93-2.42) or in other countries (PRR: 2.12, 95% CI: 1.89-2.38), having poor self-rated general health (PRR: 1.38, 95% CI: 1.24-1.53), having poor mental wellbeing (PRR: 1.14, 95% CI: 1.04-1.24), having ≥6 depressive symptoms (PRR: 1.18, 95% CI: 1.05-1.32), being a current smoker (PRR: 1.34, 95% CI: 1.06-1.70) and having more decayed tooth surfaces (PRR:1.01, 95% CI: 1.00-1.02) were associated with higher impact scores. CONCLUSIONS Overall, older Australian men exhibit good oral health-related quality of life. The inter-relationship between perceptions of general health and well-being, health and oral health variables and social background supports policy objectives of closer integration of general health and oral health services for older Australian men.
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Affiliation(s)
- Fredrick Alan Clive Wright
- Centre for Education and Research on Ageing, Concord Clinical School the University of Sydney and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Ellie C-C Shu
- Centre for Education and Research on Ageing, Concord Clinical School the University of Sydney and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Robert G Cumming
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Clinical School the University of Sydney and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Fiona M Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Vasant Hirani
- School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, Concord Clinical School the University of Sydney and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, Concord Repatriation General Hospital, University of Sydney, Concord, New South Wales, Australia
| | - Markus J Seibel
- Concord Clinical School, University of Sydney and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Clinical School the University of Sydney and Sydney Local Health District, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Fiona F Stanaway
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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Smith J, Dodd RH, Gainey KM, Naganathan V, Cvejic E, Jansen J, McCaffery KJ. Factors Influencing Primary Care Practitioners' Cancer Screening Recommendations for Older Adults: a Systematic Review. J Gen Intern Med 2023; 38:2998-3020. [PMID: 37142822 PMCID: PMC10593684 DOI: 10.1007/s11606-023-08213-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/12/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Primary care practitioners (PCPs) play a key role in cancer screening decisions for older adults (≥ 65 years), but recommendations vary by cancer type and jurisdiction. PURPOSE To examine the factors influencing PCPs' recommendations for breast, cervical, prostate, and colorectal cancer screening for older adults. DATA SOURCES MEDLINE, Pre-Medline, EMBASE, PsycINFO, and CINAHL, searched from 1 January 2000 to July 2021, and citation searching in July 2022. STUDY SELECTION Assessed factors influencing PCPs' breast, prostate, colorectal, or cervical cancer screening decisions for older adults' (defined either as ≥ 65 years or < 10-year life expectancy). DATA EXTRACTION Two authors independently conducted data extraction and quality appraisal. Decisions were crosschecked and discussed where necessary. DATA SYNTHESIS From 1926 records, 30 studies met inclusion criteria. Twenty were quantitative, nine were qualitative, and one used a mixed method design. Twenty-nine were conducted in the USA, and one in the UK. Factors were synthesized into six categories: patient demographic characteristics, patient health characteristics, patient and clinician psycho-social factors, clinician characteristics, and health system factors. Patient preference was most reported as influential across both quantitative and qualitative studies. Age, health status, and life expectancy were also commonly influential, but PCPs held nuanced views about life expectancy. Weighing benefits/harms was also commonly reported with variation across cancer screening types. Other factors included patient screening history, clinician attitudes/personal experiences, patient/provider relationship, guidelines, reminders, and time. LIMITATIONS We could not conduct a meta-analysis due to variability in study designs and measurement. The vast majority of included studies were conducted in the USA. CONCLUSIONS Although PCPs play a role in individualizing cancer screening for older adults, multi-level interventions are needed to improve these decisions. Decision support should continue to be developed and implemented to support informed choice for older adults and assist PCPs to consistently provide evidence-based recommendations. REGISTRATION PROSPERO CRD42021268219. FUNDING SOURCE NHMRC APP1113532.
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Affiliation(s)
- Jenna Smith
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006 Australia
| | - Rachael H. Dodd
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
- The Daffodil Centre, a joint venture between Cancer Council NSW and The University of Sydney, Faculty of Medicine and Health, Sydney, NSW Australia
| | - Karen M. Gainey
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
- Centre for Education and Research On Ageing, Department of Geriatric Medicine, Concord Repatriation Hospital, Sydney, NSW Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Kirsten J. McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
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20
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Scott D, Blyth F, Naganathan V, Le Couteur DG, Handelsman DJ, Waite LM, Hirani V. Sarcopenia prevalence and functional outcomes in older men with obesity: Comparing the use of the EWGSOP2 sarcopenia versus ESPEN-EASO sarcopenic obesity consensus definitions. Clin Nutr 2023; 42:1610-1618. [PMID: 37481869 DOI: 10.1016/j.clnu.2023.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/17/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND & AIMS The potential for older adults with obesity to also have sarcopenia, and the health consequences of 'sarcopenic obesity', may be underappreciated by health professionals. The primary aim of this secondary analysis of a prospective cohort study of older men was to explore the prevalence and functional outcomes of sarcopenic obesity based on different consensus definitions. METHODS 1416 community-dwelling men aged ≥70 years were classified into sarcopenia categories according to the European Working Group on Sarcopenia in Older People (EWGSOP2) definition, and sarcopenic obesity categories according to the European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity (ESPEN-EASO) definition. Descriptive analyses determined prevalence of sarcopenia in obese and non-obese older men. Multivariable analyses compared associations with functional outcomes including activity of daily living (ADL) and instrumental activity of daily living (IADL) disability and 12-month incident falls. RESULTS According to the EWGSOP2 definition, 12.6% of men had confirmed sarcopenia but only 0.3% of men had sarcopenia and obesity (BMI ≥30 kg/m2). Conversely, 9.6% of men had sarcopenic obesity according to the ESPEN-EASO definition. Notably, no men with a BMI ≥32 kg/m2 were classified as having EWGSOP2-confirmed sarcopenia, despite the fact that 60.8% of all men with BMI ≥32 kg/m2 had low muscle strength. Due to low numbers (N = 4) of obese older men with EWGSOP2-confirmed sarcopenia, associations with functional outcomes were not assessed. Men with sarcopenic obesity according to the ESPEN-EASO definition had significantly lower hand grip strength, higher chair-stands time and slower gait speed (all P < 0.05), increased odds for ADL (odds ratio: 5.02, 95% CI: 1.85-13.58) and IADL (2.18, 1.38-3.45) disability, and higher 12-month incident falls rates (incident rate ratio: 1.59, 95% CI: 1.03-2.44) than men with neither sarcopenia nor obesity. CONCLUSION Low muscle strength is common in older men with obesity, but the prevalence of sarcopenia is likely to be underestimated when the EWGSOP2 operational definition is applied in this population. The ESPEN-EASO operational definition of sarcopenic obesity appears to provide a valid approach for identifying older men with obesity who are at risk of poor functional outcomes related to sarcopenia.
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Affiliation(s)
- David Scott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia; School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
| | - Fiona Blyth
- School of Public Health, University of Sydney, New South Wales, Sydney, Australia; Centre for Education and Research, Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia; The ARC Centre of Excellence in Population Ageing Research, University of Sydney, New South Wales, Sydney, Australia
| | - Vasi Naganathan
- Centre for Education and Research, Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia; Concord Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Sydney, Australia
| | - David G Le Couteur
- Centre for Education and Research, Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia; ANZAC Research Institute & Charles Perkins Centre, University of Sydney, New South Wales, Sydney, Australia
| | - David J Handelsman
- Department of Andrology, Concord Hospital & ANZAC Research Institute, University of Sydney, New South Wales, Sydney, Australia
| | - Louise M Waite
- Centre for Education and Research, Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Vasant Hirani
- School of Public Health, University of Sydney, New South Wales, Sydney, Australia; The ARC Centre of Excellence in Population Ageing Research, University of Sydney, New South Wales, Sydney, Australia
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21
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Thillainadesan J, Box H, Kearney L, Naganathan V, Cunich M, Aitken SJ, Monaro SR. The experience of hospital care for older surgical patients and their carers: A mixed-methods study. Australas J Ageing 2023; 42:535-544. [PMID: 36847376 PMCID: PMC10946774 DOI: 10.1111/ajag.13176] [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: 10/13/2022] [Revised: 12/18/2022] [Accepted: 01/23/2023] [Indexed: 03/01/2023]
Abstract
OBJECTIVE A growing proportion of older adults are undergoing surgery, but there is a paucity of patient and carer experience research in this group. This study investigated the experience of hospital care in an older vascular surgery population for patients and their carers. METHODS This was a mixed-methods convergent design, including simultaneous collection of quantitative and qualitative research strands by combining open-ended questions with rating scales in a questionnaire. Recently hospitalised vascular surgery patients aged ≥65 years at a major teaching hospital were recruited. Carers were also approached to participate. RESULTS Forty-seven patients (mean age 77 years, 77% male, 20% with a Clinical Frailty Scale score >4) and nine carers participated. The majority of patients reported that their views were listened to (n = 42, 89%), they were kept informed (n = 39, 83%), and were asked about their pain (n = 37, 79%). Among carers, seven reported their views were listened to and that they were kept informed. Thematic analysis of patients' and carers' responses to open-ended questions about their experience of hospital care revealed four themes in terms of what mattered to them: fundamental care including hygiene and nutrition, comfort of the hospital environment such as sleep and meals, being informed and involved in health-care decision-making, and treating pain and deconditioning to help recovery. CONCLUSIONS Older adults admitted to hospital for vascular surgery and their carers, valued highly the care that met both their fundamental needs and facilitated shared decisions for care and recovery. These priorities can be addressed through Age-Friendly Health System initiatives.
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Affiliation(s)
- Janani Thillainadesan
- Department of Geriatric MedicineConcord HospitalSydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
- Centre for Education and Research on AgeingConcord HospitalSydneyNew South WalesAustralia
- Sydney Health Economics CollaborativeSydney Local Health DistrictCamperdown, SydneyNew South WalesAustralia
| | - Helen Box
- Centre for Education and Research on AgeingConcord HospitalSydneyNew South WalesAustralia
| | - Leanne Kearney
- Centre for Education and Research on AgeingConcord HospitalSydneyNew South WalesAustralia
| | - Vasi Naganathan
- Department of Geriatric MedicineConcord HospitalSydneyNew South WalesAustralia
- Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
- Centre for Education and Research on AgeingConcord HospitalSydneyNew South WalesAustralia
| | - Michelle Cunich
- Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
- Sydney Health Economics CollaborativeSydney Local Health DistrictCamperdown, SydneyNew South WalesAustralia
| | - Sarah J. Aitken
- Faculty of Medicine and HealthThe University of SydneyCamperdown, SydneyNew South WalesAustralia
- Concord Institute of Academic Surgery, Concord HospitalSydneyNew South WalesAustralia
- Department of Vascular SurgeryConcord HospitalSydneyNew South WalesAustralia
| | - Sue R. Monaro
- Department of Vascular SurgeryConcord HospitalSydneyNew South WalesAustralia
- Susan Wakil School of NursingThe University of SydneySydneyNew 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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Etherton-Beer C, Page A, Naganathan V, Potter K, Comans T, Hilmer SN, McLachlan AJ, Lindley RI, Mangin D. Deprescribing to optimise health outcomes for frail older people: a double-blind placebo-controlled randomised controlled trial-outcomes of the Opti-med study. Age Ageing 2023; 52:7181253. [PMID: 37247404 DOI: 10.1093/ageing/afad081] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND potentially harmful polypharmacy is very common in older people living in aged care facilities. To date, there have been no double-blind randomised controlled studies of deprescribing multiple medications. METHODS three-arm (open intervention, blinded intervention and blinded control) randomised controlled trial enrolling people aged over 65 years (n = 303, noting pre-specified recruitment target of n = 954) living in residential aged care facilities. The blinded groups had medications targeted for deprescribing encapsulated while the medicines were deprescribed (blind intervention) or continued (blind control). A third open intervention arm had unblinded deprescribing of targeted medications. RESULTS participants were 76% female with mean age 85.0 ± 7.5 years. Deprescribing was associated with a significant reduction in the total number of medicines used per participant over 12 months in both intervention groups (blind intervention group -2.7 medicines, 95% CI -3.5, -1.9, and open intervention group -2.3 medicines; 95% CI -3.1, -1.4) compared with the control group (-0.3, 95% CI -1.0, 0.4, P = 0.053). Deprescribing regular medicines was not associated with any significant increase in the number of 'when required' medicines administered. There were no significant differences in mortality in the blind intervention group (HR 0.93, 95% CI 0.50, 1.73, P = 0.83) or the open intervention group (HR 1.47, 95% CI 0.83, 2.61, P = 0.19) compared to the control group. CONCLUSIONS deprescribing of two to three medicines per person was achieved with protocol-based deprescribing during this study. Pre-specified recruitment targets were not met, so the impact of deprescribing on survival and other clinical outcomes remains uncertain.
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Affiliation(s)
- Christopher Etherton-Beer
- WA Centre for Health and Ageing, University of Western Australia, M577, 35 Stirling Hwy, Crawley WA 6009, Australia
| | - Amy Page
- WA Centre for Health and Ageing, University of Western Australia, M577, 35 Stirling Hwy, Crawley WA 6009, Australia
| | - Vasi Naganathan
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kathleen Potter
- Operations, Ryman Healthcare, Christchurch, Canterbury, New Zealand
| | - Tracy Comans
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Sarah N Hilmer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew J McLachlan
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Richard I Lindley
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Dee Mangin
- Family Medicine, McMaster University. Hamilton, Canada
- General Practice, University of Otago, Christchurch, New Zealand
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Quek HW, Etherton-Beer C, Page A, McLachlan AJ, Lo SY, Naganathan V, Kearney L, Hilmer SN, Comans T, Mangin D, Lindley RI, Potter K. Deprescribing for older people living in residential aged care facilities: Pharmacist recommendations, doctor acceptance and implementation. Arch Gerontol Geriatr 2023; 107:104910. [PMID: 36565605 DOI: 10.1016/j.archger.2022.104910] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 10/21/2022] [Revised: 12/07/2022] [Accepted: 12/17/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Deprescribing is an intervention to address the high prevalence of inappropriate polypharmacy in older people living in residential aged care facilities (RACFs). Many deprescribing interventions are complex and involve several stages including initial pharmacist recommendation, subsequent acceptance of the recommendations by a prescriber and the patient, and then actual implementation. OBJECTIVES This study aimed to investigate pharmacist deprescribing recommendations for residents within RACFs, general practitioner (GP) acceptance, and the actual implementation of the accepted recommendations at 12-month. METHODS The intervention occurred as part of a randomised controlled trial and comprised a pharmacist-led medication review using an evidence-based algorithm, with the focus on identifying medications to potentially deprescribe. Consent to participate was obtained from residents (or surrogate decision-makers), RACF nursing staff and the resident's GP. Deprescribing recommendations were reviewed by GPs before implementation as part of the intervention and control arms of the trial, although control group participants continued to receive their usual medications in a blinded manner. RESULTS There were 303 participants enrolled in the study, and 77% (941/1222) of deprescribing recommendations suggested by the pharmacists were accepted by GPs. Of the recommendations accepted by GPs, 74% (692/ 941) were successfully implemented at the end of the follow-up visit at 12 months. The most common reason for deprescribing was because medications were no longer needed (42%, 513/ 1231). CONCLUSION Pharmacist-led deprescribing recommendations arising from an algorithm-based medication review are acceptable to doctors and can have a significant impact on reducing the number of inappropriate medications consumed by older people in RACFs. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613001204730.
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Affiliation(s)
- Hui Wen Quek
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; School of Allied Health, University of Western Australia, Perth, Western Australia, Australia.
| | - Christopher Etherton-Beer
- Western Australia Centre for Health and Aging, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Amy Page
- School of Allied Health, University of Western Australia, Perth, Western Australia, Australia; Western Australia Centre for Health and Aging, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sarita Y Lo
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia; Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Kolling Institute, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney and Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia; Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Leanne Kearney
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Sarah N Hilmer
- Kolling Institute, Faculty of Medicine and Health, Northern Clinical School, The University of Sydney and Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Tracy Comans
- Menzies Health Institute Queensland, Griffith University, University Drive Meadowbrook, Brisbane, Queensland Australia
| | - Derelie Mangin
- Primary Care Research Unit, Department of Public Health and General Practice, Christchurch School of Medicine & Health Sciences, University of Otago, Christchurch, New Zealand
| | - Richard I Lindley
- Sydney Medical School, University of Sydney, Sydney, New South Wales; Australia and The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Kathleen Potter
- Western Australia Centre for Health and Aging, School of Medicine, University of Western Australia, Perth, Western Australia, Australia; Ryman Healthcare, Christchurch, New Zealand
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Weir KR, Bonner C, Naganathan V, Tam CWM, Rigby D, McLachlan AJ, Jansen J. Supporting conversations about medicines and deprescribing: GPs' perspectives on a Medicines Conversation Guide. Int J Pharm Pract 2023; 31:102-105. [PMID: 36413580 DOI: 10.1093/ijpp/riac088] [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: 08/12/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To explore GP perspectives on a Medicines Conversation Guide to support deprescribing communication. METHODS Semistructured interviews with GPs from Australia (n = 32). Participants were purposively sampled with varying experiences and locations. Transcribed audio recordings of interviews were coded using framework analysis. KEY FINDINGS Most GPs stated they would use the Guide in consultation with an older patient to discuss medications. The strengths of the Guide included empowering the patient voice on an important topic. Limitations included time and complex concepts. CONCLUSIONS Overall, the Medicines Conversation Guide was perceived by GPs to be a useful communication tool to support discussions about deprescribing with patients.
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Affiliation(s)
- Kristie Rebecca Weir
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Carissa Bonner
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chun Wah Michael Tam
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,School of Population Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Debbie Rigby
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane City, Queensland, Australia
| | - Andrew J McLachlan
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jesse Jansen
- Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Wang J, James S, Hilmer SN, Aitken SJ, Soo G, Naganathan V, Kearney L, Thillainadesan J. Optimising Medications in Older Vascular Surgery Patients Through Geriatric Co-management. Drugs Aging 2023; 40:335-342. [PMID: 36862371 PMCID: PMC9979113 DOI: 10.1007/s40266-023-01015-7] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Prescribing of potentially inappropriate medications and under-prescribing of guideline-recommended medications for cardiovascular risk modification have both been associated with negative outcomes in older adults. Hospitalisation represents an important opportunity to optimise medication use and may be achieved through geriatrician-led interventions. OBJECTIVE We aimed to evaluate whether implementation of a novel model of care called Geriatric Comanagement of older Vascular (GeriCO-V) surgery patients is associated with improvements in medication prescribing. METHODS We used a prospective pre-post study design. The intervention was a geriatric co-management model, where a geriatrician delivered comprehensive geriatric assessment-based interventions including a routine medication review. We included consecutively admitted patients to the vascular surgery unit at a tertiary academic centre aged ≥ 65 years with an expected length of stay of ≥ 2 days and who were discharged from hospital. Outcomes of interest were the prevalence of at least one potentially inappropriate medication as defined by the Beers Criteria at admission and discharge, and rates of cessation of at least one potentially inappropriate medication present on admission. In the subgroup of patients with peripheral arterial disease, the prevalence of guideline-recommended medications on discharge was determined. RESULTS There were 137 patients in the pre-intervention group (median [interquartile range] age: 80.0 [74.0-85.0] years, 83 [60.6%] with peripheral arterial disease) and 132 patients in the post-intervention group (median [interquartile range] age: 79.0 (73.0-84.0) years, 75 [56.8%] with peripheral arterial disease). There was no change in the prevalence of potentially inappropriate medication use from admission to discharge in either group (pre-intervention: 74.5% on admission vs 75.2% on discharge; post-intervention: 72.0% vs 72.7%, p = 0.65). Forty-five percent of pre-intervention group patients had at least one potentially inappropriate medication present on admission ceased, compared with 36% of post-intervention group patients (p = 0.11). A higher number of patients with peripheral arterial disease in the post-intervention group were discharged on antiplatelet agent therapy (63 [84.0%] vs 53 [63.9%], p = 0.004) and lipid-lowering therapy (58 [77.3%] vs 55 [66.3%], p = 0.12). CONCLUSIONS Geriatric co-management was associated with an improvement in guideline-recommended antiplatelet agent prescribing aimed at cardiovascular risk modification for older vascular surgery patients. The prevalence of potentially inappropriate medications was high in this population, and was not reduced with geriatric co-management.
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Affiliation(s)
- Jeff Wang
- grid.414685.a0000 0004 0392 3935Centre for Education and Research on Ageing, Concord Hospital, Concord, Sydney, NSW Australia
| | - Sophie James
- grid.414685.a0000 0004 0392 3935Centre for Education and Research on Ageing, Concord Hospital, Concord, Sydney, NSW Australia
| | - Sarah N. Hilmer
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Concord, Sydney, NSW Australia ,grid.412703.30000 0004 0587 9093Kolling Institute of Medical Research, Sydney Medical School, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, NSW Australia
| | - Sarah J. Aitken
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Concord, Sydney, NSW Australia ,grid.414685.a0000 0004 0392 3935Department of Vascular Surgery, Concord Hospital, Concord, Sydney, NSW Australia
| | - Garry Soo
- grid.414685.a0000 0004 0392 3935Department of Pharmacy, Concord Hospital, Concord, Sydney, NSW Australia
| | - Vasi Naganathan
- grid.414685.a0000 0004 0392 3935Centre for Education and Research on Ageing, Concord Hospital, Concord, Sydney, NSW Australia ,grid.1013.30000 0004 1936 834XFaculty of Medicine and Health, The University of Sydney, Concord, Sydney, NSW Australia ,grid.414685.a0000 0004 0392 3935Department of Geriatric Medicine, Concord Hospital, Hospital Road, Building 12, Concord, Sydney, NSW 2139 Australia
| | - Leanne Kearney
- grid.414685.a0000 0004 0392 3935Centre for Education and Research on Ageing, Concord Hospital, Concord, Sydney, NSW Australia
| | - Janani Thillainadesan
- Centre for Education and Research on Ageing, Concord Hospital, Concord, Sydney, NSW, Australia. .,Faculty of Medicine and Health, The University of Sydney, Concord, Sydney, NSW, Australia. .,Department of Geriatric Medicine, Concord Hospital, Hospital Road, Building 12, Concord, Sydney, NSW, 2139, Australia.
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Page AT, Potter K, Naganathan V, Hilmer S, McLachlan AJ, Lindley RI, Coman T, Mangin D, Etherton-Beer C. Polypharmacy and medicine regimens in older adults in residential aged care. Arch Gerontol Geriatr 2023; 105:104849. [PMID: 36399891 DOI: 10.1016/j.archger.2022.104849] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/14/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe medicines regimens used by older people living in residential aged care facilities (RACFs). MATERIALS AND METHODS This cross-sectional study presents baseline data from a randomised controlled trial in seventeen Australian RACFs that recruited residents aged 65 years and older at the participating facilities. The main outcome measures were to evaluation of medicines utilisation, including the number of medicines, medicine regimen complexity, potential under-prescribing and high-risk prescribing (prescribing cascades, anticholinergic or sedative medicines or other potentially inappropriate medicines) with data analysed descriptively. RESULTS Medicines regimens were analysed for 303 residents (76% female) with a mean age of 85.0 ± 7.5 years, of whom the majority were living with dementia (72%). Residents were prescribed an average of 10.3 ± 4.5 regular medicines daily. Most participants (85%) had highly complex regimens. Most residents (92%) were exposed to polypharmacy (five or more medicines). Nearly all, 302 (98%) residents had at least one marker of potentially suboptimal prescribing. At least one instance of potential under-prescribing was identified in 86% of residents. At least one instance of high-risk prescribing was identified in 81% of residents including 16% of participants with at least one potential prescribing cascade. CONCLUSION(S) Potentially suboptimal prescribing affected almost all residents in this study, and most had highly complex medicines regimens. If generalisable, these findings indicate most older people in RACFs may be at risk of medicines-related harm from suboptimal prescribing, in addition to the burden of administration of complex medicines regimens for facility staff and residents.
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Affiliation(s)
- Amy Theresa Page
- Centre for Optimisation of Medicines, School of Allied Health, The University of Western Australia, Crawley, Western Australia, Australia; WA Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia.
| | | | - Vasi Naganathan
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah Hilmer
- Kolling Institute, Faculty of Medicine and Health, The University of Sydney and Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Andrew J McLachlan
- ydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Richard I Lindley
- University of Sydney, Sydney, Australia and the George Institute for Global Health, Sydney, Australia
| | - Tracy Coman
- Menzies Health Institute Queensland, Griffith University, University Drive Meadowbrook, Brisbane, Queensland, Australia
| | | | - Christopher Etherton-Beer
- WA Centre for Health and Ageing, The University of Western Australia, Perth, Western Australia, Australia; Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
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Luong R, Ribeiro RV, Rangan A, Naganathan V, Blyth F, Waite LM, Handelsman DJ, Le Couteur DG, Seibel MJ, Hirani V. Haem Iron Intake Is Associated with Increased Major Adverse Cardiovascular Events, All-Cause Mortality, Congestive Cardiac Failure, and Coronary Revascularisation in Older Men: The Concord Health and Ageing in Men Project. J Nutr Health Aging 2023; 27:559-570. [PMID: 37498103 DOI: 10.1007/s12603-023-1945-6] [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: 02/27/2023] [Accepted: 06/22/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Nutritional intake can influence major adverse cardiovascular events (MACE). Dietary iron is found in two forms: haem-iron (HI) only found in animal sources and non-haem iron (NHI) present mostly in plant sources. OBJECTIVE We evaluated the associations between dietary iron intakes with MACE and iron status biomarkers. DESIGN Prospective cohort study. SETTING The Concord Health and Ageing in Men Project, Sydney, Australia. PARTICIPANTS 539 community-dwelling older Australian men aged 75 years and older. METHODS Men underwent nutritional assessment using a validated diet history questionnaire. Entries were converted to food groups and nutrients. The dietary calculation was used to derive HI and NHI intakes from total iron intakes. Analyses of iron intakes with iron status biomarkers were conducted using linear regression, and with MACE and individual endpoints were conducted using Cox regression. Five-point MACE comprised of all-cause mortality, myocardial infarction (MI), congestive cardiac failure (CCF), coronary revascularisation, and/or ischaemic stroke. Four-point MACE included the four endpoints of MI, CCF, coronary revascularisation, and/or ischaemic stroke, and excluded all-cause mortality. RESULTS At a median of 5.3 (4.6 - 6.3) years follow-up, the incidences were: 31.2% (n = 168) five-point MACE, 17.8% (n = 96) four-point MACE excluding all-cause mortality, 20.1% (n = 111) all-cause mortality, 11.3% (n = 61) CCF, and 3.1% (n = 15) coronary revascularisation. In adjusted analyses, higher HI intake (per 1mg increment) was associated with increased five-point MACE (HR: 1.45 [95% CI: 1.16, 1.80, P = .001]), four-point MACE excluding all-cause mortality (HR: 1.64 [95% CI: 1.26, 2.15, P <.001]), all-cause mortality (HR: 1.51 [95% CI: 1.15, 1.99, P = .003]), CCF (HR: 2.08 [95% CI: 1.45, 2.98, P <.001]), and coronary revascularisation (HR: 1.89 [95% CI: 1.15, 3.10, P = .012]). Compared with the bottom tertile of NHI intake, the middle tertile of NHI intake was associated with reduced risk of all-cause mortality (HR: 0.56 [95% CI: 0.33, 0.96, P = .035]). Total iron intake was not associated with MACE and individual endpoints. Dietary iron intakes were not associated with serum iron and haemoglobin. CONCLUSION Higher haem iron intake was independently associated with increased risks of five-point MACE, four-point MACE excluding all-cause mortality, all-cause mortality, CCF, and coronary revascularisation in older men over 5 years.
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Affiliation(s)
- R Luong
- Rebecca Luong, Level 4, Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia,
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Siriwardana A, Gray NA, Makris A, Li CK, Yong K, Mehta Y, Ramos J, Di Tanna GL, Gianacas C, Addo IY, Roxburgh S, Naganathan V, Foote C, Gallagher M. Treatment decision-making and care among older adults with kidney failure: protocol for a multicentre, prospective observational cohort study with nested substudies and linked qualitative research (the Elderly Advanced CKD Programme). BMJ Open 2022; 12:e066156. [PMID: 36581411 PMCID: PMC9806093 DOI: 10.1136/bmjopen-2022-066156] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Shared treatment decision-making and planning of care are fundamental in advanced chronic kidney disease (CKD) management. There are limited data on several key outcomes for the elderly population including survival, quality of life, symptom burden, changes in physical functioning and experienced burden of healthcare. Patients, caregivers and clinicians consequently face significant uncertainty when making life-impacting treatment decisions. The Elderly Advanced CKD Programme includes quantitative and qualitative studies to better address challenges in treatment decision-making and planning of care among this increasingly prevalent elderly cohort. METHODS AND ANALYSIS The primary component is OUTcomes of Older patients with Kidney failure (OUTLOOK), a multicentre prospective observational cohort study that will enrol 800 patients ≥75 years with kidney failure (estimated glomerular filtration rate ≤15 mL/min/1.73 m2) across a minimum of six sites in Australia. Patients entered are in the decision-making phase or have recently made a decision on preferred treatment (dialysis, conservative kidney management or undecided). Patients will be prospectively followed until death or a maximum of 4 years, with the primary outcome being survival. Secondary outcomes are receipt of short-term acute dialysis, receipt of long-term maintenance dialysis, changes in biochemistry and end-of-life care characteristics. Data will be used to formulate a risk prediction tool applicable for use in the decision-making phase. The nested substudies Treatment modalities for the InfirM ElderLY with end stage kidney disease (TIMELY) and Caregivers of The InfirM ElderLY with end stage kidney disease (Co-TIMELY) will longitudinally assess quality of life, symptom burden and caregiver burden among 150 patients and 100 caregivers, respectively. CONsumer views of Treatment options for Elderly patieNts with kiDney failure (CONTEND) is an additional qualitative study that will enrol a minimum of 20 patients and 20 caregivers to explore experiences of treatment decision-making and care. ETHICS AND DISSEMINATION Ethics approval was obtained through Sydney Local Health District Human Research Ethics Committee (2019/ETH07718, 2020/ETH02226, 2021/ETH01020, 2019/ETH07783). OUTLOOK is approved to have waiver of individual patient consent. TIMELY, Co-TIMELY and CONTEND participants will provide written informed consent. Final results will be disseminated through peer-reviewed journals and presented at scientific meetings.
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Affiliation(s)
- Amanda Siriwardana
- Renal and Metabolic Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas A Gray
- Department of Renal Medicine, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
- School of Health and Behavioural Science, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Angela Makris
- Department of Renal Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Chenlei Kelly Li
- Department of Renal Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Kenneth Yong
- Department of Renal Medicine, Prince of Wales Hospital and Community Health Services, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Yachna Mehta
- Renal and Metabolic Division, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Jannel Ramos
- Renal and Metabolic Division, The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Gian Luca Di Tanna
- Statistics Division, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Chris Gianacas
- Statistics Division, George Institute for Global Health, Sydney, New South Wales, Australia
| | - Isaac Yeboah Addo
- Faculty of Arts and Social Sciences, University of New South Wales Centre for Social Research in Health, Sydney, New South Wales, Australia
| | - Sarah Roxburgh
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Concord Repatriation General Hospital, The University of Sydney Centre for Education and Research on Ageing, Sydney, New South Wales, Australia
| | - Celine Foote
- Department of Renal Medicine, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Martin Gallagher
- Renal and Metabolic Division, The George Institute for Global Health, Sydney, New South Wales, Australia
- Department of Renal Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
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Thillainadesan J, Aitken S, Monaro S, Cullen J, Kerdic R, Hilmer S, Naganathan V. GERIATRICIAN CO-MANAGEMENT AND EDUCATION OF JUNIOR DOCTORS IMPROVE THE CARE OF HOSPITALIZED OLDER SURGICAL PATIENTS. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.333] [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: 12/24/2022] Open
Abstract
Abstract
We evaluated changes in processes of care after the introduction of a novel model of care for older vascular surgery inpatients. This model, called Geriatrics Co-management of older vascular surgery patients (GeriCO-V) embedded a geriatrician into the vascular surgery team who provided proactive geriatrics assessment of patients and education for junior surgical doctors. A pre-post study of the GeriCO-V model comparing prospectively recruited pre-intervention (n=150) and post-intervention (n=152) cohorts of consecutively admitted vascular surgery patients aged ≥65 years at an acute care academic hospital. Education of junior surgical doctors was embedded in the new model of care and included role modelling, provision of delirium and frailty screening lanyards and mobile Apps for ‘just-in-time’ learning, and a Wiki page of tips on assessing older patients. We measured processes of care by review of medical charts. After implementing the novel geriatrician and education embedded model of care, there was a significant increase in several processes of care by the junior surgical doctor: screening for cognition (8% vs 76%, p<.001) and delirium (2% vs 69%, p<.001), documentation of functional history (34% vs 76%, p<.001), medications (53% vs 74%, p<.001) and treatment preferences (5% vs 46%, p<.001) and prescribing of pharmacological venous thromboprophylaxis (93% vs 99%, p=.03) and co-prescription of laxative with opioid (60% vs 81%, p=.002). A collaborative model of care that embeds proactive geriatrician care and education of junior surgical doctors improves the quality of care for older vascular surgical patients.
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Affiliation(s)
- Janani Thillainadesan
- Department of Geriatric Medicine and Centre for Education and Research on Ageing (CERA), Concord Hospital , Concord, New South Wales , Australia
| | - Sarah Aitken
- Concord Hospital , Concord, New South Wales , Australia
| | - Sue Monaro
- Concord Hospital , Concord, New South Wales , Australia
| | - John Cullen
- Concord Hospital , Concord, New South Wales , Australia
| | | | - Sarah Hilmer
- Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Thillainadesan J, Box H, Kearney L, Naganathan V, Cunich M, Aitken S, Monaro S. WHAT MATTERS TO OLDER SURGICAL PATIENTS AND THEIR CARERS DURING THEIR HOSPITALIZATION? Innov Aging 2022. [PMCID: PMC9766384 DOI: 10.1093/geroni/igac059.2040] [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: 12/24/2022] Open
Abstract
Older adults account for a growing proportion of the surgical population. We investigated patient- and carer-reported experiences of hospitalization in this group. A mixed-methods study using telephone and postal surveys of recently hospitalized vascular surgical patients aged ≥ 65 years at an acute care academic hospital. Qualitative data were thematically analyzed using a framework approach. In total 46 patients (mean age 77 years, 78% male) and nine carers were surveyed. Nine (20%) patients were frail (Clinical Frailty Scale score >4). The majority of patients reported overall they felt their views were listened to (n=42, 89%), were kept informed (n=39, 83%) and were asked about their pain level (n=37, 79%). Among the nine carers, seven reported overall they felt their views were listened to (n=42, 89%) and were kept informed (n=39, 83%). Thematic analysis of responses to open-ended survey questions about their experience of hospitalization revealed four key themes: receiving fundamental care including hygiene and nutrition, importance of the hospital environment such as sleep and meals, being informed and involved in health care decision-making, and treating pain and deconditioning to help recovery. Findings from this study identified that older adults admitted to hospital for surgical care, and their carers, highly value care that meets fundamental needs and involves them in decision-making and recovery. These priorities can be addressed through Age-Friendly Health System initiatives such as the implementation of the “4Ms” of geriatrics care: what matters, medication, mobility and mentation.
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Affiliation(s)
- Janani Thillainadesan
- Department of Geriatric Medicine and Centre for Education and Research on Ageing (CERA), Concord Hospital, Concord, New South Wales, Australia
| | - Helen Box
- Concord Hospital, Concord, New South Wales, Australia
| | | | | | | | - Sarah Aitken
- Concord Hospital, Concord, New South Wales, Australia
| | - Sue Monaro
- Concord Hospital, Concord, New South Wales, Australia
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Smith J, Dodd RH, Wallis KA, Naganathan V, Cvejic E, Jansen J, McCaffery KJ. General practitioners' views and experiences of communicating with older people about cancer screening: a qualitative study. Fam Pract 2022:cmac126. [PMID: 36334011 DOI: 10.1093/fampra/cmac126] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Older adults should be supported to make informed decisions about cancer screening. However, it is unknown how general practitioners (GPs) in Australia communicate about cancer screening with older people. AIM To investigate GPs' views and experiences of communicating about cancer screening (breast, cervical, prostate, and bowel) with older people (≥70 years). DESIGN AND SETTING Qualitative, semi-structured interviews, Australia. METHOD Interviews were conducted with GPs practising in Australia (n = 28), recruited through practice-based research networks, primary health networks, social media, and email invitation. Interviews were audio-recorded and analysed thematically using Framework Analysis. RESULTS Findings across GPs were organized into 3 themes: (i) varied motivation to initiate cancer screening discussions; some GPs reported that they only initiated screening within recommended ages (<75 years), others described initiating discussions beyond recommended ages, and some experienced older patient-initiated discussions; (ii) GPs described the role they played in providing screening information, whereby detailed discussions about the benefits/risks of prostate screening were more likely than other nationally funded screening types (breast, cervical, and bowel); however, some GPs had limited knowledge of recommendations and found it challenging to explain why screening recommendations have upper ages; (iii) GPs reported providing tailored advice and discussion based on personal patient preferences, overall health/function, risk of cancer, and previous screening. CONCLUSIONS Strategies to support conversations between GPs and older people about the potential benefits and harms of screening in older age and rationale for upper age limits to screening programmes may be helpful. Further research in this area is needed.
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Affiliation(s)
- Jenna Smith
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachael H Dodd
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Katharine A Wallis
- General Practice Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation Hospital, Concord, NSW, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Kirsten J McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Shu C, Wright FAC, Naganathan V, Blyth FM, Le Couteur DG, Handelsman DJ, Stanaway FF. Does social support predict increased use of dental services in older men? Aust Dent J 2022; 67:262-270. [PMID: 35373341 PMCID: PMC9790329 DOI: 10.1111/adj.12911] [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: 12/22/2021] [Revised: 03/07/2022] [Accepted: 03/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Past research on social support and dental visits in older people has been limited by cross-sectional design, limited social support dimensions and non-representative samples. METHODS Data came from men with natural teeth completing Waves 3 and 4 of the Concord Health and Ageing in Men Project in Sydney, Australia. The relationship between social support at Wave 3 (2011-2012) and at least one dental visit per year at Wave 4 (2014-2016) was examined by Poisson regression. Social support was measured by structural (marital status, living arrangements, family support and social interaction) and functional (social support satisfaction) domains. RESULTS About 673 men were analysed. Structural and functional social support were not associated with the pattern of usual dental visits 5 years later in univariable or multivariable analyses. The only consistent significant factor was income source, with older men who had other sources of income more likely to regularly visit the dentist than older men solely reliant on the pension for income (prevalence ratio: 1.31, 95% CI: 1.13-1.52). CONCLUSIONS We found no differences in the pattern of usual dental visits between older men with different levels and types of social support. For older Australian men, income source seems to be the most important determinant of regular dental visits. © 2022 Australian Dental Association.
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Affiliation(s)
- C‐C Shu
- Centre for Education and Research on Ageing, Department of Geriatric MedicineConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - FAC Wright
- Centre for Education and Research on Ageing, Department of Geriatric MedicineConcord Repatriation General HospitalSydneyNew South WalesAustralia
| | - V Naganathan
- Centre for Education and Research on Ageing, Department of Geriatric MedicineConcord Repatriation General HospitalSydneyNew South WalesAustralia,Concord Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - FM Blyth
- School of Public Health, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - DG Le Couteur
- Centre for Education and Research on Ageing, Department of Geriatric MedicineConcord Repatriation General HospitalSydneyNew South WalesAustralia,Concord Clinical School, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia,ANZAC Research InstituteSydneyNew South WalesAustralia
| | - DJ Handelsman
- ANZAC Research InstituteSydneyNew South WalesAustralia
| | - FF Stanaway
- School of Public Health, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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Sirimanna P, Ravindran P, Smigielski M, Gladman MA, Naganathan V. Validation and reliability testing of a rating scale for objective assessment of performance in laparoscopic appendicectomy surgery. ANZ J Surg 2022; 92:1731-1736. [PMID: 35748500 PMCID: PMC9546355 DOI: 10.1111/ans.17862] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/23/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022]
Abstract
Backgrounds To achieve a competency‐based training paradigm, the ability to obtain reliable and valid quantitative assessments of intraoperative performance is required. Through this, weaknesses can be identified and practiced, and competency assessed. This study aimed to determine the validity and reliability an objective evaluation tool for assessment of performance in laparoscopic appendicectomy (LA). Methods A prospective single‐blinded observational study design was used. Videos of inexperienced (performed <10 LAs) and experienced (performed >100 LAs) surgeons performing LA surgery were collected. Surgical performance during each recording was rated by two independent, blinded expert surgeons using the LA Rating Scale (LARS) and the modified Objective Structured Assessment of Technical Skill (OSATS) scale. Results The intraclass correlation coefficient (ICC) for LARS was 0.95 (95%CI 0.83–0.98). The ICC for each step ranged from 0.48 to 0.90, and the test–retest ICC for LARS was 0.91 (95%CI 0.69–0.98). Significant differences (P < 0.001) between median performance scores as rated by LARS were observed between the inexperienced and experienced surgeons. A Spearman's correlation coefficient of 0.87 (P < 0.001) was observed between LARS performance scores and modified OSATS scores. Conclusion LARS demonstrated excellent inter‐rater and test–retest reliability, and construct and concurrent validity and can be used to quantitatively evaluate performance during LA. This can potentially allow specific weaknesses to be identified and improved upon through deliberate practice. Progress can be tracked through re‐evaluation and scores of expert surgeons can be used as performance goals for credentialing in LA.
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Affiliation(s)
- Pramudith Sirimanna
- Department of Surgery, Sydney Medical School—Concord University of Sydney Sydney New South Wales Australia
| | - Praveen Ravindran
- Australian National University and Australian Robotic Colorectal Surgery Canberra Australian Capital Territory Australia
| | | | - Marc A Gladman
- Adelaide Medical School University of Adelaide Adelaide South Australia Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing Concord Hospital and University of Sydney Sydney New South Wales Australia
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Stavert BM, Monaro S, Tienstra L, Naganathan V, Aitken SJ. Protocol for a qualitative study exploring haemodialysis dependent patients' arteriovenous fistula experience, values and concerns in Sydney, Australia. BMJ Open 2022; 12:e058152. [PMID: 36691241 PMCID: PMC9171227 DOI: 10.1136/bmjopen-2021-058152] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/11/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION The experiences of patients from culturally and linguistically diverse backgrounds, with chronic mental illness, disabilities or who identify as sexual or religious minorities are under-represented in clinical research on arteriovenous fistula (AVF) for haemodialysis access. A greater understanding of the experiences, values and concerns of these diverse patient groups are needed to provide haemodialysis access care that addresses the needs of all haemodialysis-dependent patients. This study seeks to describe a broad range of patient experiences related to the creation, care and surveillance of AVFs, including interactions with healthcare teams. METHODS AND ANALYSIS This qualitative study will use semistructured interviews with individual patients purposefully selected to provide a diverse patient population. A deliberate strategy will be used to recruit a demographically broad range of participants. Thematic analysis of interview transcripts, using a constant comparative methodology, will generate themes that describe patient experiences, values and concerns. Findings from this study will give a nuanced insight into the experiences of patients on haemodialysis with respect to their AVF. ETHICS AND DISSEMINATION Ethical approval for this study was provided by the Sydney Local Health District Human Research Ethics Committee (REGIS identifier: 2021/ETH00362, CH reference number: CH62/6/2021-033). Results will be made available to the participants, local health district, funders and other researchers through various hospital and academic forums. Data will also be published in peer-reviewed journals and be part of a larger body of work looking into patient-reported outcome measures for patients with AVF.
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Affiliation(s)
- Bethany Miriam Stavert
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Susan Monaro
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Lisa Tienstra
- Renal Medicine Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Sarah Joy Aitken
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Vascular Surgery Department, Concord Repatriation General Hospital, Concord, New South Wales, Australia
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Dai Z, Hirani V, Sahni S, Felson DT, Naganathan V, Blyth F, Couteur DL, Handelsman D, Seibel MJ, Waite L, Kiel DP, Cumming R. Association of dietary fiber and risk of hip fracture in men from the Framingham Osteoporosis Study and the Concord Health and Ageing in Men Project. Nutr Health 2022; 28:229-238. [PMID: 33940973 PMCID: PMC10622166 DOI: 10.1177/02601060211011798] [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] [Indexed: 06/12/2023]
Abstract
BACKGROUND Data in the Offspring Framingham Osteoporosis Study (FOS) suggested that higher intake of dietary fiber was modestly protective against loss of bone mineral density at the femoral neck in men but not in women. AIM To examine the relationship of fiber intake with risk of hip fractures in men. METHODS We included 367 men from the FOS Original cohort, 1730 men from the FOS Offspring cohort, and 782 men from the Concord Health and Ageing in Men Project (CHAMP) in the analysis. Incident fractures were defined as medically confirmed first occurrence of osteoporotic fractures at the proximal femur. Fiber intake was estimated via a validated food frequency questionnaire (FFQ) or diet history. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). A random-effects model was used to estimate the pooled relative risk in meta-analysis. RESULTS Seventy-two incident hip fractures were identified, of which 24 occurred in the FOS Original cohort [mean (SD): age 75.3 (5.1) years; follow-up time: 8.5 (6.2) years; dietary fiber: 19 (8) (g/d)], 19 in the FOS Offspring cohort [58.8 (9.8) years; 11.0 (5.9) years; 19 (8) (g/d)], and 29 in CHAMP [81.4 (4.5) years; 5.2 (1.5) years; 28 (10) (g/d)]. We did not find significant associations within each cohort between fiber intake and risk of hip fractures. The pooled HR (95% CI) was 0.80 (0.39, 1.66) comparing energy-adjusted dietary fiber at tertile 3 vs. tertile 1 (I2 = 0, p = 0.56). CONCLUSION These data suggested that dietary fiber was not associated with risk of incident hip fractures in men.
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Affiliation(s)
- Zhaoli Dai
- Charles Perkins Centre, School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, D17, The Hub, Camperdown, NSW, 2006, Australia
- Boston University School of Medicine, Department of Medicine, Rheumatology and Clinical Epidemiology, USA
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia
| | - Vasant Hirani
- Centre for Education and Research on Aging, Concord Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research, University of Sydney, Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Shivani Sahni
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - David T. Felson
- Boston University School of Medicine, Department of Medicine, Rheumatology and Clinical Epidemiology, USA
- Central Manchester Foundation Trust and University of Manchester, Manchester UK
| | - Vasi Naganathan
- Centre for Education and Research on Aging, Concord Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Fiona Blyth
- Aging and Alzheimer’s Institute, Concord Hospital, Sydney, New South Wales, Australia
| | - David Le Couteur
- Centre for Education and Research on Aging, Concord Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - David Handelsman
- Centre for Education and Research on Aging, Concord Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Aging and Alzheimer’s Institute, Concord Hospital, Sydney, New South Wales, Australia
| | - Markus J Seibel
- ANZAC Research Institute, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Louise Waite
- Bone Research Program, ANZAC Research Institute, and Department of Endocrinology and Metabolism, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Robert Cumming
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2109, Australia
- Centre for Education and Research on Aging, Concord Hospital, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Xu P, Blyth FM, Naganathan V, Cumming RG, Handelsman DJ, Seibel MJ, Le Couteur DG, Waite LM, Khalatbari-Soltani S. Socioeconomic Inequalities in Elective and Nonelective Hospitalizations in Older Men. JAMA Netw Open 2022; 5:e226398. [PMID: 35389499 PMCID: PMC8990350 DOI: 10.1001/jamanetworkopen.2022.6398] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
IMPORTANCE Among older adults, there is limited and inconsistent evidence on the association between socioeconomic position (SEP) and elective and nonelective hospitalization. OBJECTIVE To evaluate the association between SEP and all-cause and cause-specific elective and nonelective hospitalization and hospital length of stay among older men. DESIGN, SETTING, AND PARTICIPANTS This population-based, prospective cohort study used data from the Concord Health and Aging in Men Project (CHAMP). CHAMP recruited 1705 men aged 70 years or older between January 28, 2005, and June 4, 2007, in Sydney, Australia. Data were analyzed from February 1 to September 30, 2021. EXPOSURES Indicators of SEP, including education (university degree certificate, diploma or no postschool qualifications), occupation (professionals and managers; small employers and self-employed; or lower clerical, service, sales workers, skilled, and unskilled workers), and source of income (other sources of income than government pension, reliance on government pensions and other sources of income, or reliant solely on a government pension), and a cumulative SEP score (tertiles) as SEP indicators; 3-level variables present high, intermediate, and low SEP. MAIN OUTCOMES AND MEASURES All-cause and cause-specific elective and nonelective hospitalizations, number of hospitalizations, and length of stay were the study outcomes, ascertained through data linkage. Associations were quantified using competing-risks survival regression and negative binomial regression. RESULTS A total of 1566 men (mean [SD] age, 76.8 [5.4] years) were included. During a mean (SD) 9.07 (3.53) years of follow-up, 1067 men had at least 1 elective hospitalization, and 1255 men had at least 1 nonelective hospitalization. No associations were found between SEP and elective hospitalizations. Being in the lowest tertile for educational level (subhazard ratio [SHR], 1.32; 95% CI, 1.11-1.58), occupational position (SHR, 1.30; 95% CI, 1.12-1.50), sources of income (SHR, 1.33; 95% CI, 1.17-1.52), and cumulative SEP tertile groups (SHR, 1.45; 95% CI, 1.24-1.68) were all associated with having at least 1 nonelective hospitalization compared with those in the highest tertiles. Significant associations were found between being in the lowest SEP groups and increased numbers and longer length of stay of nonelective hospitalizations. CONCLUSIONS AND RELEVANCE In this prospective cohort study, low SEP was inversely associated with nonelective hospitalizations but not elective hospitalization in older men in Australia. These findings point to the existence of socioeconomic inequalities in health care use, indicative of a need to take action to reduce these inequalities.
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Affiliation(s)
- Peiyao Xu
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
| | - Fiona M. Blyth
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Ageing and Alzheimer’s Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Concord, New South Wales, Australia
| | - Robert G. Cumming
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, New South Wales, Australia
| | - David J. Handelsman
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, New South Wales, Australia
| | - Markus J. Seibel
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, New South Wales, Australia
| | - David G. Le Couteur
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Ageing and Alzheimer’s Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Concord, New South Wales, Australia
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, New South Wales, Australia
| | - Louise M. Waite
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Ageing and Alzheimer’s Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Concord, New South Wales, Australia
| | - Saman Khalatbari-Soltani
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, New South Wales, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, New South Wales, Australia
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Luong R, Ribeiro RV, Rangan A, Naganathan V, Blyth F, Waite LM, Handelsman DJ, Cumming RG, Le Couteur DG, Hirani V. Changes in dietary total and non-haem iron intake is associated with incident frailty in older men: The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2022; 77:1853-1865. [PMID: 35352124 PMCID: PMC9434472 DOI: 10.1093/gerona/glac077] [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: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Nutritional intake could influence the development of frailty. The aim was to evaluate the associations between dietary iron intakes and changes in dietary iron intakes with frailty. Methods Cross-sectional analyses involved 785 men with Fried frailty phenotype (FP) and 758 men with Rockwood frailty index (FI) data aged 75 years and older at nutrition assessment from the Concord Health and Ageing in Men Project prospective cohort study. Of these, 563 men who were FP robust or prefrail, and 432 men who were FI nonfrail were included in the longitudinal analyses for more than 3 years. Dietary intake was assessed at both timepoints using a validated diet history questionnaire. The dietary calculation was used to derive heme iron and nonheme iron intakes from total iron intakes. The associations were evaluated through binary logistic regression. Results Incidence of FP frailty was 15.3% (n = 86). In longitudinal analyses, maintaining total iron intakes (medium tertile −2.61–0.81 mg/d), increases in total iron and nonheme iron intakes (high tertiles ≥0.82 mg/d and ≥0.80 mg/d), and changes in nonheme iron intake (1 mg increment) were associated with reduced risks of incident FP frailty (OR: 0.47 [95% confindence interval (CI): 0.24, 0.93, p = .031], OR 0.48 [95% CI: 0.23, 0.99, p = .048], OR 0.41 [95% CI: 0.20, 0.88, p = .022], and OR 0.89 [95% CI: 0.82, 0.98, p = .017]). Conclusion Maintaining or increases in total dietary iron and increases or changes in dietary nonheme iron intakes more than 3 years were associated with reduced incidence of FP frailty in older men.
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Affiliation(s)
- Rebecca Luong
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia
| | - Rosilene V Ribeiro
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, NSW, Australia
| | - Anna Rangan
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia.,Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - Fiona Blyth
- ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia.,School of Public Health, The University of Sydney, NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia.,Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - David J Handelsman
- ANZAC Research Institute, The University of Sydney and Concord Hospital, Concord, NSW, Australia
| | - Robert G Cumming
- ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia.,School of Public Health, The University of Sydney, NSW, Australia
| | - David G Le Couteur
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,ANZAC Research Institute, The University of Sydney and Concord Hospital, Concord, NSW, Australia
| | - Vasant Hirani
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia.,ANZAC Research Institute, The University of Sydney and Concord Hospital, Concord, NSW, Australia
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Sirimanna P, Boyce S, Gunanayagam P, Gladman MA, Naganathan V. Development of a rating scale for objective assessment of performance in laparoscopic appendicectomy surgery. ANZ J Surg 2022; 92:1724-1730. [PMID: 35338678 PMCID: PMC9544375 DOI: 10.1111/ans.17601] [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: 10/17/2021] [Revised: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022]
Abstract
Backgrounds Laparoscopic appendicectomy (LA) is the most common index procedure for junior surgical trainees. Despite the shift towards competency‐based training, there is no method of quantitatively assessing performance during LA. This study aimed to obtain expert consensus regarding the items required to create a LA Rating Scale (LARS). Methods A list of steps required for LA surgery, as well as descriptors of “poor”, “average” and “excellent” performance for each of these steps were created for potential inclusion into an objective assessment tool for LA surgery. Using a Delphi method, 20 experts from multiple institutions rated on a Likert scale from 1 to 5 the suitability of these steps and descriptors of performance. Responses were obtained until consensus (Cronbach's α > 0.8) was achieved. Results Fifteen experts participated in the study. Consensus was achieved for all items during the first iteration of the Delphi with a Cronbach's α of 0.96. The Cronbach's α for the steps was 0.87 and 0.92 for the descriptors of performance. Steps and descriptors of performance that >80% of experts rated as ≥4 were used to create the final LARS tool. Conclusion Multi‐institutional expert consensus was obtained regarding the steps and, for the first time, descriptors of performance for LA, demonstrating their face and content validity, as well as generalisability. Subsequently, the LARS tool was created that can be used to quantitatively assess intra‐operative performance. This instrument can be used to identify weaknesses in performance and facilitate deliberate practice, thus shifting training in LA to a competency‐based approach.
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Affiliation(s)
- Pramudith Sirimanna
- Faculty of Medicine and Health, Concord Clinical School, University of Sydney, Sydney, Australia
| | | | - Prashanth Gunanayagam
- Faculty of Medicine and Health, Concord Clinical School, University of Sydney, Sydney, Australia
| | - Marc A Gladman
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Vasi Naganathan
- Faculty of Medicine and Health, Concord Clinical School, University of Sydney, Sydney, Australia.,Centre for Education and Research on Ageing, Concord Hospital and University of Sydney, Sydney, Australia
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40
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Wu H, Mach J, Gnjidic D, Naganathan V, Blyth FM, Waite LM, Handelsman DJ, Le Couteur DG, Hilmer SN. Comparing Effects of Polypharmacy on Inflammatory Profiles in Older Adults and Mice: Implications for Translational Ageing Research. J Gerontol A Biol Sci Med Sci 2022; 77:1295-1303. [PMID: 35299251 PMCID: PMC9255679 DOI: 10.1093/gerona/glac061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/04/2021] [Indexed: 11/14/2022] Open
Abstract
Aging and multimorbidity are associated with inflammation. Polypharmacy is common in older people with multimorbidity. Given the potential for interactions between polypharmacy and inflammation, the relationship between inflammation and polypharmacy were studied in older adults with multimorbidity and in healthy aging mice. A cross-sectional analysis of data from the 5-year wave of the Concord Health and Ageing in Men Project, a population-based study of community-dwelling men aged ≥70 years. Serum concentrations of 27 cytokines were measured using a multiplex immunoassay. Associations between polypharmacy (≥5 medications) and cytokines were evaluated using multivariable linear regression adjusting for age, frailty, comorbidities, and individual drug classes. Interaction between polypharmacy and Drug Burden Index (DBI―drugs with anticholinergic and sedative effects) was analyzed. Effects of polypharmacy and DBI on serum levels of 23 cytokines were determined in aging male mice treated with chronic polypharmacy or control. Compared to the nonpolypharmacy group (n = 495), CHAMP participants with polypharmacy (n = 409) had significantly higher concentrations of IL-8, IL-6, CCL3, Eotaxin, IL-1ra, IL-1β, IP-10, and lower concentrations of anti-inflammatory cytokine IL-4. In fully-adjusted multivariable models, polypharmacy was positively associated with concentrations of IL-8 and CCL3. There were no significant differences in inflammatory profiles between control and polypharmacy-treated mice. The relationship was not influenced by DBI in men or in mice. Inflammatory markers associated with polypharmacy in older adults were not seen in healthy aged mice administered polypharmacy, and may be related to underlying diseases. The polypharmacy mouse model provides opportunities for mechanistic investigations in translational research.
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Affiliation(s)
- Harry Wu
- Laboratory of Ageing and Pharmacology, Kolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - John Mach
- Laboratory of Ageing and Pharmacology, Kolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Hospital, Concord, New South Wales, Australia.,Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, New South Wales, Australia
| | - Fiona M Blyth
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, New South Wales, Australia.,School of Public Health, ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, New South Wales, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Hospital, Concord, New South Wales, Australia.,Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, New South Wales, Australia
| | - David J Handelsman
- Department of Andrology, Concord Hospital and ANZAC Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - David G Le Couteur
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia.,Centre for Education and Research on Ageing (CERA), Department of Geriatric Medicine, Concord Hospital, Concord, New South Wales, Australia.,Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Concord, New South Wales, Australia.,ANZAC Research Institute, Ageing and Alzheimer's Institute (AAAI), University of Sydney, Concord, New South Wales, Australia
| | - Sarah N Hilmer
- Laboratory of Ageing and Pharmacology, Kolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney and Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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Abstract
Older adults undergoing surgery have high perioperative morbidity and mortality. Age-related physiological changes and prevalence of geriatric syndromes such as frailty increase the risk of adverse postoperative outcomes. Geriatricians utilise comprehensive geriatric assessment (CGA) and management to identify and manage geriatric syndromes, and deliver patient-centred perioperative care. Perioperative models of CGA are established for older patients undergoing hip fracture surgery. Recent trials support the benefits of perioperative models of CGA for non-orthopaedic surgery, and have influenced current care recommendations for older surgical patients. Areas for further action include addressing the implementation gap between recommended evidence-based perioperative care and routine perioperative care, evaluating the clinical and cost-effectiveness of perioperative models of CGA for patients living with frailty, and embedding routine use of patient-reported outcome measures to inform quality improvement.
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Affiliation(s)
- Janani Thillainadesan
- Department of Geriatric Medicine, Concord Hospital, Sydney, Australia
- Faculty of Medicine and Health, Concord Clinical School, University of Sydney, Sydney, Australia
- Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Sydney, Australia
| | - Sarah N Hilmer
- Department of Aged Care, Kolling Institute of Medical Research, Sydney Medical School, University of Sydney and Royal North Shore Hospital, Sydney, Australia
| | - Aisling M Fleury
- Perioperative Medicine Unit, Division of Surgery, Logan Hospital, Logan, Queensland, Australia
| | - Vasi Naganathan
- Department of Geriatric Medicine, Concord Hospital, Sydney, Australia
- Faculty of Medicine and Health, Concord Clinical School, University of Sydney, Sydney, Australia
- Centre for Education and Research on Ageing, and Ageing and Alzheimers Institute, Sydney, Australia
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42
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Gnanenthiran S, Ng AC, Cumming RG, Brieger DB, Le Couteur DG, Waite LM, Seibel M, Handelsman DJ, Naganathan V, Kritharides L, Blyth FM. Hemoglobin, Frailty and Long-Term Cardiovascular Events in Community-Dwelling Older Men Aged ≥70 years. Can J Cardiol 2022; 38:745-753. [DOI: 10.1016/j.cjca.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 12/11/2022] Open
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Thillainadesan J, Hilmer S, Mudge A, Aitken S, Naganathan V. Understanding the Role and Value of Process Quality Indicators in Hospitalized Older Surgical Patients. Innov Aging 2021. [PMCID: PMC8680742 DOI: 10.1093/geroni/igab046.2235] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Despite the development of geriatrics surgery process quality indicators (QIs), few studies have reported on these QIs in routine surgical practice. Even less is known about the links between these QIs and clinical outcomes, and patient characteristics. We aimed to measure geriatrics surgery process QIs, and investigate the association between process QIs and outcomes, and QIs and patient characteristics, in hospitalized older vascular surgery patients. Methods This was a prospective cohort study of 150 consecutive patients aged ≥ 65 years admitted to a tertiary vascular surgery unit. Occurrence of geriatrics surgery process QIs as part of routine vascular surgery care was measured. Associations between QIs and high-risk patient characteristics, and QIs and clinical outcomes were assessed using clustered heatmaps. Results QI occurrence rate varied substantially from 2% to 93%. Some QIs, such as cognition and delirium screening, documented treatment preferences, and geriatrician consultation were infrequent and clustered with high-risk patients. There were two major process-outcome clusters: (a) multidisciplinary consultations, communication and screening-based process QIs with multiple adverse outcomes, and (b) documentation and prescribing-related QIs with fewer adverse outcomes. Conclusions Clustering patterns of process QIs with clinical outcomes are complex, and there is a differential occurrence of QIs within older vascular surgery patients, suggesting process QIs alone may be unreliable targets for quality improvement. Prospective intervention studies are needed to understand the causal pathways between process QIs and outcomes to help prioritize care processes that are most clearly linked to improved outcomes.
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Affiliation(s)
| | - Sarah Hilmer
- The University of Sydney, St Leonards, New South Wales, Australia
| | - Alison Mudge
- Royal Brisbane and Women’s Hospital, Royal Brisbane and Women’s Hospital, Queensland, Australia
| | - Sarah Aitken
- University of Sydney, Concord, New South Wales, Australia
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44
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Thillainadesan J, Aitken S, Monaro S, Cullen J, Kerdic R, Hilmer S, Naganathan V. Geriatric Comanagement Reduces Hospital-Acquired Geriatric Syndromes in Older Vascular Surgery Inpatients. Innov Aging 2021. [PMCID: PMC8680491 DOI: 10.1093/geroni/igab046.1261] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aims Based on our meta-analysis, surveys and qualitative studies of geriatricians in Australia and New Zealand, we designed and implemented a novel inpatient model to co-manage older vascular surgical inpatients at a tertiary academic hospital in Sydney. This model, called Geriatrics co-management of older vascular surgery patients (Gerico-V), embedded a geriatrician into the vascular surgery unit who introduced a range of interventions targeting older people. Here we evaluated this model of care. Methods We undertook a prospective before-and-after study of consecutive patients aged ≥65 years admitted under vascular surgery. One hundred and fifty-two GeriCO-V patients were compared with 150 patients in the pre- GeriCO-V group. The primary outcomes were hospital-acquired geriatric syndromes, delirium, and length of stay. Results The GeriCO-V group had more frail (43% vs 30%), urgently admitted (47% vs 37%), and non-operative patients (34% vs 22%). These differences were attributed to COVID-19. GeriCO-V patients had fewer hospital-acquired geriatric syndromes (49% vs 65%; P =.005) and incident delirium (3% vs 10%; P = .02), in unadjusted and adjusted analyses. Cardiac (5% vs 20%; P <.001) and infective complications (3% vs 8%]; P = .04) were fewer in the GeriCO-V group. LOS was unchanged. Frail patients in the GeriCO-V group experienced significantly less geriatric syndromes and delirium. Conclusions The Gerico-V model of care led to reductions in hospital-acquired geriatric syndromes, delirium, and cardiac and infective complications. These benefits were seen in frail patients. The intervention requires close collaboration between surgeons and geriatricians, and may be translated to other surgical specialties.
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Affiliation(s)
| | - Sarah Aitken
- University of Sydney, Concord, New South Wales, Australia
| | - Sue Monaro
- Concord Hospital, Concord, New South Wales, Australia
| | - John Cullen
- Concord Hospital, Concord, New South Wales, Australia
| | | | - Sarah Hilmer
- The University of Sydney, St Leonards, New South Wales, Australia
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Ischia L, Naganathan V, Waite LM, Le Couteur DG, Thillainadesan J. COVID-19 and geriatric medicine in Australia and New Zealand. Australas J Ageing 2021; 41:301-308. [PMID: 34904362 DOI: 10.1111/ajag.13027] [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: 06/20/2021] [Revised: 10/12/2021] [Accepted: 10/28/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To investigate geriatricians' views about issues facing geriatric medicine, and the preparedness of the health-care system during the COVID-19 pandemic. METHODS An online survey of heads of geriatric medicine departments in hospitals in Australia and New Zealand undertaken in May 2020. RESULTS The majority of hospitals had admitted one or more patients with suspected COVID-19. Most geriatricians believed their hospital was 'adequately' or 'well prepared' for the pandemic. Inpatient capacity increased to manage acute, post-acute and rehabilitative care of older patients with COVID-19. Non-inpatient services for older people were reduced and telehealth-instituted widely. Increases in work hours, on-call and staffing levels were reported. Geriatricians voiced major concerns about the preparedness of residential aged care facilities to manage the pandemic. CONCLUSIONS The COVID-19 pandemic impacted on geriatricians and the provision of geriatric medicine services. Many issues that subsequently affected older people were predicted in advance.
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Affiliation(s)
- Liesl Ischia
- Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia.,Centre for Education and Research on Ageing, Ageing and Alzheimers Institute, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Concord, Sydney, New South Wales, Australia
| | - Louise M Waite
- Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia.,Centre for Education and Research on Ageing, Ageing and Alzheimers Institute, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Concord, Sydney, New South Wales, Australia
| | - David G Le Couteur
- Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia.,Centre for Education and Research on Ageing, Ageing and Alzheimers Institute, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Concord, Sydney, New South Wales, Australia.,ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, New South Wales, Australia
| | - Janani Thillainadesan
- Department of Geriatric Medicine, Concord Hospital, Sydney, New South Wales, Australia.,Centre for Education and Research on Ageing, Ageing and Alzheimers Institute, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Concord, Sydney, New South Wales, Australia
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Cheyne S, Lindley RI, Smallwood N, Tendal B, Chapman M, Fraile Navarro D, Good PD, Jenkin P, McDonald S, Morgan D, Murano M, Millard T, Naganathan V, Srikanth V, Tuffin P, Vogel J, White H, Chakraborty SP, Whiting E, William L, Yates PM, Callary M, Elliott J, Agar MR. Care of older people and people requiring palliative care with COVID-19: guidance from the Australian National COVID-19 Clinical Evidence Taskforce. Med J Aust 2021; 216:203-208. [PMID: 34865227 PMCID: PMC9299653 DOI: 10.5694/mja2.51353] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/16/2021] [Accepted: 08/25/2021] [Indexed: 12/26/2022]
Abstract
Introduction Older people living with frailty and/or cognitive impairment who have coronavirus disease 2019 (COVID‐19) experience higher rates of critical illness. There are also people who become critically ill with COVID‐19 for whom a decision is made to take a palliative approach to their care. The need for clinical guidance in these two populations resulted in the formation of the Care of Older People and Palliative Care Panel of the National COVID‐19 Clinical Evidence Taskforce in June 2020. This specialist panel consists of nursing, medical, pharmacy and allied health experts in geriatrics and palliative care from across Australia. Main recommendations The panel was tasked with developing two clinical flow charts for the management of people with COVID‐19 who are i) older and living with frailty and/or cognitive impairment, and ii) receiving palliative care for COVID‐19 or other underlying illnesses. The flow charts focus on goals of care, communication, medication management, escalation of care, active disease‐directed care, and managing symptoms such as delirium, anxiety, agitation, breathlessness or cough. The Taskforce also developed living guideline recommendations for the care of adults with COVID‐19, including a commentary to discuss special considerations when caring for older people and those requiring palliative care. Changes in management as result of the guideline The practice points in the flow charts emphasise quality clinical care, with a focus on addressing the most important challenges when caring for older individuals and people with COVID‐19 requiring palliative care. The adult recommendations contain additional considerations for the care of older people and those requiring palliative care.
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Affiliation(s)
- Saskia Cheyne
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW.,Cochrane Australia, Monash University, Melbourne, VIC
| | - Richard I Lindley
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW.,George Institute for Global Health, Sydney, NSW
| | | | - Britta Tendal
- Cochrane Australia, Monash University, Melbourne, VIC
| | | | | | | | | | | | - Deidre Morgan
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA.,Flinders University, Adelaide, SA
| | | | - Tanya Millard
- Cochrane Australia, Monash University, Melbourne, VIC
| | - Vasi Naganathan
- Centre for Education and Research on Ageing (CRGH), University of Sydney, Sydney, NSW
| | | | - Penelope Tuffin
- Royal Perth Hospital, Perth, WA.,Fiona Stanley Hospital, Perth, WA
| | - Joshua Vogel
- Cochrane Australia, Monash University, Melbourne, VIC.,Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC
| | - Heath White
- Cochrane Australia, Monash University, Melbourne, VIC
| | | | | | - Leeroy William
- Cochrane Australia, Monash University, Melbourne, VIC.,Eastern Health, Melbourne, VIC
| | - Patsy M Yates
- Centre for Cancer and Palliative Care Outcomes, Queensland University of Technology, Brisbane, QLD
| | | | | | - Meera R Agar
- IMPACCT Centre, University of Technology Sydney, Sydney, NSW
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Smith J, Dodd RH, Hersch J, McCaffery KJ, Naganathan V, Cvejic E, Jansen J. Psychosocial and clinical predictors of continued cancer screening in older adults. Patient Educ Couns 2021; 104:3093-3096. [PMID: 33962825 DOI: 10.1016/j.pec.2021.04.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 06/16/2020] [Revised: 03/21/2021] [Accepted: 04/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Many older adults (aged 75+) continue cancer screening despite guidelines suggesting they should not. Using mixed-methods, we examined psychosocial and clinical factors associated with continued breast/prostate screening. METHODS We conducted an online, scenario-based, randomized study in Australia with participants aged 65+ years. The primary outcome was screening intention (10-point scale, dichotomized: low (1-5) and high (6-10)). We also measured demographic, psychosocial, and age-related clinical variables. Participants provided reason/s for their screening intentions in free-text. RESULTS 271 eligible participants completed the survey (aged 65-90 years, 71% adequate health literacy). Those who reported higher cancer anxiety, were men, screened more recently, had family history of breast/prostate cancer and were independent in activities of daily living, were more likely to intend to continue screening. Commonly reported reasons for intending to continue screening were grouped into six themes: routine adherence, the value of knowing, positive screening attitudes, perceived susceptibility, benefits focus, and needing reassurance. CONCLUSIONS Psychosocial factors may drive continued cancer screening in older adults and undermine efforts to promote informed decision-making. PRACTICE IMPLICATIONS When communicating benefits and harms of cancer screening to older adults, both clinical and psychosocial factors should be discussed to support informed decision-making.
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Affiliation(s)
- Jenna Smith
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia.
| | - Rachael H Dodd
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Jolyn Hersch
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Kirsten J McCaffery
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, Sydney, Australia
| | - Erin Cvejic
- Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, Australia; Sydney Health Literacy Laboratory, Sydney School of Public Health, The University of Sydney, Sydney, Australia; School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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48
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Smith J, Dodd RH, Gainey KM, Naganathan V, Cvejic E, Jansen J, McCaffery KJ. Patient-Reported Factors Associated With Older Adults' Cancer Screening Decision-making: A Systematic Review. JAMA Netw Open 2021; 4:e2133406. [PMID: 34748004 PMCID: PMC8576581 DOI: 10.1001/jamanetworkopen.2021.33406] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Decisions for older adults (aged ≥65 years) and their clinicians about whether to continue to screen for cancer are not easy. Many older adults who are frail or have limited life expectancy or comorbidities continue to be screened for cancer despite guidelines suggesting they should not; furthermore, many older adults have limited knowledge of the potential harms of continuing to be screened. OBJECTIVE To summarize the patient-reported factors associated with older adults' decisions regarding screening for breast, prostate, colorectal, and cervical cancer. EVIDENCE REVIEW Studies were identified by searching databases from January 2000 to June 2020 and were independently assessed for inclusion by 2 authors. Data extraction and risk of bias assessment were independently conducted by 2 authors, and then all decisions were cross-checked and discussed where necessary. Data analysis was performed from September to December 2020. FINDINGS The search yielded 2475 records, of which 21 unique studies were included. Nine studies were quantitative, 8 were qualitative, and 4 used mixed method designs. Of the 21 studies, 17 were conducted in the US, and 10 of 21 assessed breast cancer screening decisions only. Factors associated with decision-making were synthesized into 5 categories: demographic, health and clinical, psychological, physician, and social and system. Commonly identified factors associated with the decision to undergo screening included personal or family history of cancer, positive screening attitudes, routine or habit, to gain knowledge, friends, and a physician's recommendation. Factors associated with the decision to forgo screening included being older, negative screening attitudes, and desire not to know about cancer. Some factors had varying associations, including insurance coverage, living in a nursing home, prior screening experience, health problems, limited life expectancy, perceived cancer risk, risks of screening, family, and a physician's recommendation to stop. CONCLUSIONS AND RELEVANCE Although guidelines suggest incorporating life expectancy and health status to inform older adults' cancer screening decisions, older adults' ingrained beliefs about screening may run counter to these concepts. Communication strategies are needed that support older adults to make informed cancer screening decisions by addressing underlying screening beliefs in context with their perceived and actual risk of developing cancer.
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Affiliation(s)
- Jenna Smith
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachael H. Dodd
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Karen M. Gainey
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Erin Cvejic
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jesse Jansen
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Kirsten J. McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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49
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Thillainadesan J, Aitken SJ, Monaro SR, Cullen JS, Kerdic R, Hilmer SN, Naganathan V. Geriatric Comanagement of Older Vascular Surgery Inpatients Reduces Hospital-Acquired Geriatric Syndromes. J Am Med Dir Assoc 2021; 23:589-595.e6. [PMID: 34756839 DOI: 10.1016/j.jamda.2021.09.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 05/28/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study evaluates the impact of a novel model of care called Geriatric Comanagement of Older Vascular surgery inpatients on clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS A pre-post study of geriatric comanagement, comparing prospectively recruited preintervention (February-October 2019) and prospectively recruited postintervention (January-December 2020) cohorts. Consecutively admitted vascular surgery patients age ≥65 years at a tertiary academic hospital in Concord and with an expected length of stay (LOS) greater than 2 days were recruited. INTERVENTION A comanagement model where a geriatrician was embedded within the vascular surgery team and delivered proactive comprehensive geriatric assessment based interventions. METHODS Primary outcomes of incidence of hospital-acquired geriatric syndromes, delirium, and LOS were compared between groups using univariable and multivariable logistic regression analyses. Prespecified subgroup analysis was performed by frailty status. RESULTS There were 150 patients in the preintervention group and 152 patients in the postintervention group. The postintervention group were more frail [66 (43.4%) vs 45 (30.0%)], urgently admitted [72 (47.4%) vs 56 (37.3%)], and nonoperatively managed [52 (34.2%) vs 33 (22.0%)]. These differences were attributed to the coronavirus disease 2019 pandemic during the postintervention phase. The postintervention group had fewer hospital-acquired geriatric syndromes [74 (48.7%) vs 97 (64.7%); P = .005] and reduced incident delirium [5 (3.3%) vs 15 (10.0%); P = .02], in unadjusted and adjusted analyses. Cardiac [8 (5.3%) vs 30 (20.0%); P < .001] and infective complications [4 (2.6%) vs 12 (8.0%); P = .04] were also fewer. LOS was unchanged. Frail patients in the postintervention group experienced significantly fewer geriatric syndromes including delirium. CONCLUSIONS AND IMPLICATIONS This is the first prospective study of inpatient geriatric comanagement for older vascular surgery patients. Reductions in hospital-acquired geriatric syndromes including delirium, and cardiac and infective complications were observed after implementing geriatric comanagement. These benefits were also demonstrated in the frail subgroup.
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Affiliation(s)
- Janani Thillainadesan
- Department of Geriatric Medicine, Concord Hospital, Concord, Sydney, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, Sydney, Australia; Center for Education and Research on Aging, and Aging and Alzheimers Institute, Concord, Sydney, Australia.
| | - Sarah J Aitken
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, Sydney, Australia; Concord Institute of Academic Surgery, Vascular Surgery Department, Concord Hospital, Concord, Sydney, Australia; Department of Vascular Surgery, Concord Hospital, Concord, Sydney, Australia
| | - Sue R Monaro
- Department of Vascular Surgery, Concord Hospital, Concord, Sydney, Australia; Susan Wakil School of Nursing, The University of Sydney, Sydney, Australia
| | - John S Cullen
- Department of Geriatric Medicine, Concord Hospital, Concord, Sydney, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, Sydney, Australia; Center for Education and Research on Aging, and Aging and Alzheimers Institute, Concord, Sydney, Australia
| | - Richard Kerdic
- Department of Vascular Surgery, Concord Hospital, Concord, Sydney, Australia
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Sydney Medical School, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Vasi Naganathan
- Department of Geriatric Medicine, Concord Hospital, Concord, Sydney, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, Sydney, Australia; Center for Education and Research on Aging, and Aging and Alzheimers Institute, Concord, Sydney, Australia
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Hsu B, Korda RJ, Lindley RI, Douglas KA, Naganathan V, Jorm LR. Use of health and aged care services in Australia following hospital admission for myocardial infarction, stroke or heart failure. BMC Geriatr 2021; 21:538. [PMID: 34635068 PMCID: PMC8504055 DOI: 10.1186/s12877-021-02519-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD), including myocardial infarction (MI), stroke and heart failure (HF) are the leading cause of death amongst the older population worldwide. The aim of this study is to investigate trajectories of use of health and aged care services after hospital admission for MI, stroke or HF among community-dwelling people not previously receiving aged care services. METHODS The study population comprised people aged 65+ years from the 45 and Up Study with linked records for hospital stays, aged care services and deaths for the period 2006-14. Among those with an index hospital admission for MI, stroke or HF, we developed Sankey plots to describe and visualize sequences and trajectories of service use (none, re-hospitalization, community care, residential care, death) in the 12 months following discharge. We used Cox proportional hazards models to estimate hazard ratios (HRs), for commencing community care and entering residential care (and the other outcomes) within 3, 6 and 12 months, compared to a matched group without MI, stroke or HF. RESULTS Two thousand six hundred thirty-nine, two thousand five hundred and two thousand eight hundred seventy-three people had an index hospitalization for MI, stroke and HF, respectively. Within 3 months of hospital discharge, 16, 32 and 29%, respectively, commenced community care (multivariable-adjusted HRs: 1.26 (95%CI:1.18-1.35), 1.53 (95%CI:1.44-1.64) and 1.39 (95%CI:1.32-1.48)); and 7, 18 and 14%, respectively, entered residential care (HRs: 1.25 (95%CI:1.12-1.41), 2.65 (95%CI:2.42-2.91) and 1.50 (95%CI:1.37-1.65)). Likewise, 26, 15 and 28%, respectively, were rehospitalized within 3 months following discharge (multivariable-adjusted HRs: 4.78 (95%CI:4.31-5.32), 3.26 (95%CI:2.91-3.65) and 4.94 (95%CI:4.47-5.46)). CONCLUSIONS Older people hospitalized for major CVD may be vulnerable to transition-related risks and have poor health trajectories, thus emphasizing the value of preventing such events and care strategies targeted towards this at-risk group.
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Affiliation(s)
- Benjumin Hsu
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia. .,School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia
| | - Richard I Lindley
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Kirsty A Douglas
- ANU Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Repatriation Hospital and University of Sydney, Sydney, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
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