Australasian Journal on Ageing

Published by Wiley
Online ISSN: 1741-6612
Print ISSN: 1440-6381
Publications
To estimate temporal trends in burn injury hospitalisations, mortality and hospital stay, for older adults with a burn-related hospitalisation. De-identified data of all incident burn hospitalisations for adults 60 years and older in Western Australia from 1983-2008 were analysed. Poisson regression analyses were used to estimate temporal trends in hospital admissions and mortality. Zero truncated negative binomial regression analysis was used to identify factors associated with hospital stay. Between 1983 and 2008, hospitalisation rates increased for scalds (incident rate ratio (IRR) 1.01, 95% CI: 1.00-1.02) and contact burns (IRR 1.05, 95% CI: 1.03-1.07) while a significant reduction in flame hospitalisation rates (IRR 0.93, 95% CI: 0.92-0.94) was estimated. No significant changes in length of stay or burn-related mortality were estimated. Burn safety and prevention strategies that include first aid education need to be developed that target older adults living in their homes, to decrease their risk of sustaining burn injuries.
 
Aim: To describe an international comparison of dependency of long-term care residents. Methods: All Auckland aged care residents were surveyed in 1998 and 2008 using the ‘Long-Term Care in Auckland’ instrument. A large provider of residential aged care, Bupa-UK, performed a similar but separate functional survey in 2003, again in 2006 (including UK Residential Nursing Home Association facilities), and in 2009 which included Bupa facilities in Spain, New Zealand and Australia. The survey questionnaires were reconciled and functional impairment rates compared. Results: Of almost 90 000 residents, prevalence of dependent mobility ranged from 27 to 47%; chronic confusion, 46 to 75%; and double incontinence, 29 to 49%. Continence trends over time were mixed, chronic confusion increased, and challenging behaviour decreased. Conclusion: Overall functional dependency for residents is high and comparable internationally. Available trends over time indicate increasing resident dependency signifying care required for this population is considerable and possibly increasing.
 
To examine the general practitioner (GP) consultation patterns for primary health-care services provided in residential aged care facilities (RACFs) by consultation type. Analyses of service provision and RACF population data for the period 1998-2011. All Medicare-subsidised services provided by GPs across Australia in RACFs were included and categorised by consultation type and by time of service delivery (business or after-hours). Overall service delivery increased from 12 118 per 1000 residents in financial year (FY) 1998-99 to 17 079 per 1000 residents in FY2010-11, a 41% increase. Since FY2007-08, the rate of brief consultations has grown by an average of 20% each year. Delivery of after-hours consultations also increased. The pattern of GP services provided in RACFs has changed substantially over time. To some extent these changes reflect regulatory adjustments; however, the pattern is at odds with the ever-increasing dependence levels of residents.
 
  To describe admissions patterns of residential aged care facility (RACF) residents admitted to a major public hospital. DESIGN, SETTING:  Retrospective longitudinal study linking hospital admissions and the Department of Health and Ageing RACF provider data from July 1999 to June 2005.   All permanent residents of aged care facilities in South Australia admitted to a single public hospital. Main outcome measures:  Description of primary diagnoses and trends.   There were 3310 admissions from 147 RACFs across South Australia. The most frequent primary diagnoses were fractured femur/pelvis, pneumonia and ischaemic heart disease. Two diagnoses increased significantly with an 11% annual increase for infections and a 5% increase for femur fractures.   Admissions from RACFs to a major South Australian public hospital are increasing primarily because of admissions for femur fractures and infections in high care. These conditions could be targeted for interventions to reduce hospital admissions.
 
To model impact of modifiable risk behaviour on dementia prevalence among the Australian population aged 45 years and over. A group-based computer model was constructed to estimate the impact of modifying risk behaviour on dementia prevalence. Based on population ageing, the number of people aged 45 years and over living with dementia is expected to triple from 187 000 in 2006 to 650 000 by 2051. A drop in proportion ever smokers by 5% every 5 years would lower population with dementia by 2% in 2051. If obesity rate drops by 5%, dementia prevalence would be lower by 6%. A decline in physical inactivity rate by 5% would reduce dementia by 11%. Persistence of the growing trend in obesity and physical inactivity would result in a larger than expected dementia epidemic. Improving the risk behaviours has potential to make a substantial reduction in the number of people with dementia.
 
  To identify factors that predict admission to a rehabilitation hospital for patients over 65 years of age.   This study reviewed the destinations of all patients over 65 years admitted to a Department of General and Vascular Surgery over 1 year to analyse factors associated with subsequent admission to a rehabilitation hospital. Data recorded included demographic characteristics, type of admission, length of stay at the primary hospital, operation, speciality type, previous admission to rehabilitation hospital, diagnoses and procedures.   Of the 2632 patients examined, 8.7% were subsequently admitted to a rehabilitation hospital. Multivariate analysis showed that previous admission to the rehabilitation hospital, increasing age, number of diagnoses and admission under vascular service were all independently associated with admission for rehabilitation.   Factors associated with increased risk of requiring transfer to a rehabilitation hospital can be identified. This allows early recognition of at-risk patients.
 
Aim: The current study was aimed to examine the short-term effects of a 3-month health education program on health-related quality of life using the Short-Form 36. Methods: Twenty-five Japanese older people aged 65 and older in the health education program were compared with two historical control groups (n = 25 each) undertaking group and resistance exercise interventions and matched by age, sex and body mass index. A series of split-design two-way analyses of variance were conducted for data analysis. Results: Significant improvements were observed in general health and vitality subscales of the Short-Form 36 in the educational program group. Multivariate analyses, adjusted for several confounding factors, revealed that the effects of the three programs were comparable. Conclusions: The findings suggest that a structured 3-month educational program may be as effective as exercise interventions in improving general health and vitality in a community-dwelling Japanese older population.
 
To explore the hypothesis that better health status of elderly populations is primarily determined by the provision of freely accessible health service at low or no cost to the user and a social welfare system. Information was collected by questionnaire from surveys of three cohorts of elderly (70 years and older) Chinese. Data from two health-care systems were compared: the low-cost or free government-subsidized system in Hong Kong, and the market-orientated user-pays system in urban (Beijing), and rural China. The Beijing rural cohort had the best health profile, whereas the Hong Kong cohort had the worst, despite the better lifestyle practices in the Hong Kong and Beijing urban cohorts compared with the Beijing rural cohort, and higher socioeconomic status in the Beijing urban and Hong Kong cohorts. However, the Beijing rural cohort had the highest prevalence of functional limitations. While health-care systems may affect life expectancy at birth, psychosocial, lifestyle and socioeconomic factors influence subsequent health status of elderly people in a complex manner.
 
To detect the validity of the Global Registry of Acute Coronary Events (GRACE) risk score in predicting acute myocardial infarction (AMI) mortality of Chinese inpatients aged 80 and over. Hospital mortality was defined as all-cause death rate of patients during hospitalisation. Using GRACE risk score to predict death risk, both discrimination (C statistic) and calibration (the predicted vs observed mortality based on the population with predicted risks) were evaluated. Three hundred eighty-six patients presenting with ST segment elevation AMI (STEMI) and non-STEMI were enrolled. The GRACE risk score ranged between 151 and 297, and the mortality was 23.3%. The overall discriminatory capacity of the GRACE model was high (C statistic 0.767, CI: 0.712-0.822). There was a high correlation (R(2) = 0.833) between the predicted and observed hospitalised AMI mortality. The GRACE score is a useful risk prediction model for hospital mortality of Chinese AMI patients aged 80 and over.
 
Baby Boomers are working and living longer than their pre-war counterparts, and are more likely to live in high density urban housing. This paper examines the relationship between housing type, working status and location of residence on health status in Baby Boomers. We investigated location of residence and housing type in 1009 participants of the Ageing Baby Boomers in Australia (ABBA) Study to identify any predictors of, or correlations between, these variables and health status. Current workers were less likely to report depression than retirees. We found a significantly higher rate of diabetes, obesity and hypertension in retirees than in current workers however rates of obesity, diabetes and hypertension were higher than predicted in current workers. The rates of chronic disease are higher than previous estimates and provide evidence to inform health promotion programs designed to increase physical activity and improve eating habits in baby boomers.
 
To examine processes of aged-care needs assessment for Aboriginal people in remote central Australia to assist development of appropriate models of aged care. A qualitative study involving 11 semistructured interviews with aged-care assessors and two focus groups with Aboriginal community members. This paper reports four major themes concerning how needs assessments relate to realities of service delivery: cultural perspectives on aged care, context of service delivery, equity and access to services, and program (mis)alignments. Disparities exist between assessment recommendations and service availability, with a potential mismatch between Aboriginal understandings of needs, interpretations by individual assessment staff and program guidelines. Incorporating a conceptual framework, such as the International Classification of Functioning, Disability and Health, into service guidelines to ensure structured consideration of a person's holistic needs may assist, as will building the capacity of communities to provide the level and type of services required. © 2014 The Authors. Australasian Journal on Ageing published by Wiley Publishing Asia Pty Ltd on behalf of Australian Council on the Ageing and The Australian and New Zealand Society for Geriatric Medicine.
 
To explore the experiences of frontline health and welfare practitioners in working with older people experiencing abuse. In-depth interviews with 16 Tasmanian community-based health and welfare practitioners regarding their experiences of working in 49 recent cases of elder abuse. Interview transcripts were analysed using thematic analysis. All participants found working in cases of elder abuse challenging and the work itself was perceived as difficult, complex and at times dangerous. The cumulative effect of intimidating work contexts, practice dilemmas and a lack of support resulted in frustration and stress for many practitioners. Nevertheless, participants were committed to providing ongoing services and support for older people experiencing abuse. Frontline practitioners working in cases of elder abuse face significant challenges and could be better supported through the strengthening of organisational elder abuse policies, increased management support and more age-inclusive family violence support services.
 
This study aimed to compare perceptions about elder abuse among health professionals and students in the same health disciplines. The Caregiving Scenario Questionnaire (CSQ) was disseminated to Australian health professionals from two metropolitan health services and to university health care students. One hundred and twenty health professionals and 127 students returned surveys. Significantly more students than health professionals identified locking someone in the house alone all day and restraining someone in a chair as abusive. There is a need for further definition clarification and education about detection and management of elder abuse for health students and professionals in Australia. Student education should include consideration of the real-life situations likely to be encountered in practice. Education for both students and health professionals should include strategies for carers to manage difficult situations such as the one described in the CSQ.
 
To investigate how older people effectively identify, select and learn to use mobile communications technologies to enhance communication and safety, and support independent living. One hundred and fifty-three older South Australians participated in a purpose-designed survey questionnaire. Older people relied on family and friends for information and advice (76%), and their children's assistance with buying (45%) and learning to use (48%) new technology. The most preferred learning method was face-to-face training (56%). Less than half (44%) were interested in trying out new designs/applications, functions and capabilities that could assist with independent living. The highest need was for personal security and emergencies (88%). Findings suggest that the family and friends of older people play an important role in identifying, selecting and learning to use mobile communication technologies. The safety and emergency capabilities of mobile communications technologies were more important than having functions that could assist with independent living.
 
To identify the impact of in-reach services providing specialist nursing care on outcomes for older people presenting to the emergency department from residential aged care. Retrospective cohort study compared clinical outcomes of 2278 presentations from 2009 with 2051 presentations from 2011 before and after the implementation of in-reach services. Median emergency department length of stay decreased by 24 minutes (7.0 vs 6.6 hours, P < 0.001) and admission rates decreased by 23% (68 vs 45%, P < 0.001). The proportion of people with repeat emergency department visits within six months decreased by 12% (27 vs 15%). The proportion of admitted patients who were discharged with an end of life palliative care plan increased by 13% (8 vs 21%, P = 0.007). There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in-reach services.
 
To evaluate the predictive validity and responsiveness of the Home Falls and Accidents Screening Tool (HOME FAST). A prospective study of 727 community dwelling Veterans and war widows aged 70 years and over. The outcome was 6-month recall of any fall at 3-year follow-up. Baseline measurements were taken of common falls risk factors, and home hazards (using the HOME FAST). Changes in the prevalence of HOME FAST items were calculated and a logistic regression model was computed to determine predictors of falls at follow-up. Prevalence of 14 HOME FAST items was significantly reduced from baseline to follow-up (P <or= 0.05). Falls were significantly related to the baseline HOME FAST score (odds ratio (OR) 1.016, 95% confidence interval (CI) 1.004-1.098, P = 0.006), and a reduction in home hazards at follow-up (OR 0.984, 95% CI 0.973-0.996, P = 0.02). The HOME FAST can predict falls in older people and is responsive to change.
 
The misuse and abuse of Enduring Powers of Attorney (EPAs) by attorneys, particularly in relation to financial decision-making, is a growing concern. This paper explores the opportunities to enhance accountability of attorneys at the time of the execution of the document in Queensland. A four-stage multi-method design comprised a critical reference group; semi-structured interviews with 32 principals or potential principals, attorneys and witnesses; two focus groups with service providers and a state-wide survey of 76 principals, attorneys and witnesses. Across all methods and user groups, understanding the role and obligations of the attorney in an EPA was consistently identified as problematic. Promoting accountability and understanding can be addressed by greater attention to the role of the attorney in the forms/ guidelines and in the structure and witnessing of the forms, increased direction about record keeping and access to appropriate advice and support.
 
To determine the accuracy of self-reported anthropometric measurements in older Australian adults 60-70 years. Self-reported anthropometric data from 103 community-dwelling participants (mean age 66 years) were compared with actual measurements. Difference and agreement were assessed using paired t-tests, correlation coefficients and Bland-Altman plots. Underreporting occurred for weight and hip circumference, especially among men, whereas waist circumference was slightly overreported, resulting in apparent underestimations of body mass index (by 0.42 kg/m(2) ) but overestimations of waist-to-hip ratio (WHR, by 0.02). Concordance correlation coefficients were generally high except for WHR. Self-reported circumference measures appeared to be more accurate than the derived WHR. The Bland-Altman plots revealed wide limits of agreement for all measures. Self-reported values correlated well with measured values and average discrepancies were small. However, use of self-reported anthropometric data may be preferable in population studies for describing overall distribution than for monitoring changes at an individual level.
 
Several tests are available for aphasia screening following stroke. However, some of them have shortcomings such as need of specialist knowledge, low sensitivity and/or specificity and lengthy administration time. Our study aims to evaluate the language component of the Addenbrooke's Cognitive Examination--Revised (ACE-R) as a screening tool for aphasia in stroke patients. The language component of ACE-R was administered to consecutive patients admitted to a post-acute stroke unit. Patients who were medically unstable or had a significant history of sensory impairment or mental health issues were excluded. The test was administered by two junior doctors with basic training in ACE-R administration. Patients recruited were also assessed by an experienced speech and language therapist (SLT). The results of the two assessments were documented by a different member of the team and the SLT results were used as the benchmark to calculate the ACE-R language component sensitivity and specificity.   Fifty-nine participants were recruited and 27 of them were women. The mean age was 72 (SD 11.9). Thirty-four participants had left and 11 right hemisphere stroke. Fourteen had bilateral affection. Six participants were left handed. A cut-off value of 22/26 of ACE-R language component showed 100% specificity and 83.1% sensitivity, while a cut-off value of 16/26 had 88.2% specificity and 100% sensitivity. Our results suggest that the language component of ACE-R has a satisfactory sensitivity and specificity compared with other screening tests used in strokes. It is easy to administer and free to use.
 
To investigate workplace cultures in the acquisition of computer usage skills by mature age workers. Data were gathered through focus groups conducted at job network centres in the Greater Brisbane metropolitan region. Participants who took part were a mixture of workers and job-seekers. The results suggest that mature age workers can be exposed to inappropriate computer training practices and age-insensitive attitudes towards those with low base computer skills. There is a need for managers to be observant of ageist attitudes in the work place and to develop age-sensitive strategies to help mature age workers learn computer usage skills. Mature age workers also need to develop skills in ways which are practical and meaningful to their work.
 
Older people receiving informal care at home appear at high falls risk. This study investigates frequency, circumstances and factors associated with falls risk for older care recipients, and their informal caregivers. Ninety-six dyads, recruited from caregiver agencies, underwent a home assessment, including falls risk, function, depression, quality of life, self-rated health and carer burden. Care recipients were at high falls risk. In the past 12 months, 58% had fallen and 26% twice or more. Common falls risk factors were polypharmacy, multiple medical conditions and requiring functional assistance. Caregivers exhibited multiple health problems, moderate burden and reduced quality of life. Where care recipients had high falls risk, caregivers had significantly higher carer burden and depression. Low functional level and high care recipient health problems were independently associated with risk of falling (P < 0.05). Strategies to reduce falls risk in this cohort are necessary, together with supporting the needs of the caregiver.
 
To identify opportunities and challenges in promoting community support for rural older women experiencing intimate partner violence (IPV). Using community-based participatory research principles, we engaged in an academic-community partnership to analyse the research literature, estimate IPV incidence and prevalence, ascertain professional and older IPV victim perspectives through focus groups and interviews, and develop a collaborative community response plan. This study took place from 2008 to 2010 in the USA. IPV in late life is underreported by victims and often unrecognised by the academic and service community. Professionals, while agreeable to collaborating to support older IPV victims, sought coordination and leadership from domestic violence agencies. Older victims stressed the need for improved professional sensitivity to their unique needs and more service options. The insights generated during this project produced a framework on which rural communities can build to address the hidden and growing problem of late life IPV.
 
To determine whether home care clients have accessed or been influenced by fall prevention programs. Mail survey of 4743 home care clients from several home care agencies. Among the clients, 47.2% completed the survey and 46% had fallen within the last year. Faller and non-fallers differed in attitude to falls and fall risk factors. Only 15% of fallers and 7% of non-fallers had taken part in a fall prevention program and only 8% knew how to access information about such activities. Fall prevention strategies should be targeted at the home care population. Such programs should take into consideration the specific needs of this group.
 
Early signs of dementia may raise concerns in family members as to the safety of the affected person when engaged in common activities. Here we report on the relative frequency of such concerns using data from the three waves of the Canadian Study of Health and Aging (CSHA). Our focus is on driving, cooking and paying bills, with a prediction that most carers' concern would be over driving. Participants were 2780 Canadians over 65 years, who underwent the first wave of CSHA and were subsequently followed during the next two waves. As predicted, concerns about driving were relatively more common than concerns about cooking and handling finances (P = 0.021) in the cognitively intact group, with the opposite order observed in the group with dementia. Carer concerns for those diagnosed with dementia shift with the progression of cognitive changes, with concerns declining over the 10-year period.
 
The increasing burden of chronic diseases including cardiovascular and cerebrovascular disease, diabetes and dementia has led to greater emphasis on health promotion, prevention and early intervention (PPEI) activities within primary care. At the same time, there is growing recognition of the importance of measuring and benchmarking health-care system performance. This includes the measurement of PPEI activities. This paper considers the issue of measuring PPEI activities that are relevant to reducing the risk of dementia within the Australian primary care system. Although Australia does not currently have a comprehensive data collection regarding primary health-care services, there are a number of national, state and other data sources. These sources could be utilised, either in their current format or modified to provide data regarding PPEI activities in primary care that may reduce the risk of dementia and we have made recommendations regarding the development of such indicators.
 
A group-based multisensory activity program (Sensory Day) for residents with dementia was developed to address the challenge of providing personalised activities within tight operational constraints in residential aged care facilities. Fourteen participants with severe and very severe dementia were observed before, during and after participation in one of four Sensory Day sessions. The Menorah Park Rating Scale was used to yield four levels of engagement. The Philadelphia Geriatric Affect Rating Scale was used to identify four affect states. Dementia severity was ascertained by PAS-CIS scores mapped onto the Global Deterioration Scale. Increased levels of constructive engagement and positive affect were observed during participation in the Sensory Day sessions, relative to measures taken before the session. This novel approach to activity programming demonstrates that it is possible to provide group-based activities for residents with severe and very severe dementia which result in increased engagement and positive mood.
 
Aim: This project explored the usability of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) for describing older Māori and non-Māori people's self-nominated important activities. Method: Within a feasibility-for-cohort study, 112 participants, 33 Māori, aged 75-79 years, and 79 non-Māori, aged 85 years, nominated their three most important activities. Verbatim responses were coded using the ICF classifications and described using non-parametric statistics. Results: Men and women mostly named domestic life, interpersonal relationships and recreation and leisure activities. While Māori frequently named extended family relationship activities as being most important, non-Māori named more recreation and leisure activities. Conclusions: The ICF is useful for classifying older New Zealanders' important activities, although some activities of older Māori were not specified in the original version used. While important activity patterns were similar for men and women, those related to ancestral connectivity and community collectivity were most important for Māori.
 
Few Australian studies have examined the impact of dementia on hospital outcomes. The aim of this study was to determine the relative contribution of dementia to adverse outcomes in older hospital patients. Prospective observational cohort study (n = 493) of patients aged ≥70 years admitted to four acute hospitals in Queensland. Trained research nurses completed comprehensive geriatric assessments using standardised instruments and collected data regarding adverse outcomes. The diagnosis of dementia was established by independent physician review of patients' medical records and assessments. Patients with dementia (n = 102, 20.7%) were significantly older (P = 0.01), had poorer functional ability (P < 0.01), and were more likely to have delirium at admission (P < 0.01) than patients without dementia. Dementia (odds ratio = 4.8, P < 0.001) increased the risk of developing delirium during the hospital stay. Older patients with dementia are more impaired and vulnerable than patients without dementia and are at greater risk of adverse outcomes when hospitalised.
 
Describe injury profile and costs of older people trauma in New South Wales; quantify variations with peer group costs; identify predictors of higher costs. Nine level 1 New South Wales trauma centres provided data on major traumas (aged ≥55 years) during 2008-2009 financial year. Trauma register and financial data of each institution were linked. Treatment costs were compared with peer group Australian Refined Diagnostic Related Groups costs, on which hospital funding is based. Variables examined through multivariate analyses. Six thousand two hundred and eighty-nine patients were admitted for trauma. Most common injury mechanism was falls (74.8%) then road trauma (14.9%). Median patient cost was $7044 (Q1-3: $3405-13 930) and total treatment costs $76 694 252. Treatment costs were $5 813 975 above peer group average. Intensive care unit admission, age, injury severity score, length of stay and traumatic brain injury were independent predictors of increased costs. Older people trauma attracts greater costs and length of stay. Cost increases with age and injury severity. Hospital financial information and trauma registry data provides accurate cost information that may inform future funding.
 
To identify Aged Care inpatients potentially suitable for Acute/Post-Acute Care (APAC)-Aged Care, a new service offering community-based acute care as an alternative to hospital admission for frail older people. Criteria were developed to identify suitable patients for APAC-Aged Care and applied to consecutive Aged Care inpatient admissions at Royal North Shore Hospital, Sydney, Australia, through retrospective chart review. Only 5/90 reviewed patients were potentially suitable for APAC-Aged Care. All five were from Residential Aged Care Facilities. The median age of the 90 patients was 86 years; 30% lived in Residential Aged Care Facilities; 53% of patients were medically stable on presentation; 70% required investigations beyond a standard baseline set; 27% had either no new functional decline on presentation or adequate community support to manage this; 91% had allied health input and 41% had medical/surgical consultation. APAC-Aged Care is a potentially suitable alternative to acute inpatient hospitalisation in a select minority of Aged Care patients.
 
To understand the dynamics underlying 'bed-blocking' in Australian public hospitals that is frequently blamed on older patients. Analysis of primary and secondary data of utilisation patterns of hospital and aged care services by older Australians. A model of the dynamics at the acute-aged care interface was developed, in which the pathway into permanent high-care Residential Aged Care (RAC) is conceptualised as competing queues for available places by applicants from the hospital, the community and from within RAC facilities. The hospital effectively becomes a safety net to accommodate people with high-care needs who cannot be admitted into RAC in a timely manner. The model provides a useful tool to explore some of the issues that give rise to access-block within the public hospital system. Access-block cannot be understood by viewing the hospital system in isolation from other sectors that support the health and well-being of older Australians.
 
Develop a measure of frailty for older acute inpatients to be performed by non-geriatricians. The Reported Edmonton Frail Scale (REFS) was adapted from the Edmonton Frail Scale for use with Australian acute inpatients. With acute patients aged over 70 years admitted to an Australian teaching hospital, we validated REFS against the Geriatrician's Clinical Impression of Frailty (GCIF), measures of cognition, comorbidity and function, and assessed inter-rater reliability. REFS was moderately correlated with GCIF (n = 105, R = 0.61, P < 0.01), Mini-Mental State Examination impairment (n = 61, R = 0.49, P < 0.001), Charlson Comorbidity Index (n = 59, R = 0.51, P < 0.001) and Katz Daily Living Scale (n = 59, R = 0.51, P < 0.001). Inter-rater reliability of REFS administered by two researchers without medical training was excellent (kappa = 0.84, n = 31). In this cohort of older acute inpatients, REFS is a valid, reliable test of frailty, and may be a valuable research tool to assess the impact of frailty on prognosis and response to therapy.
 
To describe models of career and lifestyle options for ageing doctors that suggest adaptability to ageing and retirement. Doctors aged 60 or older from Australia, Canada and the United States (n= 25) deemed to be ageing well by peers were administered a semistructured interview to obtain demographic and qualitative data regarding lifestyle, attitudes to ageing and retirement. Emergent themes included: (i) insights into the physical and psychological vicissitudes of ageing and the effects of such on practice; (ii) the need for adaptations in working hours and choice of work; (iii) the importance of long-term retirement planning; (iv) the usefulness of a transitional phase to ease into retirement; and (v) the need to cultivate a variety of medical and non-medical pursuits and relationships early in one's career. These insights might encourage doctors to engage in long-term occupational, familial, social and financial planning and provide potential models of adaptive ageing in doctors for further study.
 
To evaluate the utility of the Addenbrooke's Cognitive Examination--Revised (ACE-R) as a screening tool for dementia. Prospective audit of 122 patients (82 with dementia, 40 with no dementia) referred to a Sydney cognition clinic. An ACE-R cut-off score of 84/100 provided an optimal balance of sensitivity, specificity and positive predictive value (0.85, 0.80 and 0.90, respectively) in identifying patients with dementia. In our sample, the ACE-R was a superior dementia screening tool to the Mini-Mental State Examination in patients with higher levels of education (≥ 10 years of formal schooling), but not in patients with lower levels of education. Patients misclassified by the instrument had evidence of high levels of education, focal executive dysfunction, medical comorbidities, significant vascular disease and polypharmacology. The ACE-R is a useful screening tool for detecting the presence of dementia in a cognition clinic setting. Caution may be warranted in some patient populations.
 
Top-cited authors
Jo-Anne Everingham
  • The University of Queensland
Michael Cuthill
  • Consultant
Hal L Kendig
  • Australian National University
Bruce Macdonald
  • University of Auckland
Elizabeth Broadbent
  • University of Auckland