J Simon Bell’s research while affiliated with Monash University (Australia) and other places

Abatract Background Information on the survival of people living with dementia over time and across systems can help policymakers understand the real-world impact of dementia on health and social care systems. This multinational cohort study examines the trends in relative mortality risk following a dementia diagnosis. Methods A common protocol was applied to population-based data from the UK, Germany, Finland, Canada (Ontario), New Zealand, South Korea, Taiwan and Hong Kong. Individuals aged 60+ with an incident dementia diagnosis recorded between 2000 and 2018 were followed until death or the end of the study period. Cox proportional hazards regression was used to assess the association of mortality in dementia patients with the year of dementia diagnosis. Results Data from 1,272,495 individuals, with the mean age at diagnosis ranging from 76.8 years (South Korea) to 82.9 years (Germany), show that the overall median length of survival following recorded diagnosis ranges from 2.4 years (New Zealand) to 7.9 years (South Korea). Hazard ratios (HRs) estimated from Cox proportional hazard models decline consistently over the study period in the UK, Canada, South Korea, Taiwan and Hong Kong, which accounted for 84% of all participants. For example, the HR decreases from 0.97 (95% CI: 0.92–1.02) in 2001 to 0.72 (0.65–0.79) in 2016 in comparison to year 2000 in the UK. Conclusions This study shows a steady trend of decreasing risk of mortality in five out of eight databases, which signals the potential positive effect of dementia plans and associated policies and provides reference for future policy evaluation.

Objective All Australian residential care facilities are recommended to have access to a medication advisory committee (MAC) to provide governance of medication management. The objective was to explore the structure and function of Australian MACs. Methods A national 43‐item survey of MACs was conducted from November 2023 to January 2024. The survey was adapted from the Australian Government Department of Health and Aged Care Audit Tool and Checklist for a Medication Advisory Committee (Audit Tool). All MAC representatives were recruited using a comprehensive and purposive strategy including the Department of Health and Aged Care newsletter, professional organisations, social media and professional contacts. Outcomes included self‐reported MAC structure and function across four key roles as per the Audit Tool, including policy development, risk management, education and quality improvement. Results Responses were received from 120 MACs covering 642 residential care facilities (24% of Australian residential care facilities) in all Australian states and mainland territories. The MACs provided oversight to a median (IQR) 116 (61–196) beds/residents and a median (IQR) 1 (1–4) facilities. Over half (58%) of MACs were multidisciplinary (nursing, pharmacist and prescriber representation). More than half of MACs reported performing all functions listed in the Audit Tool relating to policy development (59%) and risk management (53%). Only 41% and 28% of MACs reported they performed all functions in the Audit Tool related to education and quality improvement, respectively. Conclusion There is extensive heterogeneity in the structure and function of MACs with scope for MACs to become more multidisciplinary, identify staff training needs and proactively lead quality improvement.

Introduction The global annual incidence of hip fractures is projected to double over the next 20 to 30 years. The rates and risk factors for new persistent opioid use after hip fracture surgery remain poorly quantified. Objective To describe trajectories, rates, and risk factors for new persistent opioid use after hip fracture surgery in Australia. Methods A retrospective population-based cohort study was conducted using linked administrative health data in Australia. Adults aged ≥30 years discharged from hospital after a first hip fracture surgery between July 2012 and June 2017, opioid-naïve on admission, and alive 12 months postdischarge were included. Group-based trajectory modelling was utilised to determine trajectories and rates of opioid use 12 months postdischarge. Multivariate multinomial logistic regression analysis was performed to identify risk factors for persistent opioid use. Results Among 10,309 opioid-naïve patients who had first hip fracture surgery, 5305 (51.5%) used opioids postdischarge. Opioid users were categorised as 58.9% (3127/5305) nonpersistent, 12.6% (670/5305) fluctuating, 12.1% (641/5305) late discontinuation, and 16.3% (867/5305) persistent. Key risk factors for persistent use were total oral morphine equivalent >600 mg in first 30 days postdischarge (relative risk [RR] 13.61, 95% confidence interval [CI] 9.34–19.83), transdermal opioid in the first 30 days postdischarge (RR 7.64, 95% CI 5.61–10.39), and hospital length of stay >60 days (RR 4.31, 95% CI 3.02–6.15). Conclusion Among opioid-naïve patients, 16.3% were persistent opioid users at 12 months posthospital discharge. Future research should focus on targeted interventions to address modifiable risk factors to reduce new persistent opioid use in older and vulnerable populations.

INTRODUCTION Identifying individuals with dementia is crucial for prevalence estimation and service planning, but reliable, scalable methods are lacking. We developed novel set algorithms using both structured and unstructured electronic health record (EHR) data, applying Diagnostic and Statistical Manual of Mental Disorders criteria for dementia case identification. METHODS Our cohort (n = 1082) included individuals aged ≥ 60 with dementia identified through specialist clinics and a comparison group without dementia. Clinicians from Australia and the United States informed predictor selection. We developed algorithms through a biostatistics stream for structured data and a natural language processing (NLP) stream for text, synthesizing results via logistic regression. RESULTS The final structured model retained 16 variables (area under the receiver operating characteristic curve [AUC] 0.853, specificity 72.2%, sensitivity 80.6%). NLP classifiers (logistic regression, support vector machine, and random forest models) performed comparably. The final, combined model outperformed all others (AUC = 0.951, P < 0.001 for comparison to structured model). DISCUSSION Embedding text‐derived insights within algorithms trained on structured medical data significantly enhances dementia identification capacity. Highlights Algorithmic tools for detection of individuals with dementia are available; however, previous work has used heterogeneous case definitions which are not clinically meaningful, and has relied on proxies such as diagnostic codes or medications for case ascertainment. We used a novel, dual‐stream algorithmic development approach, simultaneously and separately modeling a clinically meaningful outcome (diagnosis of dementia according to specialized clinical impression) using structured and unstructured electronic health record datasets. Our clinically grounded case definition supported the inclusion of key structured variables (such as dementia International Classification of Disease codes and medications) as modeling predictors rather than outcomes. Our algorithms, published in detail to support validation and replication, represent a major step forward in the use of routinely collected data for detection of diagnosed dementia.

Aim: The Western Pacific region has the fastest aging population and 38% of the world's diabetes population. It is unknown to what extent medication management recommendations are included for older adults in type 2 diabetes (T2D) clinical practice guidelines (CPGs). Method: MEDLINE, Embase, Scopus, guideline-specific registries and gray literature searches were performed in November 2024. Data were extracted on guideline characteristics and recommendations relevant to older adults, dementia, frailty, co-morbidities associated with aging or end-of-life. Quality appraisal was performed using the AGREE II (Appraisal of Guidelines, Research and Evaluation) tool. Results: From the 37 countries and areas of the Western Pacific region, 16 CPGs were identified, of which 15 included 1-29 relevant recommendations. Thirteen CPGs recommended less stringent and/or individualized glycemic targets focused on reducing hypoglycemia for older adults. Five CPGs recommended individualized antihyperglycemic treatment choices. Seven CPGs included recommendations about de-intensification/simplification of complex regimens. The quality of CPGs varied, with scope and purpose rated the highest. Conclusions: There was heterogeneity in the number of recommendations within CPGs; however, none comprehensively addressed the T2D medication management needs of older adults or those living with dementia, frailty or receiving end-of-life care. Collaboration between diabetes and geriatric societies as well as the assistance of higher-income countries in helping those with less resource availability could provide a way forward to improving future CPGs. Geriatr Gerontol Int 2025; ••: ••-••.

Background Pancreatic cancer is the third leading cause of cancer-related death in Australia, with a persistently poor 5-year survival rate of around 13%. Symptoms arising from the disease and chemotherapy such as epigastric pain, anorexia, bloating and fat-malabsorptive diarrhoea cause poor oral intake and weight loss, and reduce an individual’s quality of life and ability to tolerate anti-cancer treatment. The primary aim of this study is to determine if an early, intensive telehealth nutrition intervention can improve quality of life compared to usual care for people undergoing treatment for pancreatic cancer. Methods This multicentre randomised controlled trial will recruit adults newly diagnosed with borderline resectable, locally advanced or metastatic pancreatic cancer from multiple health services across Victoria (metropolitan and regional). The control group will receive usual nutrition care, which is site-dependent. The intervention group will receive weekly telehealth dietetic consultations for six months, targeting nutritional adequacy through dietary education and counselling, oral nutrition supplement drinks and dietetics-led symptom management advocacy, including appropriate dosing of pancreatic enzymes. Escalation to supplemental jejunal tube feeding may occur if clinically required in the intervention arm. The primary outcome is quality of life (EORTC-QLQ C30 summary score); secondary outcomes include survival, chemotherapy dosing changes, and nutrition status markers including body composition. Outcomes will be measured at baseline, and three- and six-months. Discussion The findings of this study will provide evidence of the impact that intensive nutrition therapy, including counselling, provision of oral nutrition supplement drinks and the option for jejunal feeding, has on quality of life and health outcomes in pancreatic cancer. The consistent dietetic approach with the use of telehealth consultations to reduce malnutrition and aid symptom management challenges the current model of care. Trial registration 31st January 2024, Australian and New Zealand Clinical Trial Registry (Trial ID/No. ACTRN12624000084583).

Objective The aim of this study was to compare the risk of seizure, recurrent stroke, fall or fracture, and mortality in individuals prescribed different antiseizure medications (ASMs) following an ischemic stroke. Methods We identified all patients admitted to a Victorian public or private hospital with a principal diagnosis of an incident ischemic stroke between 2013 and 2017 and dispensed an ASM within 12 months of discharge. Cox proportional hazards regression was used to estimate the risk of cause‐specific rehospitalization or emergency department visits (seizure, fall or fracture, recurrent stroke) and all‐cause mortality over a 2‐year period. Inverse probability of treatment weighting was applied to each model to adjust for baseline covariates. Results Of 19 601 individuals hospitalized for incident ischemic stroke, 897 initiated ASM treatment within 12 months. More than three quarters were initiated on a non‐enzyme‐inducing ASM (78.0%). Levetiracetam (41.9%), valproate (28.4%), and carbamazepine (11.4%) were commonly dispensed initial ASMs. Non‐enzyme‐inducing ASMs demonstrated similar risk of seizure (hazard ratio [HR] = .93, 95% confidence interval [CI] = .63–1.37), fall or fracture (HR = 1.47, 95% CI = .92–2.34), stroke (HR = .83; 95% CI = .52–1.33), and mortality (HR = .96; 95% CI = .69–1.32) compared to enzyme‐inducing ASMs. However, when valproate was grouped as a separate class, non‐enzyme‐inducing ASMs (HR = 1.67, 95% CI = 1.04–2.71) showed higher risk of fall or fracture compared to enzyme‐inducing ASMs. Significance At a population level, ASMs of different types showed no significant differences in the risk of hospitalization or emergency department presentation for seizure, fall or fracture, stroke, and mortality within 2 years of an incident stroke presentation, suggesting similar short‐term health outcomes in a real‐world setting. Future research should investigate decision‐making around ASM choice for stroke survivors and examine the impact of long‐term ASM exposure on health outcomes.

Myocardial infarction (MI) imposes a significant health burden to the Australian population. However, detailed economic implication of MI on the Australian healthcare system has not been exhaustively explored. To estimate the current chronic management cost and project the future healthcare cost burden of MI, from the Australian healthcare system perspective. A generalized linear model with a gamma outcome distribution and negative inverse link function was used to estimate the current chronic management cost burden of MI while a dynamic multistate Markov model constructed to project the future healthcare cost burden of MI over 20 years (2019–2038). For all projected costs, 5% annual discounting was applied in the base case, as per Australian guidelines. We identified all people, 59,260, aged ≥ 30 years discharged from a public or private hospital following MI between 2012 and 2017 from the Victorian Admitted Episode Dataset. We estimated annual chronic management cost of MI by age, sex, socioeconomic disadvantage and years of follow-up. We used these data to project the future healthcare cost burden of MI. Cost in Australian dollar (AUD). The current annual chronic management cost of MI was estimated to be AUD 14,412 (95% confidence interval: AUD 14,282, AUD 14,542) per person. This cost was higher among advanced age group, male participants, during first year of follow-up and people in the most socioeconomically disadvantaged quintile. The projected total healthcare cost following MI was AUD 85.1 billion (95% uncertainty interval AUD 80.8 billion, AUD 89.8 billion) from 2019 to 2038. Our projections suggest that MI will cost the Australian healthcare system over AUD 85 billion in the coming years. Cost estimates based on key sociodemographic characteristics and socioeconomic disadvantage are expected to inform future health economic modelling studies for MI prevention strategies and interventions.