Stephanie A. Ward's research while affiliated with UNSW Sydney and other places

Publications (50)

Article
Background and objective: The clinical significance of sleep-disordered breathing (SDB) in older age is uncertain. This study determined the prevalence and associations of SDB with mood, daytime sleepiness, quality of life (QOL) and cognition in a relatively healthy older Australian cohort. Methods: A cross-sectional analysis was conducted from...
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Purpose Physical health-related quality of life (HRQoL) is associated with adverse health outcomes, including hospitalizations and all-cause mortality. However, little is known about how physical HRQoL changes over time in older people and the predictors of this trajectory. This study (a) identified trajectories of physical HRQoL among older people...
Article
Prolonging survival in good health is a fundamental societal goal. However, the leading determinants of disability-free survival in healthy older people have not been well established. Data from ASPREE, a bi-national placebo-controlled trial of aspirin with 4.7 years median follow-up, was analysed. At enrolment, participants were healthy and withou...
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Background: There is considerable variability in the rate at which we age biologically, and the brain is particularly susceptible to the effects of aging. Objective: We examined the test-retest reliability of brain age at one- and three-year intervals and identified characteristics that predict the longitudinal change in brain-predicted age diff...
Article
BACKGROUND Frailty is associated with chronic inflammation, which may be modified by aspirin. The purpose of this study was to determine whether low dose aspirin reduces incident frailty in healthy older adult participants of the ASPirin in Reducing Events in the Elderly (ASPREE) trial. METHODS In the U.S and Australia, 19,114 community-dwelling i...
Article
The many changes that occur in the lives of older people put them at an increased risk of being socially isolated and lonely. Intergenerational programs for older adults and young children can potentially address this shortfall, because of the perceived benefit from generations interacting. This study explores whether there is an appetite in the co...
Article
Brain age is a neuroimaging-based biomarker of aging. This study examined whether the difference between brain age and chronological age (brain-PAD) is associated with cognitive function at baseline and longitudinally. Participants were relatively healthy, predominantly white community-dwelling older adults (n=531, aged ≥70 years), with high educat...
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Background Brain age is a novel neuroimaging-based marker of ageing that uses machine learning to predict a person’s biological brain age. A higher brain age relative to chronological age (i.e., brain-predicted age difference [brain-PAD]) is considered a sign of accelerated ageing. We examined whether brain-PAD is associated with cognition and the...
Article
Background: This study examined the risk of mortality in older adults with newly detected cognitive impairment or dementia. Methods: Data from the Australian cohort of the ASPirin in Reducing Events in the Elderly (ASPREE) trial were examined. The ASPREE clinical trial compared daily low-dose aspirin to a placebo and involved 16,703 individuals...
Article
Frailty is a state of heightened vulnerability and susceptibility to physiologic stressors that increases with age. It has shown increasing utility in predicting a range of adverse health outcomes. Here, we characterise a 67-item deficit-accumulation frailty index (FI) in 19,110 community-dwelling individuals in the ASPREE clinical trial. Participa...
Article
Clinical quality registries are increasingly utilised to monitor and improve healthcare quality. Opt-out consent is recommended to maximise participation and ensure validity of data, however, presents specific considerations when including persons with impaired decision-making abilities. This paper describes the innovative Australian Dementia Netwo...
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Care quality has important implications for people with dementia. We examined trends and geographical variation of four clinical quality indicators (CQIs) in Australia. This retrospective cohort study included all people with dementia using Australian government-subsidised aged care in 2008–2016 (n = 373,695). Quality indicator data were derived fr...
Article
Background Anticholinergic medications may increase risk of dementia and stroke, but prospective studies in healthy older people are lacking.Objective Compare risk of incident dementia and stroke by anticholinergic burden among initially healthy older people.DesignProspective cohort study.SettingPrimary care (Australia and USA).Participants19,114 c...
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Purpose Clinical quality registries (CQRs) are being established in many countries to monitor, benchmark, and report on the quality of dementia care over time. Case ascertainment can be challenging given that diagnosis occurs in a variety of settings. The Registry of Senior Australians (ROSA) includes a large cohort of people with dementia from all...
Article
Background Social isolation is associated with an increased risk of adverse health outcomes, including functional decline, cognitive decline, and dementia. Intergenerational engagement, i.e. structured or semi structured interactions between non-familial older adults and younger generations is emerging as tool to reduce social isolation in older ad...
Article
Background Cerebrovascular events, dementia and cancer can contribute to physical disability with activities of daily living (ADL). It is unclear whether low-dose aspirin reduces this burden in aging populations. In a secondary analysis, we now examine aspirin’s effects on incident and persistent ADL disability within a primary prevention aspirin t...
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Research Aims: This study seeks to understand whether those with dementia experience higher risk of death, using data from the ASPREE (ASPirin in Reducing Events in the Elderly) clinical trial study. Methods: ASPREE was a primary intervention trial of low-dose aspirin among healthy older people. The Australian cohort included 16,703 dementia-free p...
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Purpose To describe the baseline participant characteristics in the ASPREE-AMD study, investigating the effect of aspirin on AMD incidence and progression. Methods Australian participants from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, randomized to 100 mg aspirin daily or placebo, had non-mydriatic, digital color fundus images...
Article
Objective Evaluate the Pain Impact Index, a simple, brief, easy‐to‐use and novel tool to assess the impact of chronic pain in community‐dwelling older adults. Methods A Rasch modelling analysis was undertaken in Stata using a partial credit model suited to the Likert‐type items that comprised the Index. The Index was evaluated for: ordering of cat...
Article
Objective: To describe the prevalence, location and impact of moderate to severe pain experienced on most days in community-dwelling older (≥70 years) adults who were ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial participants. Methods: Cross-sectional ASPREE Longitudinal Study of Older Persons (ALSOP) data were collected from se...
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Background: Dementia was identified as a priority area for the development of a Clinical Quality Registry (CQR) in Australia in 2016. The Australian Dementia Network (ADNeT) Registry is being established as part of the ADNeT initiative, with the primary objective of collecting data to monitor and enhance the quality of care and patient outcomes fo...
Article
Objective Low back pain is prevalent in older populations and modifiable risk factors may include being overweight or obese. This study aimed to describe the prevalence and impact of moderate or severe low back pain in community-dwelling older adults and its association with body mass index (BMI). Methods Cross-sectional study involving 16,439 Aus...
Article
Background and objectives: Patient-reported outcome measures (PROMs) captures the patient's perspective regarding quality of life, daily functioning, symptom severity, and overall health, and how these may be impacted by health care or other interventions. PROMs are used in clinical quality registries (CQRs) for a number of diseases to assess the...
Article
Background: A clinical quality registry (CQR) for dementia provides benefits to those living with dementia and their carers by improving the quality and experience of care through benchmarking and monitoring patient outcomes. CQRs use data collected to form clinical quality indicators (CQIs) through which variations in clinical processes and outco...
Article
Objectives Australian guidelines advocate referral to comprehensive memory services for dementia diagnosis, but many patients may be diagnosed elsewhere. This study aimed to determine common settings for dementia diagnosis in Australia and to compare patient and carer experience between settings. Methods Exploratory cross‐sectional‐study of patien...
Article
The impact of dietary patterns and the commensal microbiome on susceptibility to and severity of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been largely ignored to date. In this Perspective, we present a rationale for an urgent need to investigate this possible impact and therapeutic options for COVID-19 b...
Article
Objective To determine the effect of low-dose aspirin vs placebo on incident all-cause dementia, incident Alzheimer disease (AD), mild cognitive impairment (MCI), and cognitive decline in older individuals. Methods Aspirin in Reducing Events in the Elderly (ASPREE) was a double-blind, placebo-controlled trial of low-dose aspirin. In the United Sta...
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Objectives This review provides insights into the potential for aspirin to preserve bone mineral density (BMD) and reduce fracture risk, building knowledge of the risk-benefit profile of aspirin. Methods We conducted a systematic review and exploratory meta-analysis of observational studies. Electronic searches of MEDLINE and Embase, and a manual...
Article
The burden of dementia is increasing globally. In the absence of curative treatment, preventive strategies to delay or reduce progression of dementia are crucial. This relies on the identification of modifiable risk factors. The effects of dementia on sleep are well recognized; however, there is now growing evidence suggesting a bidirectional relat...
Article
Background Poor nutritional status is a risk factor for the development of frailty. Likewise, oral health is independently associated with nutrition. The potential association between oral health and frailty in hospitalised elderly adults has, however, not previously been investigated. Objective To investigate the relationship between oral health...
Conference Paper
The prevalence of dementia and mild cognitive impairment (MCI) is significantly increasing. Currently more than 425,000 Australians are living with dementia and is expected to increase to 530,000 by 2025. Estimated prevalence of MCI is 5.9% and rising. Evidence suggests that clinical care delivered to persons living with dementia and MCI needs impr...
Article
Background: Intestinal gases are currently used for the diagnosis of disorders including small intestinal bacterial overgrowth and carbohydrate malabsorption. Aim: To compare the performance of measuring hydrogen production within the gut directly with the telemetric gas-sensing capsule with that of indirect measurement through breath testing....
Article
Objectives: To ascertain the trajectories of mental health among women in Australia assessed in repeat waves from their early 70 s to the end of their lives or their mid 80 s. Method: Secondary analysis of data contributed by the 1921–26 cohort of the Australian Longitudinal Study of Women's Health Waves 1–6. Primary outcome was the 4-item SF-36 Vi...
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Objectives: The onset of many illnesses is confounded with age and sex. Increasing age is a risk factor for the development of many illnesses, and sexual dimorphism influences brain anatomy, function, and cognition. Here, we examine frequency-specific connectivity in resting-state networks in a large sample (n = 406) of healthy aged adults. Metho...
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Ingestible sensors are potentially a powerful tool for monitoring human health. Sensors have been developed that can, for example, provide pH and pressure readings or monitor medication, but capsules that can provide key information about the chemical composition of the gut are still not available. Here we report a human pilot trial of an ingestibl...
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Purpose: Although aspirin therapy is used widely in older adults for prevention of cardiovascular disease, its impact on the incidence, progression and severity of age-related macular degeneration (AMD) is uncertain. The effect of low-dose aspirin on the course of AMD will be evaluated in this clinical trial. Design: A sub-study of the 'ASPirin...
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Gastroenterologists are still unable to differentiate between some of the most ordinary disorders of the gut and consequently patients are misdiagnosed. We have developed a swallowable gas sensor capsule for addressing this. The gases of the gut are the by-product of the fermentation processes during digestion, affected by the gut state and can con...
Article
Rationale: Cerebral microbleeds seen on brain magnetic resonance imaging are markers of small vessel disease, linked to cognitive dysfunction and increased ischemic and hemorrhagic stroke risk. Observational studies suggest that aspirin use may induce cerebral microbleeds, and associated overt intracranial hemorrhage, but this has not been definit...
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Background Venous leg ulceration is a common and costly problem that is expected to worsen as the population ages. Current treatment is compression therapy; however, up to 50 % of ulcers remain unhealed after 2 years, and ulcer recurrence is common. New treatments are needed to address those wounds that are more challenging to heal. Targeting the i...
Conference Paper
Objectives: Almost 400,000 Australians suffer from venous leg ulceration costing over $3 billion/year. The burden of disease is expected to rise with an ageing population and growing diabetes and obesity epidemics. Best practice treatment is compression therapy to aid venous return. Our compression clinical trial results have been translated to cli...
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Disability, mortality and healthcare burden from fractures in older people is a growing problem worldwide. Observational studies suggest that aspirin may reduce fracture risk. While these studies provide room for optimism, randomised controlled trials are needed. This paper describes the rationale and design of the ASPirin in Reducing Events in the...
Article
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The advent of optofluidic systems incorporating suspended particles has resulted in the emergence of novel applications. Such systems operate based on the fact that suspended particles can be manipulated using well-appointed active forces, and their motions, locations and local concentrations can be controlled. These forces can be exerted on both i...
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The role of aspirin in the secondary prevention of occlusive cardiovascular events has now been well established. Given this, aspirin in primary prevention has been the focus of several large trials and subsequent meta-analyses over the past 3 decades, and yet the issue remains controversial. Recent studies in populations with high baseline risk -...

Citations

... The difference between chronological and brain age is referred to as brain-PAD (the brain-predicted age difference). We have found a brain-PAD representing an older brain age relative to chronological age is associated with a lower cognitive performance [12], and others have shown brain-PAD to predict dementia and mortality risk [6,13]. ...
... Therefore, assessments of verbal abilities may still add value to a comprehensive cognitive battery in dementia screening and prediction, although COWAT-F may be less reflective of brain aging than tests for other cognitive domains. (32). ...
... We have recently shown that higher anticholinergic burden was associated with an increased risk of incident dementia, particularly for mixed/vascular dementia (which was the classification employed when there was a likely non-Alzheimer's contribution, typically small vessel vascular disease on neuroimaging), over a 4.7-year follow-up period in participants of the ASPirin in Reducing Events in the Elderly (ASPREE) trial. 12 In this analysis, we aimed to expand this earlier work to determine whether anticholinergic burden is associated with change over time in global cognition and within specific domains, including processing speed, executive function, and episodic memory. We hypothesize that higher anticholinergic burden would be associated with higher rates of cognitive decline in all domains, but especially executive functioning. ...
... Similarly, a recent analysis of the Registry of Senior Australians identified that individuals had died at an average of 2-years follow-up period and were on average 88 years old. 6 ...
... The same inclusion criteria will be used for the RCT as in the co-creation trajectories and the pilot study (i.e., speaking Dutch; having at least one grandparent or grandchild; and having no serious physical, cognitive, or psychological health problems). Based on effect sizes of intergenerational programs of children and older adults, an effect size of 0.15 will be intended for the outcomes of PA, cognitive functioning, psychosocial wellbeing, and quality of the family relationship [65]. The required sample size has been calculated using the software GPower 3.1.9.7 (Universität Düsseldorf, Düsseldorf, Germany) [60]. ...
... As a condition of enrolment, ASPREE participants had to be free of documented evidence of cardiovascular or cerebrovascular disease (CVD), dementia and major physical disability (18). Specifically, individuals were excluded if they had a dementia diagnosis or evidence of cognitive impairment based on the Modified Mini-Mental State (3MS) examination, history of cardiovascular disease or event (myocardial infarction, congestive heart failure, angina pectoris, stroke, transient ischemic attack, carotid stenosis, etc.), clinical diagnosis of atrial fibrillation, or a lot of difficulty -or an inability to independently performany of six Katz activities of daily living (ADL), including walking across a room, bathing, dressing, transferring, toileting, and eating (19). Prior cancer or other illnesses were not an exclusion provided life expectancy was judged to be at least 5 years. ...
... Buitendijk and his associates [135] retrospectively surveyed 330 patients with and without AP or AC, and detected no association of AP or AC with either visual decline or the occurrence of hemorrhages. A large-scale clinical trial, investigating the effect of aspirin on AMD incidence, progression, and subretinal hemorrhages, is currently underway and hopefully will provide further evidence in this matter [136,137]. ...
... 8 It is estimated that aged care assessments conducted from 2009 to 2015 captured approximately 36% of the estimated total population of people with dementia in Australia (prevalent cases) at the end of 2015. 9 Therefore, understanding and studying the cohort with dementia captured within the aged care sector can significantly contribute to our understanding of the individuals that may not be captured earlier for a national CQR. Information about health service use, medicines, hospitalisations, mortality and other information can then be monitored for these individuals over time. ...
... 49 Our ndings indicating that a high BMI was associated with greater CLBP-related disability (greater ADL limitations and SP restrictions) in our sample are consistent with similar associations reported in the literature. [50][51][52][53][54] Correlations of BMI with CLBPrelated disability and symptom severity may re ect biomechanical stress on the joints and spinal structures 52 , postural alterations 55 , and higher levels of adipokines being secreted by enlarged fat cells inducing greater release of pain and proin ammatory cytokines. 56 ...