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

Publications (61)

Article
Background: There is a need for clinical quality indicators (CQIs) that can be applied to dementia quality registries to monitor care outcomes for people with Alzheimer’s disease and other forms of dementia. Objective: To develop tertiary and primary care-based dementia CQIs for application to clinical registries for individuals with dementia acces...
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In 2018, the Australian Dementia Network (ADNeT) was established to bring together Australia’s leading dementia researchers, people with living experience and clinicians to transform research and clinical care in the field. To address dementia diagnosis, treatment, and care, ADNeT has established three core initiatives: the Clinical Quality Registr...
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Introduction: The world is undergoing a demographic transition to an older population. Preventive healthcare has reduced the burden of chronic illness at younger ages but there is limited evidence that these advances can improve health at older ages. Statins are one class of drug with the potential to prevent or delay the onset of several causes o...
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Background: Optimism is a disposition characterised by positive future expectancies, while pessimism is characterised by expecting the worst. High optimism and low pessimism promote the health of older adults and may potentiate full engagement in life. We identified socioeconomic, behavioural, and social factors associated with optimism and pessim...
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Objective: The role of circulating sex hormones on structural brain ageing is yet to be established. This study explored whether concentrations of circulating sex hormones in older women are associated with the baseline and longitudinal changes in structural brain ageing, defined by the brain-predicted age difference (brain-PAD). Design: Prospec...
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Introduction Neuroimaging-based ‘brain age’ can identify individuals with ‘advanced’ or ‘resilient’ brain aging. Brain-predicted age difference (brain-PAD) is predictive of cognitive and physical health outcomes. However, it is unknown how individual health and lifestyle factors may modify the relationship between brain-PAD and future cognitive or...
Article
Objectives: Informal carers play a critical role in supporting people with dementia. We conducted a scoping review and a qualitative study to inform the identification and development of carer-reported measures for a dementia clinical quality registry. Methods: Phase 1-Scoping review: Searches to identify carer-reported health and well-being mea...
Article
Importance: Falls and fractures are frequent and deleterious to the health of older people. Aspirin has been reported to reduce bone fragility and slow bone loss. Objective: To determine if daily low-dose aspirin (100 mg) reduces the risk of fractures or serious falls (fall-related hospital presentations) in healthy older men and women. Design,...
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Introduction: To determine whether slowed gait and weakened grip strength independently, or together, better identify risk of cognitive decline or dementia. Methods: Time to walk 3 meters and grip strength were measured in a randomized placebo-controlled clinical trial involving community-dwelling, initially cognitively healthy older adults (N =...
Article
Background: Studies related to clinical quality indicators (CQIs) in dementia have focused on hospitalizations, medication management, and safety. Less attention has been paid to indicators related to primary and secondary care. Objective: To evaluate the incidence of primary and secondary care CQIs for Australians with dementia using government...
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Background: Few studies have explored the impact of low back or lower limb pain severity on recurrent (≥2) falls in older adults. Objectives: Investigate the association between the severity of low back or lower limb pain, and ≥2 falls or falls-related injuries. Methods: Community-dwelling Australian males and females in the ASPREE Longitudina...
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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...
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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...
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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...
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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...
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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...
Article
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...
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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

... A meta-analysis of efficacy and safety of participants (n = 14,483) from 28 trials in older adults shows that statin therapy or a more intensive statin regimen produced a 21% proportional reduction in major vascular events per 1.0 mmol/L reduction in low-density lipoprotein cholesterol [18]. It will be interesting to see the result of the Statins in Reducing Events in the Elderly (STAREE) trial, which is a large randomised clinical trial, that will provide further insight on the safety and efficacy of statin therapy for primary prevention in older adults [19]. ...
... It was also shown that steroid levels in the brain were not associated with cognitive performance in elderly women. (39,40) It further stated that low SHBG levels still need to be proven to be associated with good processing speed in the brain. (39) We agree with the above, but bioavailable steroids take precedence. ...
... В исследованиях по первичной профилактике терапия АСК продемонстрировала незначительное снижение риска ССО при значительном увеличении риска геморрагических осложнений: 1,53% против 0,4% в группе плацебо [37]. Согласно данным подисследования рандомизированного клинического исследования ASPREE, результаты которого опубликованы в ноябре 2022 года, низкие дозы аспирина для первичной профилактики в пожилом возрасте не только не снижают риск переломов (1,394 в группе аспирина, 1,471 в контрольной группе), но, напротив, повышают риск серьезных осложнений после падений (общее число падений 884 против 804 в контрольной группе) [38]. В настоящее время первичная профилактика ССЗ ацетилсалициловой кислотой у пожилых пациентов без сопутствующих сердечно-сосудистых или цереброваскулярных заболеваний не рекомендована ввиду недостаточной оценки соотношения польза/ риск в этой группе. ...
... Open access accessible measures to assess people's risk for dementia. Identified non-invasive biomarkers include changes in movement (speed, rhythm, accuracy) and strength, specifically in walking (gait), 5 hand grip strength 6 and finger tapping variability. 7 Changes in movement and strength have also been documented in the tongue, affecting swallowing and speech production. ...
... To understand long-term health outcomes and service use of registry participants, the ADNeT CQR will conduct data linkage on a regular basis to access data that is routinely collected by various government bodies, such as data on medication and hospital and aged care utilization. To facilitate this, the ADNeT CQR has collaborated with the Registry of Senior Australians (ROSA) and explored the feasibility of post-diagnostic data collection for the registry using ROSA datasets [15]. ...
... Several large cross-sectional and longitudinal cohort studies showed lower cognitive performance in OSA patients as compared to non-OSA participants [18,33,50,69,76,83,86,88], but others did not [2,37,44,45,60]. Different methodologies used to identify OSA participants (e.g., questionnaires, self-reported diagnosis, national registry, objective measures) may explain part of the heterogeneity. ...
... Another systematic review also found an association between walking speed and the probability of disability [32]. A recently developed prediction model demonstrated that age, walking speed, and cognitive function were the strongest predictors of disability-free survival in healthy older people [33]. We only found two studies, both longitudinal, carried out in the Netherlands aimed at predicting disability assessed with the GARS by frailty items [34,35]. ...
... 4 Using a brain age model based on structural magnetic resonance imaging (MRI), 3 we previously reported that brain-PAD is negatively associated with cognitive performance in older community-dwelling individuals, and observed a faster rate of brain ageing in men compared with women, over 3-years of follow-up. 5,6 Sex differences in brain ageing may arise from differences in the concentration of circulating sex hormones. 7 Oestrogens have received considerable attention in this field, especially as there are changes in the production of oestrogens after menopause. ...
... 26 Frailty score was derived using modified Fried criteria from items relating to low body mass index, gait speed, grip strength, exhaustion, and low physical activity (assessed by study staff); individuals were categorised as frail (≥3 characteristics), pre-frail (1-2 characteristics), or non-frail. 27 ...
... The deviation from expected aging is often quantified as the brain age gap (BAG; also referred to as brainPAD, brainAGE, etc.), which is calculated by subtracting chronological age from brain age. The BAG has shown broad associations with brain disorders [9], risk of mortality [8], and cognitive function [22], to name a few (see [23], [24] for recent reviews). However, there are relatively few longitudinal studies in healthy participants. ...