ObjectiveTo systematically assess the effects of exercise interventions on body composition and functional outcomes in older adults with sarcopenia. MethodsPubMed/Medline, Embase and Cochrane Library were searched from 2006 to 2017 for exercise randomised controlled trials and controlled clinical trials in adults 60 years and older with sarcopenia. Preferred Reporting Items for Systematic Review and Meta-Analysis protocol (PRISMA-P) and Physiotherapy Evidence Database (PEDro) scale assessed internal validity. Meta-analysis and sensitivity analysis were performed. ResultsSearches retrieved 1512 titles. Thirty-two full texts were evaluated, and six trials were included. Methodological quality was 5.5 (0-10). Meta-analysis revealed that knee-extension strength (P 0.01), timed up and go (P < 0.0001), appendicular muscle mass (P = 0.04) and leg muscle mass (P = 0.04) significantly improved in response to exercise interventions. ConclusionsExercise interventions significantly improved strength, balance and muscle mass. However, the number of trials was small and the training effect was inconsistent due to heterogeneity in exercise mode, duration and intensity. Lack of detailed description makes it impossible to reflect on the progressive resistance training approaches used. More research is needed to confirm these findings.
Aim: To evaluate the association between loss of fat‐free mass and mortality among older people. Methods: Information of healthy Chilean older people evaluated by dual energy X‐ray absorptiometry was used, identifying those who died in a period of 12 years. A Cox proportional hazards model was used to identify mortality predictors. Life tables were constructed calculating survival using predictive variables. Results: Information from 1413 participants aged 74.3 ± 5.6 years (1001 women), was obtained. During the follow‐up (median 1594 days), 221 participants died. The Cox model identified age and appendicular fat‐free mass as predictors of death (hazard ratios 1.08 and 0.85, respectively). According to life tables, participants in the lower sex‐specific quartile for appendicular fat‐free mass/height had significantly higher mortality. This association was significant among participants aged over 73 years. Conclusion: A low fat‐free mass was predictive of mortality in older people.
ObjectivesThere are growing concerns that social isolation presents risks to older people's health and well-being. Thus, the objective of the review was to explore how technology is currently being utilised to combat social isolation and increase social participation, hence improving social outcomes for older people. MethodsA systematic review of the literature was conducted across the social science and human-computer interaction databases. ResultsA total of 36 papers met the inclusion criteria and were analysed using a four-step process. Findings were threefold, suggesting that: (i) technologies principally utilised social network services and touch-screen technologies; (ii) social outcomes are often ill-defined or not defined at all; and (iii) methodologies used to evaluate interventions were often limited and small-scale. ConclusionResults suggest a need for studies that examine new and innovative forms of technology, evaluated with rigorous methodologies, and drawing on clear definitions about how these technologies address social isolation/participation.
To evaluate the need for and the feasibility of a pharmacist-led physician-supported deprescribing model. All patients aged ≥65 years, with polypharmacy, admitted to the acute general medical unit (GMU) of an Australian tertiary hospital over a 6-week period were prospectively evaluated for deprescribing by team pharmacists. Clinical decision-making was supported by physicians. One hundred and twenty-nine patients met inclusion criteria, and 58 (45%) were identified for deprescribing. Ninety-two (7.2%) deprescribing instances were identified of 1277 medications prescribed. Of these, 46 (50%) were successfully deprescribed during inpatient admission in 35 (60%) patients. The most prevalent rationale for deprescribing was "harm outweighing benefits." Outpatient deprescribing was planned in 16 (17%) of instances, and 39 (42%) would require outpatient follow-up to ensure adherence to recommendations and safety. No predictors for deprescribing were identified on univariate analyses. A pharmacist-led physician-supported deprescribing model is feasible in GMU patients who have polypharmacy.
Aim: This study investigated the attitudes and preferences of staff, residents and relatives of residents in a retirement village towards a health‐care robot. Methods: Focus groups were conducted with residents, managers and caregivers, and questionnaires were collected from 32 residents, 30 staff and 27 relatives of residents. Results: The most popular robot tasks were detection of falls and calling for help, lifting, and monitoring location. Robot functionality was more important than appearance. Concerns included the loss of jobs and personal care, while perceived benefits included allowing staff to spend quality time with residents, and helping residents with self‐care. Residents showed a more positive attitude towards robots than both staff and relatives. Conclusions: These results provide an initial guide for the tasks and appearance appropriate for a robot to provide assistance in aged care facilities and highlight concerns.
The aim of the study was to improve the measurement of ageing in Oceania taking into account characteristics of populations and, in particular, changes in life expectancy. Using past and projected life tables, we calculated prospective old age dependency ratios (POADRs) to 2060, placing the boundary to old age at a moving point with a fixed remaining life expectancy (RLE) for thirteen territories of Oceania. In some territories, POADRs grow less rapidly than old age dependency ratios (OADRs). For example, in Australia and Guam, the OADR is forecast to increase from 0.20 and 0.07 in 1980, respectively, to 0.45 and 0.39 in 2050-55, while the POADR is forecast to increase from 0.17 and 0.07 to 0.19 and 0.19, respectively, over the same period. Policymakers may consider this more rational approach to measurement when considering holistic policy responses to both current issues relating to ageing and mitigating against future challenges.
This commentary aimed to determine whether nursing home (NH) providers have a responsibility for the safe mobility of residents outside the facility. The Safe System approach was applied to NH resident road safety, and fatality crash data involving NH residents were reviewed, to identify potential countermeasures to prevent injurious road crashes for older people living in a NH. Viewing NH resident road safety through the Safe System approach identified actions that NH providers can take to actively contribute to: safe roads/roadsides for residents by better land use, infrastructure and design improvements; ensuring vehicles purchased and used for transporting residents have safety features; safe speed zones within and on nearby streets to NH; and safer road user behaviour through ensuring travel care plans for each resident. Applying the Safe System approach has provided new and innovative insights into how road safety can be improved for NH residents.
To assess the ability of the Australian Modified Lawton's Instrumental Activities of Daily Living (IADL) Scale (Modified Lawton's Scale) to screen for cognitive impairment in patients without physical or sensory deficits. Prospective single-blind study of diagnostic accuracy. Data were available for 249 patients. At ≤25 points on the Modified Lawton's Scale, the area under the receiver operating characteristic curve (AUC) for patients with dementia was 0.90 (95% CI 0.83, 0.96), with sensitivity of 95% and specificity of 84%. The scale had decreased ability to identify patients with mild cognitive impairment (MCI) with the AUC highest at 0.76 (95% CI 0.67, 0.84), with a sensitivity of 77% and specificity of 74% at ≤26 points. The Modified Lawton's Scale had a significant strong correlation with the Mini-Mental State Examination (0.73) (P ≤ 0.001). A score of ≤25 on the Modified Lawton's Scale may indicate cognitive impairment impacting on IADL.
Guided by the unified theory of acceptance and use of technology (UTAUT), the study explored information and communications technology (ICT) use and anticipation among middle-aged adults in urban China. Path analysis was performed on data from 401 participants aged 45-65 to examine the associations between anticipated ICT support and the acceptance and adoption process of ICT. For the late middle-aged adults, those who had greater belief in ICT usefulness and received more social support for ICT use were more likely to anticipate greater ICT support in old age. These associations were not found in the early middle-aged group. The frequency of ICT use may be the key explanation for different ICT predictors and patterns. The constructs of UTAUT are sequential steps. Middle-aged adults may believe in ICT usefulness even though they have not witnessed it in person.
Examine policies of aged care organisations relating to healthcare and lifestyle decision-making. Seven aged care organisations submitted policy documents. Policies were analysed using the Australian Law Reform Commission (ALRC) "Decision-Making Principles" as a framework. Senior staff (N = 9) with policy development roles participated in follow-up interviews. The structure and content of policy documents varied significantly between organisations. Most acknowledged the need to support the rights of care recipients in decision-making; however, the nature of this support was often unclear. Interview themes included factors relating to "organisational contexts" "policy development and implementation" and "ethical challenges." An overarching theme among high-performing organisations was "proactive response aimed at pre-empting decision-making dilemmas". We provide recommendations for policy development, including a self-assessment audit tool. Aged care provider organisations may need to review policies in the areas of healthcare and lifestyle decision-making to meet current best practice principles.
To identify discharge medications, especially psychotropic medications that are associated with falls, amongst older adults within 6 months following hospitalisation. Negative binomial regression was used to examine relationships between discharge medications and falls in older post-hospitalised adults. Multiple regression that considered falls risk factors at discharge was performed. Data for 267 participants showed that discharge medications were not independently associated with falls postdischarge after adjustment for other falls risk factors. Male gender (adjusted incidence rate ratio [95% confidence interval, CI]) 2.15 [1.36-3.40]), higher depression scores (1.14 [1.05-1.25]) and co-morbidity of neurological disease other than stroke (5.98 [3.08-11.60]) were independently associated with an increased rate of falls. Higher depression scores (1.20 [1.11-1.31]) and co-morbidity of cancer (1.97 [1.20-3.25]) were independently associated with an increased rate of injurious falls in the 6 months postdischarge. Falls prevention strategies, other than hospital discharge medication management in the postdischarge older adults, warrant investigation.
To better understand the individual journeys of people living with dementia and their carers through the Australian health-care system. Stories were collected from 25 participants, through five face-to-face workshops, across Australia. This produced 18 visual storyboards and a range of opportunities for improvement, which were then synthesised into an aggregated "ideal-journey" model. Several issues were identified: long lead times to diagnosis; diverse experiences of treatment and support; and little coordination of care or thought for its impact on the consumer. Information about services, their purpose and eligibility criteria was difficult to obtain, and potential care pathways were largely unexplained. Much of the carer support received was reactive rather than proactive. A better understanding of the current health-care pathway of dementia is essential for the design and delivery of future health-care services. It is vital to include the consumer voice in future research and allocation of health-care resources.
To investigate the decision-making processes applied by people with dementia and family carers participating in using health economic approaches to value dementia-specific quality of life states. People with dementia (n = 13) and family carers (n = 14) participated in valuing quality of life states using two health economic approaches: Discrete Choice Experiment (DCE) and Best Worst Scaling (BWS). Participants were encouraged to explain their reasoning using a "Think Aloud" approach. People with dementia and family carers adopted a range of decision-making strategies including "anchoring" the presented states against current quality of life, or simplifying the decision-making by focusing on the sub-set of attributes deemed most important. Overall, there was strong evidence of task engagement for BWS and DCE. Health economic valuation approaches can be successfully applied with people with dementia and family carers. These data can inform the assessment of benefits from their perspectives for incorporation within economic evaluation.
To evaluate the implementation of a model of care known as the Confused Hospitalised Older Persons (CHOPs) program to improve recognition, assessment and management of older persons with cognitive impairment (delirium and/or dementia) admitted to acute hospitals. The model of care was implemented in six selected hospitals across New South Wales. Pre- and postimplementation medical record audits, environmental audits, and staff knowledge and care confidence surveys were performed. Interviews with clinical leads postimplementation identified enablers and barriers. There were significant increases in cognitive screening within 24 hours (OR = 3.32 [2.50-4.91]), delirium risk identification (OR = 4.04 [2.89-5.64]), assessment of cognitive impairment (OR = 2.55 [1.90-3.43]) and interaction with families (OR = 2.81 [2.09-3.79]). Staff education and care confidence were improved, and positive environmental changes occurred in all hospitals. Barriers and enablers to implementation were identified. The CHOPs program improved identification, risk assessment and management of cognitive impairment in older hospitalised patients.
To explore perceptions of the impacts of dementia on people living with the condition and those close to them and examine the relationship between dementia, disadvantage and social exclusion. Semi-structured in-depth interviews were conducted with 111 participants: people with dementia (n = 19), carers (n = 28), health-care professionals (n = 21), social workers (n = 23) and service professionals (n = 20). NVivo 11 was used to code descriptions and identify impact areas. Participants described social, psychological, carer, material, service-based and disparity impacts associated with the experience of dementia. Some of these impacts correspond to social exclusion associated with age, but some are distinctive to dementia. It is argued that dementia generates its own forms of social disadvantage and exclusion. This is in addition to being subject to structural risk factors. The implications of the active effects of dementia as a social phenomenon should give rise to new policy and practice priorities.
This paper visually explores older aged care resident's day-to-day lived experience, as well as providing a brief introduction to the participatory documentary photography method of photovoice. Ten residents from one Australian residential aged care facility collaborated with researchers and care staff to photograph, reflect on and share their lives. Photographs were shortlisted in individual and group discussions. Residents' photographs and narratives provide a visual understanding of what they value. Photographs captured three core themes: the restorative joy of nature (frangipanis); active engagement through leisure activities (football); and the value of social interactions and connections, especially with fellow residents and staff (friendship). As old age and aged care remain virtually invisible within popular visual culture, this research highlights the communicative value of participatory photography for challenging stereotypes, as well as the opportunities, challenges and value of visual methods with this cohort.