In residential aged care settings, the relationships between family members and care staff are recognised as a factor in high quality care. To determine the effectiveness of interventions designed to promote constructive staff-family relationships in the care of older people in aged care facilities. Systematic review and planned meta-analysis. A systematic review was conducted using a comprehensive search, updating a previous review. Searches were conducted in seven electronic databases to 17 December 2024. Risk of bias was assessed by two independent reviewers using the Cochrane Risk of Bias Tool (ROB-2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I). Statistical analysis was not possible due to incomplete data reporting in most studies. GRADE Certainty of Evidence was conducted using the GRADEPro GDT software. There were nine studies identified. Studies reported outcome measures that reflected characteristics of a constructive staff-family relationship, the experience of staff, the experience of family and outcomes relevant to older people receiving care. There was moderate certainty of evidence that an intervention designed to promote a constructive staff-family relationship might lead to small absolute benefits for older people, particularly reduction in hospital transfers. The evidence for quantifiable benefits for staff and family members was highly uncertain. Through a comprehensive review and evidence evaluation, we have identified that interventions to promote staff-family relationships require long term organisation and staff commitment, may require high intensity and durations to achieve a sustained impact, and the outcomes may be better evaluated using person-level analysis and qualitative data. Prospero: CRD42023453919.

Healthy aging is a major public health priority, particularly for women, who have a longer life expectancy and a high prevalence of conditions associated with frailty, sarcopenia, and loss of functional independence. Therefore, the objective of this systematic review and meta-analysis was to evaluate the effects of functional exercise on physical and psychosocial outcomes in women over 60 years of age. A systematic review and meta-analysis was conducted following PRISMA guidelines. Searches were performed in PubMed, Scopus, Web of Science, and Cochrane Library up to September 2025. Only randomized controlled trials involving women aged 60 years and older who participated in functional exercise interventions were included. Methodological quality was assessed with the PEDro scale, and pooled analyses were conducted using standardized mean differences (SMD) with 95% confidence intervals. Seventeen randomized controlled trials with a total of 968 participants met the inclusion criteria. Meta-analyses showed that functional exercise significantly improved physical capacities, including functionality (SMD = 0.81; 95% CI = 0.62 to 0.99), strength (SMD = 0.51; 95% CI = 0.11 to 0.91), and power (SMD = 0.28; 95% CI = 0.10 to 0.46). Additional evidence suggested improvements in psychosocial outcomes and reductions in proinflammatory cytokines, although results were more heterogeneous. The overall methodological quality of the included studies was moderate to high. Functional exercise may be a beneficial strategy to enhance physical and psychosocial capacities in women over 60 years of age. It may also contribute to modulating inflammatory and immunosenescence-related responses; however, the evidence remains limited and should be interpreted with caution. Further high-quality studies are needed to support its integration into healthy aging and preventive care programs.

Impact of multimodal training on nursing staff's competencies in dementia mealtime support: A mixed-methods pilot study.

Virtual Care (VC) enables clinicians to remotely assess and manage healthcare needs. While many healthcare services have integrated virtual components into existing in-person care models, the COVID-19 pandemic prompted organisations worldwide to rapidly develop new VC services from the ground up. This article outlines the establishment of a statewide adult urgent VC Service, detailing its conception, development and the first 6 months of operations. The conceptual phase (7 weeks) involved the project team collecting data and insights from stakeholders to build a business case for the VC Service, with a focus on two referral pathways. The development phase (7 weeks) included creating the model and establishing infrastructure, a workforce, and governance to ensure a high-quality, timely and safe service. The initial operations phase (26 weeks) fully integrated the first two referral pathways. During this time, the leadership team completed recruitment, developed a learning system, expanded operating hours and built a model to expand its referral pathways. The leadership team plans to enhance VC by improving assessment capabilities and by enabling new referral pathways into settings such as aged care. Including research methods in this model is essential to capture the benefits and risks associated with these important changes in healthcare delivery.

A Scoping Review of Australian Hospitals' Policies on the Deactivation of Implantable Cardioverter Defibrillators.

ABSTRACT This retrospective cohort study aimed to characterize individuals who self-identify as LGBTI+ entering the long-term aged care sector in Australia and their aged and health care services utilization after an aged care eligibility assessment or entering care. About 471 individuals were identified in the three-year study period. The median age at assessment was 77 (IQR 71–84), 45% (n = 212) identified as female, and 21.9% (n = 103) had a diagnosis of dementia. Within 12 months of their aged care eligibility assessment, 29.1% (n = 137) of the participants had not accessed any aged care services. LGBTI+ adults that did access services were young with a median age of 80 (IQR 73–85) for permanent residential care and a median age of 76 (IQR 70–84) for home care packages. Following aged care eligibility assessment, 21.9% (n = 101) of the participants had accessed a chronic disease management plan, and 26.5% (n = 111) experienced unplanned hospitalization. Our findings provide insights into how LGBTI+ older adults use aged and health care services in Australia to inform policy to improve health equity, service design and positively influence outcomes for this population.

ABSTRACT As populations age and older adults face heightened risks of isolation and loneliness, intergenerational programs are gaining prominence. This qualitative study explored residents’ perspectives via semi-structured interviews with six participants in an aged care facility. Reflexive thematic analysis identified two themes: the promise versus limits of intergenerational activities, and the complex realities of connection in aged care. Conversation with children was the most valued benefit, yet monthly sessions were seen as insufficient for enduring impact. Opportunities for interaction were constrained by residents’ cognitive impairment and other barriers to participation. An unanticipated finding was the vicarious effect of witnessing peers’ loneliness and exclusion, which shaped participants’ own sense of vulnerability. The study highlights the multifaceted nature of loneliness in residential care and the potential of intergenerational programs, alongside broader social initiatives, to address social deficits. A rights-based, resident-informed approach is recommended to ensure programs reflect older adults’ needs across diverse contexts.

Re-presentations to the Emergency Department for older persons experiencing pain: A retrospective cohort study.

Aged care staff are exposed to workplace risk factors that have the potential to considerably impact mental health. This study aimed to explore mental ill health, burnout, and associated occupational factors in a nationwide sample of residential aged care workers in Australia (N = 1085). Cross-sectional online survey data were collected. Rates of depression, anxiety, wellbeing, burnout, and turnover intentions were explored using descriptive statistics. Regression models were used to analyse occupational factors associated with mental ill health, wellbeing, and burnout. One quarter (24%) of participants reported symptoms indicating a probable depressive disorder, and over one third (35%) reported symptoms consistent with an anxiety disorder. Over half (56%) reported burnout at elevated levels. Lower perceived supervisor support and previous assault by a resident/client were associated with significantly higher anxiety, depression, and burnout. These findings suggest there is an urgent need for evidence-based interventions to improve conditions for residential aged care workers, including preventing staff assaults and upskilling managers in supporting the mental health of staff.

The institutionalisation of older adults has become increasingly common in Sri Lanka due to recent socioeconomic changes. Tai Chi is a traditional Chinese martial art that provides numerous physical and psychological health benefits. Despite its proven effectiveness, Tai Chi is a relatively new intervention in Sri Lanka, with no local research on its feasibility and efficacy among older adults. This study aims to evaluate the feasibility and effectiveness of Tai Chi on physical function and fall risk, lung function, depression, pain and health-related quality of life (HRQOL) in older adults residing in aged care homes in Sri Lanka. A single-arm pretest-posttest feasibility study will be conducted among older adults aged 60 and over (n=40) living in aged care homes in Kandy District, Sri Lanka. A certified Tai Chi instructor will deliver two 60 min sessions of the Tai Chi for Arthritis and Fall Prevention programme per week over a 12-week period in aged care home settings. Acceptability, demand, implementation, practicality, adaptation, integration, expansion and study limitations will be assessed to determine feasibility. Baseline and post-12-week Tai Chi programme outcomes will be assessed, focusing on physical function and fall risk, lung function, pain, depression and HRQOL. Additionally, field notes will be taken during the intervention, and a post-intervention follow-up group discussion will be conducted. Paired t-tests will be used to assess the effectiveness of the Tai Chi programme. A narrative synthesis will be used to analyse qualitative data. The Research Ethics Committee of the Faculty of Medicine, University of Peradeniya, Sri Lanka, approved this study (No.: 2024/EC/34). Written informed consent will be obtained from each participant before data collection. The findings will be presented at national and international research conferences and published in a reputed journal. This study was registered with the Sri Lanka Trial Registration (SLCTR/2025/025) at https://slctr.lk/trials/slctr-2025-025 (date: 26 June 2025).

To develop a grounded theory explaining the psychosocial processes older adults use when adapting to life in residential aged care. An evolved grounded theory methodology was used. Semi-structured interviews were conducted with 20 residents and three staff members across four residential aged care homes in Victoria, Australia, supplemented with ethnographic observations. Theoretical sampling continued until theoretical saturation was achieved. The theory of Adapting to a shrunken world comprises three categories: realising the need for care; facing a life in care; and living with loss. Adaptation is an active, ongoing process shaped by accumulating losses. Positive adaptation requires residents to recognise and accept care needs while ceding aspects of independence, autonomy and control. This theory extends transition-focused accounts of adaptation by showing that, while early phases of adjustment and acceptance are important, adaptation to life in residential aged care remains an active, ongoing, psychosocial process shaped by continual change and accumulating loss across residents' lives in care. Adaptation continues throughout residents' lives in care. Acceptance of care needs is critical, as perceived losses of independence and control can lead to resistance or resentment that inhibits adjustment. This theory provides a framework for person-centred policies and practices that support positive adaptation. Healthcare professionals can recognise early signs of maladaptation and implement interventions that foster acceptance while maintaining resident autonomy. This study addresses gaps in understanding long-term adaptation to residential care, informing nursing practice, aged care policy and care models internationally. Data were analysed using grounded theory methods. The COREQ checklist was applied to guide transparent reporting of study design, data collection and analysis. This study did not include patient or public involvement in its design, conduct or reporting.

Rising life expectancy and an aging population highlight the importance of cancer control. DNA methylation (DNAm)-based biological age (BA) may provide insights into aging, carcinogenesis, and cancer prevention and care. We estimated five BA metrics among 1916 participants aged 50-75 years at baseline in the German ESTHER cohort, with repeat BA measurements available for 894 participants after 8 years. Multivariable linear regression was used to assess associations between prior cancer and baseline BA, while Cox proportional hazards models and restricted cubic splines evaluated associations of BA levels and trajectories with subsequent cancer risk. A history of malignant tumors was associated with higher baseline PCHannum and PCGrimAge in fully adjusted models. Older BA levels were significantly associated with increased long-term cancer risk, with hazard ratios up to 1.67 (95% CI 1.25-2.24) per standard deviation (SD) increase in PCGrimAge. Except for PCGrimAge, BA trajectories showed monotonic, linear associations with cancer risk, corresponding to a 33% to 37% higher risk per SD increase in slopes of four BA matrices. Accelerated biological aging was consistently associated with increased overall cancer risk, highlighting the potential value of longitudinal BA measures for cancer risk assessment, prevention, and monitoring.

Periodontal disease is characterized in part by a host immune-inflammatory response that releases proteolytic enzymes, which damage periodontal tissue. Nonsteroidal anti-inflammatory drugs (NSAIDs) modulate host immune-inflammatory responses. We investigated cross-sectional and prospective relationships between NSAID use and indicators of periodontal disease, for which there is limited epidemiologic evidence. Data were from the Buffalo OsteoPerio Study of 1342 postmenopausal women ages 53-81 years. Periodontal assessments included measurements of alveolar crestal height (ACH), probing pocket depth (PPD), clinical attachment level (CAL), and gingival bleeding, taken at baseline (1997-2001) and 5 years later. Prospective outcomes included measures of periodontal disease progression defined by ACH loss, incident tooth loss, and gingival bleeding. NSAID use was assessed via medication inventory at baseline. Demographic, lifestyle, dental hygiene, and medical history information were collected. Multivariable linear and logistic regression modeling was used to examine associations between NSAID use and periodontal health outcomes. At baseline, 45.8% of participants used NSAIDs, half of whom exclusively used aspirin. No significant cross-sectional differences in periodontal measures were found between NSAID users and nonusers. Prospectively, NSAID users had 37% lower odds of periodontal disease progression defined by ACH loss (odds ratio [OR] 0.63, 95% confidence interval; [CI]: 0.45-0.88), after controlling for demographic variables, lifestyle factors, comorbidities, and dental hygiene behaviors. Prospective associations with PPD, CAL, gingival bleeding, and tooth loss were of variable magnitude and did not achieve statistical significance. In a cohort of postmenopausal women with well-characterized clinical periodontal measurements, use of NSAIDs at baseline was associated with lower odds of periodontal disease progression defined by ACH loss over 5 years of follow-up. NSAID use was not associated with changes to PPD, CAL, gingival bleeding, or tooth loss. Periodontal disease, a common condition characterizing poor oral health, can worsen over time due to the body's inflammatory response, which damages the tissues supporting teeth. Nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin, can reduce inflammation, but whether they have any role in preventing periodontal disease has not been well-studied. We explored this connection in more than 1,300 postmenopausal women from the Buffalo OsteoPerio Study, tracking their oral health over 5 years. At the start, nearly half of the women reported using NSAIDs, mostly aspirin. While NSAID users and nonusers had similar gum health at the beginning, we found that women who used NSAIDs had a 37% lower odds of losing the bone that supports their teeth over the next 5 years. This protective association remained even after accounting for age, lifestyle, medical conditions, and dental care habits. However, NSAID use was not associated with other measures of oral health, like gum bleeding, pocket depth around teeth, or tooth loss. These findings suggest that NSAIDs may help slow some aspects of periodontal disease progression, but their overall effects on oral health remain unclear. Understanding how common medications like NSAIDs affect oral health could guide strategies to protect against gum disease in older adults.

To explore how healthcare providers in rural aged care homes communicate about medications during transitions of care involving residents. Two residential aged care homes in rural Australia. Ten female healthcare providers including nurses, personal care assistants and pharmacists. Qualitative exploratory study using semi-structured interviews, analysed thematically, with engagement mapped via the Patient and Family Engagement Framework. Consolidated Criteria for Reporting Qualitative Research guidelines were followed. Two themes emerged from the interview data: (1) Providers' perceptions of medication communication roles and responsibilities, and (2) Providers' perceptions of challenges to engaging in medication communication. Nurses played a central but often reactive role, with resident and family engagement varying by capacity, proximity and interest. Personal care assistants and visiting pharmacists and personal care assistants contributed valuable safety and observational insights. Communication with other providers was fragmented and influenced by systemic and contextual inefficiencies. Healthcare providers in rural aged care homes, particularly nurses, face challenges in medication communication during care transitions. Structured, collaborative strategies are needed to ensure consistent information sharing and proactive resident and family engagement, with opportunities to strengthen contributions from pharmacists and personal care assistants in supporting person-centred care.

To explore the perceptions of rural residential aged care home (RACH) residents and family carers about the integration of allied health students in service delivery, and its impact on residents' health and wellbeing. Two rural RACHs in Northern NSW, where allied health students (Physiotherapy, Occupational Therapy, Speech Pathology, Nutrition and Dietetics and Social Work) attended rural clinical placements and were integrated in service delivery for residents. Twelve residents who received student-integrated services from the RACHs and five family carers. This was a qualitative evaluation. Residents and family carers were approached to participate in a semi-structured interview. Interviews were recorded, and audio interviews were transcribed verbatim. The transcripts were analysed using reflexive thematic analysis to generate themes and sub-themes. Three themes, each with several sub-themes, emerged from the interview data. The first theme was facilitators of effective care, and sub-themes were: modes of services, team-based approach and continuity of care. Continuity of care between successive groups of students was identified as an aspect of placement that requires improvement. The second theme presented how residents' functional abilities and emotional wellbeing improved after participating in student-led assessments and interventions. The third theme was participants' satisfaction with the students' competency and professionalism in delivering services. From the perspectives of residents and family carers, allied health student placements can enhance service provision in rural RACHs in Northern NSW. These placements offer potential to grow the rural allied health workforce and assist in meeting the health service needs of older rural adults within the region.

A previous study by our research group identified psychomotor and neurofunctional impairments following SARS-CoV-2 infection. This study continues that investigation, aiming to evaluate whether these impairments persisted over time, as part of the broader characterization of long COVID. Moreover, it was explored potential correlations with variables such as age, blood type, symptoms, and medical care. From an initial pool of 214 subjects, 30 post-COVID-19 participants and 30 healthy controls were selected after strict exclusion criteria. The assessments protocol included eight psychomotor tests-Fine Motor Development (Diadochokinesia, Puppets, Fan, and Paper) and Balance (Immobility, Static Balance on One Foot, Feet in Line, and Persistence)-as well as three cognitive screening tasks from the Mini-Mental State Examination: Episodic Memory After Distracters, Verbal Fluency, and Clock tests. Evaluations were performed at three time points: baseline (post-COVID-19), 12 weeks, and 24 weeks. Participants were stratified by age (18-30, 31-45, and 46-64 years), symptoms profile, medical care, and blood type. COVID-19 induced psychomotor and neurofunctional sequelae lasting at least 24 weeks post-infection. These impairments were more pronounced and persistent in the 31-45-years age group, while memory-related impairments were more evident in the 18-30 age group. Body pain, coryza, and sore throat were key symptoms linked to long-term sequelae. Rh-negative blood type was suggested as a potential risk factor. The findings support that long COVID included sustained psychomotor and neurofunctional sequelae, premature senescence, and associations with specific clinical and biological variables.

Intergenerational solidarity is globally being seen as the key to enabling inclusive, safe, and sustainable cities and communities, especially for children and seniors. Owing to this, intergenerational shared sites are gaining traction in Australia as a spatial nexus for combatting age segregation among seniors, children, and youth. While the existing research has focused on shared sites that co-locate senior care facilities with childcare institutions, there is a lack of research on intergenerational living and learning campuses (ILLCs) that co-locate schools with aged care facilities (ACFs) to foster interactions between seniors and teenagers, particularly from a spatio-environmental lens. Using a single-case study approach based on interviews using photo-elicitation and observations, this research empirically studied the case of an ACF co-located with a middle school in Australia. The findings reveal the key spatio-environmental attributes of place making for ILLCs at a micro, meso, and macro level and opportunities, barriers, and considerations for place making in the context of ILLCs.

Frailty increases with age and is associated with increased vulnerability to adverse health outcomes. International guidelines recommend screening for frailty in primary care; however, this is not routine practice in Australia. Once identified, frailty progression has the potential to be halted or reversed with early intervention. The FRAIL (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) Scale Tool, a simple and validated screening and management tool, offers a feasible approach for integration into the Australian health assessment for those aged 75 years and older (75+HA), which can be performed annually by primary care providers. This study explores the rates of frailty, resources required to support management, and the determinants of implementing frailty screening and providing management for older Australians at the 75+HA. A mixed methods evaluation was conducted in 24 general practices across 2 Australian Primary Health Network regions, Sydney North and Brisbane South. The FRAIL Scale Tool was implemented during the 75+ health assessment, and data were collected on FRAIL Scale scores, hospitalization rates, recommended frailty interventions, and barriers to frailty management. Practice staff perceptions of the long-term sustainment of the FRAIL Scale Tool were assessed using the Provider Report of Sustainment Scale. Semistructured qualitative interviews were conducted with practice staff and patients, exploring barriers and enablers to implementing frailty screening and management. Guided by the Consolidated Framework for Implementation Research, transcripts were coded and themes developed. Of the 1484 patients aged ≥75 years who were screened, 223 (15%) patients were frail, 616 (41.5%) patients were prefrail, and 645 (43.5%) patients were robust. People who were frail were more likely to be female, older, and have more prescribed medications. Of those screened as frail, 23 (11%) had a nonelective hospitalization in the 3 months prior to screening compared with 28 (5%) who screened as prefrail and 5 (1%) who screened as robust (P=.012). Management recommendations commonly included medication reviews, aged care packages, assessment for depression, and exercise programs. Barriers identified to accessing interventions included health, transport, cost, and time. Survey and qualitative findings highlighted that the FRAIL Scale Tool was easy to use, integrated well into existing workflows as part of the 75+HA, and sustained use would be supported by software integration. Patients valued the assessment and tailored health support offered by trusted primary care providers. Incorporating the FRAIL Scale Tool into the annual health assessment for people aged 75 years and older provides a funded opportunity for addressing frailty in general practice. Patients and staff value the Tool's simplicity and the opportunity to raise awareness and manage frailty proactively. Incorporating the Tool into practice software systems would enhance adoption. Broader implementation research in diverse settings and with Aboriginal and Torres Strait Islander populations is needed to improve frailty prevention and management.

The global need to improve access to primary care in residential aged care homes (RACHs) has driven interest in virtual care models. Despite rapid telehealth adoption, little is known about the sociotechnical factors influencing use in aged care settings, particularly from the perspectives of primary care providers, aged care staff, and residents. This review applied the Systems Engineering Initiative for Patient Safety (SEIPS) framework to synthesise evidence on barriers, enablers, processes, and outcomes of virtual care delivery in RACHs and primary care. We conducted a systematic review in accordance with PRISMA guidelines and registered with PROSPERO (CRD42024562423). Databases searched included MEDLINE, Embase, CINAHL, and Scopus (January 2016-March 2025). Eligible studies reported qualitative, quantitative, or mixed-methods findings on virtual care involving RACHs and primary care. Data were extracted using a SEIPS-informed template and synthesised deductively across sociotechnical domains. Thirteen studies met the inclusion criteria. Common barriers included limited digital literacy, sensory and cognitive impairments, poor audio-visual quality, lack of staff training, and workflow disruption. System-level challenges included poor technology interoperability, inadequate digital infrastructure, and insufficient organisational and policy support. Enablers included strong clinician-resident relationships, access to remote monitoring tools, and peer support. Reported outcomes were mixed: improved access, communication, and reduced emergency transfers were noted, alongside concerns about increased workload, reduced relational care, and diagnostic limitations. Studies reporting resident perspectives are lacking. Virtual care has the potential to improve aged care access and outcomes, but effective implementation requires more than technology alone. Hybrid models integrating virtual with in-person care require supportive policies, funding models, and organisational workflows. Addressing interoperability gaps, infrastructure needs, and increasing co-design with residents are essential to create virtual care models that are sustainable, person-centred, and scalable in primary care and aged care contexts.

To establish expert consensus on the critical factors shaping implementation of oral health assessment in Australian residential aged care (RAC) using an e-Delphi approach. A modified electronic Delphi (e-Delphi) process, informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, was conducted over two iterative survey rounds to refine expert perspectives. 60 experts were purposively sampled from oral health, aged care, policy, and implementation science. Quantitative responses were summarized with descriptive statistics, while qualitative feedback was analyzed through reflexive thematic analysis. Consensus was reached on the importance of mandating oral health care in national aged care accreditation standards, embedding oral health into broader aged care policies and requiring systematic oral health assessments as part of routine care. Participants highlighted workforce shortages, insufficient training, limited practitioner access, and organizational readiness as key barriers. Enablers included workforce development, simplified and standardized assessment tools, mobile and outreach dental services, policy mandates, and cultural change recognizing oral health as integral to person-centered care. Round two resolved areas of initial uncertainty, with consensus achieved on all outstanding items. This study provides the first consensus-based priorities for embedding oral health assessment tools in RAC, signaling sector-wide readiness for reform. Applying the EPIS framework, the findings highlight that enforceable accreditation standards must be paired with workforce training, oral health champions, and practical tools to ensure sustainable uptake. These insights offer an evidence-informed roadmap for policymakers and service providers, reframing oral health from a peripheral task to a regulated element of clinical governance and quality care.