Elderly Australians Research Articles

Oral hygiene and periodontal disease in Victorian nursing homes

To investigate oral hygiene and periodontal disease in residents of Victoria nursing homes. The Australian population is ageing with a growing proportion of elderly Australians living in nursing homes. With declining edentulism rates, periodontal disease is becoming more prevalent in this population. A total of 275 dentate residents from 31 Victorian nursing homes had a questionnaire and clinical examination using the Visual Plaque Index and a modified Community Periodontal Index. Self-reported oral hygiene habits of residents were poor, with less than one-third of residents cleaning their teeth twice daily or more. Periodontal health was found to be extremely poor, and the prevalence of 4 mm+ periodontal pockets was 35.6%, with 10.2% having 6 mm+ pockets. Logistic regression found that age, gender, number of teeth present and oral hygiene were all strongly associated with the prevalence of 4 mm+ periodontal pockets. Poor oral hygiene and the presence of significant plaque and calculus were common findings in this study. Periodontal diseases are a significant problem for residents in nursing homes. Addressing this health issue will require improved training for carers and better access to appropriate dental services.

Joint Modelling of Survival and Cognitive Decline in the Australian Longitudinal Study of Ageing

SummaryThe paper describes the use of a longitudinal tobit model to characterize cognitive decline over a 13-year period in a cohort of 2087 elderly Australians. Use of a tobit formulation allows for the so-called ‘ceiling effect’ wherein many subjects achieve perfect test scores. A Bayesian hierarchical joint model is presented that allows for random subject-specific intercepts and slopes, as well as for informative dropout. Results suggest several potential areas of intervention. For example, there is a clear dose–response effect of exercise whereby increasing levels of exercise are associated with higher cognitive scores.

Malnutrition on the menu: nutritional status of institutionalised elderly Australians in low-level care.

Most studies reporting malnutrition in the elderly relate to high-level care. However, one third of Australians in aged care reside in low-level care facilities. Data is limited on their nutritional status. To investigate the nutritional status of elderly in low-level care facilities. A cross sectional study design. 14 low-level aged care facilities in metropolitan Melbourne. Convenience sample of 103 ambulatory elderly (86 +/- 6.6 years (mean +/- SD), 76% female, comprising 15% of the hostel population) able to perform daily functions of living. Nutritional intake assessed by three-day weighed food records, and nutritional status by haematological and biochemical markers and body composition (dual energy X-ray absorptiometry). FOOD served did not supply the estimated average requirements (EAR) for 5 of the 14 nutrients analysed. Compared with EAR, 34% of participants were protein malnourished and 62% had energy intake deficits. Micronutrient intake was low for calcium, magnesium, folate, zinc (for men) and dietary fibre. Vitamin D deficiency (serum 25OH Vitamin D < 50 nmol/L) was present in 58% of residents. More men than women had low haemoglobin (P < 0.000), low red blood cells (P < 0.000), and a raised white blood cell count (P = 0.004). Forty three percent of men and 21% women had sarcopenia, 28% of men and 44% women had excess body fat (> 28% and >40%, respectively) and 14% of men and 12 % of women were sarcopenic-obese. Only 12% showed no sign of undernutrition using seven different nutritional indicators. Around 65% had two or more indicators of undernutrition. These findings highlight the need for the supply of more, better quality, nutrient dense food to residents and better detection of undernutrition in aged care facilities. Maintenance of nutritional status has the potential to reduce morbidity and delay the transition to high-level care.

Malnutrition on the menu: Nutritional status of institutionalised elderly Australians in low-level care

Malnutrition on the menu: Nutritional status of institutionalised elderly Australians in low-level care

Uncovering the potential risk of serotonin toxicity in Australian veterans using pharmaceutical claims data

We examined potential risk of serotonin toxicity in Australian veterans by quantifying the concomitant use of serotonergic medicine combinations from claims data collected by the Department of Veterans' Affairs (DVA). This was a retrospective cohort study of 273 228 Australian veterans, war widows, widowers and dependents aged >or=55 years and holding full treatment entitlement for the period July 2000 to June 2004 or until death. The main outcome measure was potential concomitant use, estimated as the number of cohort members with an overlap in days of supply for serotonergic medicine combinations over the 4 year period for all medicine combinations and potentially life threatening combinations. From July 2000 to June 2004, 115 969 (42%) cohort members were dispensed at least one serotonergic medicine. 20 658 (8%) had at least one episode of potential concomitant use. We identified 1811 (0.7%) cohort members with at least one overlapping period of potentially life-threatening serotonergic medicine combinations, 937 of whom had the combinations dispensed within the recommended washout period. Three hundred and seventeen of these individuals were dispensed potentially life-threatening medicine combinations on the same day. The most common combinations were moclobemide with a selective serotonin reuptake inhibitor or tramadol. The individuals potentially at risk of mild to moderate serotonin toxicity were considerable and potentially life threatening combinations were not infrequent. While we were unable to determine how many individuals experienced serotonin toxicity this study indicates, for the first time, the potential size of the problem in a subgroup of elderly Australians. Clinicians and patients need to be vigilant regarding inadvertent concomitant use, especially that of moclobemide with a selective serotonin reuptake inhibitor or tramadol.

Dental service provision in Victorian residential aged care facilities

The Australian population is ageing, and a growing proportion of elderly Australians are now living in residential aged care facilities (RACFs). These residents are at high risk of developing dental diseases, have more teeth present now than at any time in the past 50 years and often have difficulty maintaining adequate oral hygiene. Traditionally, dental service provision has been problematic and sporadic for these residents. A postal survey of a random sample of Victorian general dentists and Directors of Nursing (DONs) of Victorian RACFs was undertaken in 2006 to ascertain the participation of dentists in the provision of dental care and to identify factors impacting on the organization and provision of dental care for residents. The response rate for dentists was 57.3 per cent, and for DONs 64.4 per cent. Half of the dentists reported that they had provided care to residents of aged care facilities in the past 12 months, and they spent an average of one hour per month providing care. Overall, dentists were concerned with their level of undergraduate education and training in various aspects of dentistry for residents of aged care facilities. DONs reported significant difficulty obtaining adequate dental care for their residents. Common problems identified by both dentists and DONs included a preference for dentists to treat residents in their own practice, dentists not willing to go to RACFs and a lack of portable dental equipment for dentists to use. There were low levels of interest and participation from Victorian dentists in providing dental care for residents of aged care facilities. Dentists had a strong preference for treating patients at their own practice, and there were a number of significant barriers that appeared to impact on the provision of dental care in RACFs.

Hospitalized community-acquired pneumonia in the elderly: an Australian case-cohort study

This study describes the epidemiology of community-acquired pneumonia (CAP) in elderly Australians for the first time. Using a case-cohort design, cases with CAP were in-patients aged > or = 65 years with ICD-10-AM codes J10-J18 admitted over 2 years to two tertiary hospitals. The cohort sample was randomly selected from all hospital discharges, frequency-matched to cases by month. Logistic regression was used to estimate risk ratios for factors predicting CAP or associated mortality. A total of 4772 in-patients were studied. There were 1952 cases with CAP that represented 4% of all elderly admissions: mean length of stay was 9.0 days and 30-day mortality was 18%. Excluding chest radiograph, 520/1864 (28%) cases had no investigations performed. The strongest predictors of CAP were previous pneumonia, history of other respiratory disease, and aspiration. Intensive-care-unit admission, renal disease and increasing age were the strongest predictors of mortality, while influenza vaccination conferred protection. Hospitalization with CAP in the elderly is common, frequently fatal and a considerable burden to the Australian community. Investigation is ad hoc and management empirical. Influenza vaccination is associated with reduced mortality. Patient characteristics can predict risk of CAP and subsequent mortality.

Inappropriate Medication Use and Prescribing Indicators in Elderly Australians

Evidence-practice gaps, adverse medication-related incidents and unplanned medical admissions to hospital are common in elderly Australians. Many prescribing indicator tools designed to address some of these problems have been reported in the literature, the most common of which is the Beers list of inappropriate medications in the elderly. However, many of these tools are not appropriate for the Australian healthcare environment without modification and validation, and there appears to be a need for a tool based on Australian data. To develop a list of prescribing indicators for elderly (aged >65 years) Australians based on the most frequent medications prescribed to Australians, and the most frequent medical conditions for which elderly Australians consult medical practitioners. The most common reasons for elderly Australians to seek or receive healthcare were cross-referenced with the 50 highest-volume Pharmaceutical Benefits Scheme medications prescribed to Australians in 2006 to develop prescribing indicators in the elderly using Australian medication and medical condition information resources. Forty-eight prescribing indicators were identified, consisting mainly of optimum as well as inappropriate medication choices for a large number of common medical conditions in the elderly. A prescribing indicators tool was developed. This tool is envisaged as forming an important part of the medication review process, which is aimed at addressing the common problem of adverse medication-related events in elderly Australians.

Influence of Diabetes and Cardiovascular Disease on the Long-Term Incidence of Cataract: The Blue Mountains Eye Study

Purpose: To assess associations between diabetes and selected cardiovascular risk factors and long-term incident cataract and cataract surgery. Methods: A cohort of initially 3654 elderly Australians were followed over a period of 10 years. Questionnaires ascertained relevant history and fasting blood samples were taken. Impaired fasting glucose (IFG) and metabolic syndrome were defined using World Health Organization criteria. Discrete logistic models were used to assess risk of incident cataract. Results: After controlling for age, sex, and other factors, baseline diabetes predicted nuclear cataract (relative risk, RR, 1.64; 95% confidence interval (CI), 1.02–2.64) and IFG predicted cortical cataract (RR, 2.01; CI, 1.20–3.36). Each standard deviation (SD) increase in glucose was positively associated with cortical cataract (RR, 1.13; CI, 1.01–1.27). Higher body mass index (BMI) was positively associated with posterior subcapsular cataract (RR per SD, 1.20; CI, 1.03–1.41). Persons using anti-hypertensive medication had a higher incidence of cataract surgery (RR, 1.61; CI, 1.18–2.20). Metabolic syndrome was associated with an increased risk of all 3 cataract subtypes. Few other significant associations were found between cardiovascular disease, cardiovascular risk factors, and incident cataract or cataract surgery. Conclusions: We confirmed diabetes as a risk factor for age-related cataract and IFG as a possible risk factor for cortical cataract. BMI and hypertension were also related to incident cataract. Overall, few associations were found between cardiovascular risk factors and long-term incident cataract. A cluster of metabolic abnormalities attributable to insulin resistance appears more likely to contribute to cataract formation than any individual cardiovascular risk factor alone.

Benzodiazepine prescribing in elderly Australian general practice patients

The use of benzodiazepines by elderly people is of limited therapeutic benefit and increases the risk of adverse events. This study aimed to examine the extent to which benzodiazepines are prescribed for elderly Australians. Data for 3,970 individuals aged 65 years or more were extracted from a general practice database. Benzodiazepine prescriptions for 2002 were reviewed. Overall, 16% (95% CI 11-21%) of elderly patients had at least one benzodiazepine prescription. Females were almost twice as likely as males to be prescribed a benzodiazepine and prescription prevalence increased with age. Despite risks, benzodiazepines are widely prescribed for the elderly. Limited availability and cost of alternative therapies and pressures on the primary care system in Australia may contribute to their continued overuse. The prescribing of benzodiazepines for elderly Australians needs to be reduced by better managing sleep and anxiety problems.

Prevalence of Mental Disorders in the Elderly: The Australian National Mental Health and Well-Being Survey

To describe the 1- and 12-month prevalence of mental disorders, their demographic correlates, and their impact on service utilization and disability in individuals 65 years of age and over in a comprehensive epidemiological survey of mental health in Australia. A noninstitutionalized national probability sample of elderly Australian residents was interviewed as part of the Australian National Mental Health and Well-being Survey (NMHWS). The prevalence of International Classification of Diseases, Tenth Revision and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders was estimated from the Composite International Diagnostic Interview and other screening instruments. Of 1,792 elderly NMHWS respondents, 13% reported symptoms consistent with a mental disorder in the past 1 month, and 16% reported symptoms consistent with a mental disorder in the past 12 months. Women experienced higher rates of affective disorders and generalized anxiety disorder and had lower rates of substance abuse compared with men. After excluding cognitive disorder, increasing age was associated with less likelihood of having symptoms of any mental disorder. Older age and never having been married were associated with less likelihood of having symptoms of an affective disorder. Those with cognitive impairment were more likely to have had symptoms consistent with an affective disorder. Comorbidity was predictive of increasing disability on the 12-item Short Form but rates of mental health consultation were low, even for those with multiple disorders. Community-dwelling elderly Australians experience substantial rates of mental disorders. Demographic correlates of mental disorder in this elderly population appear to differ from those established in younger populations. Mental disorder in elderly Australians is associated with significant disability, but rates of specialist mental health consultation is low, even for those with multiple comorbidities. The reasons for this must be examined.

Improving the management of acute coronary syndromes in Australia: translating evidence to outcomes

Cardiovascular disease imposes a heavy burden of morbidity and mortality on the Australian community. This situation is likely to exacerbate as the number of elderly Australians increase. Management of acute coronary syndromes (ACS) is underpinned by a robust evidence base, which is outlined in clinical practice guidelines. Yet, despite wide diffusion of guidelines, many Australians who experience acute coronary syndromes do not receive optimal care. This article reviews what we have learnt from previous quality improvement initiatives and discusses what we need to know to improve acute coronary syndromes management in Australia.

Medication Review: Patient Selection and General Practitioner's Report of Drug‐Related Problems and Actions Taken in Elderly Australians

To investigate which patients general practitioners (GPs) selected for medication review based on risk factors for medication problems and patient demographics; to describe drug-related problems and actions taken to solve those problems during medication review consultations based on GPs' self-report. Cross-sectional. General practices. Four hundred fifty-two patients recruited from 11 GPs. Patients' self-reported risk factors for medication misadventures collected from Medication Risk Assessment Forms; doctors' report of patients' drug-related problems and actions taken to solve those problems collected from Medication Review Checklists. Patients completed a Medication Risk Assessment Form in the waiting room, which they presented to their doctor, who then decided whether the patient needed a medication review. GPs completed a Medication Review Checklist. GPs completed 124 Medication Review Checklists. The group that had a medication review had a lower proportion of individuals aged 65 to 74 than the group that did not (40% vs 56%). The proportion of people with risk factors for medication misadventure was consistently higher for patients who received a medication review. GPs found that 88% (95% confidence interval (CI) =66-97) of patients who had a medication review had at least one problem with use of their medication. GPs reported taking at least one action for 104 (88%) patients (95% CI=65-97) to rectify medication problems. Most common actions taken were monitoring (55%), improving compliance (50%), dose change (37%), cessation of drug (28%), and ordering of a pathology test (26%). A Medication Risk Assessment Form completed by patients can be used to select patients for medication review, and medication reviews conducted by GPs can be beneficial in improving the use of medication in older people living in the community.

The oral health and treatment needs of community‐dwelling older people in a rural town in Western Australia

Objectives: The aim of this study was to assess, in a sample of older rural community‐dwelling Australians, their: oral health status, dental treatment needs, perceived barriers to access dental services and the prevalence and severity of dental anxiety. Methods: A cross‐sectional study of elderly rural Australians. Results: Eighty participants (mean age of 71.7 years) had a mean number of 0.69 (SD 1.6) decayed teeth, 15.72 (SD 13.3) missing teeth and 3.9 (SD 5.4) filled teeth. Forty‐one per cent were edentulous. Xerostomia was reported by 53% of the edentulous and 43% of the dentate. The average Corah Dental Anxiety Scale score was 8.72 (SD 3.8). Prevalence of dental anxiety was 15.6%. Two‐thirds needed dental treatment. Conclusions: Caries experience was lower than that reported in other studies. Reported barriers to use of dental services were long waiting times, lack of perceived dental need and costs.

Repeat adverse drug reactions causing hospitalization in older Australians: a population‐based longitudinal study 1980–2003

To examine trends in the rate of repeat adverse drug reactions (ADRs) causing hospitalization in older Australians and to identify the most common ADRs and drugs most often implicated in repeat and first-time ADRs. Analysis of routinely collected hospital record administrative data, with International Classification of Diseases external cause codes for ADRs extracted from the Western Australia (WA) Hospital Morbidity Data System and WA Death Register, for people aged > or =60 years in 1980-2003. A total of 37 296 people aged > or =60 years with an ADR-related hospitalization were identified. Among them, 6853 (18.4%) patients had 10 212 repeat ADRs. Repeat ADRs consistently increased from 1980 and reached 30.3% of all ADRs by 2003. The mean time interval declined with each successive repeat ADR (810, 606 and 299 days for the first, second and higher ranked repeat episodes, respectively). The most common repeat ADRs were nausea/vomiting (8.0%), haemorrhage due to anticoagulants (5.5%), drug-induced osteoporosis (4.8%) and poisoning by cardiovascular agents (3.9%). The drugs most often involved in repeat ADRs were cardiovascular agents (15.6%), antineoplastic drugs (11.0%), corticoids (10.1%), anticoagulants (8.6%), antirheumatics/nonsteroidal anti-inflammatory drugs (5.1%) and opioids (4.9%). The trends of anticoagulants and antineoplastic drugs implicated in repeat ADRs were still rising at the end of the study. The specific drug classes involved in repeat ADRs differed in relative importance from first-time ADRs. Repeat ADR-related hospitalizations have consistently increased in elderly Australians from 1980 to 2003. Strategies to ensure the safer use of medicines, in particular anticoagulants, in this population are warranted.

Patterns and predictors of nursing home placement over 14 years: Dubbo study of elderly Australians

Objective: To describe patterns and predictors of nursing home placement. Methods: This is a longitudinal study of an elderly cohort living in Dubbo, New South Wales, Australia. A total of 1233 men and 1572 women aged 60 years and older living in the community were examined in 1988 and followed for 14 years. The incidence of nursing home placement and underlying clinical diagnoses were assessed. Results were modelled for baseline predictors of placement using Cox proportional hazards regression. Results: From 2805 subjects in the study there were 244 (8.7%) nursing home placements, 95 in men (7.7%) and 149 in women (9.5%). A total of 44% placements were primarily due to dementia, but dementia was a secondary diagnosis in another 20% of cases. The other principal diagnoses were stroke (16%) and coronary heart disease (14%). Median time to death in a nursing home was 10.5 months in men and 9.0 months in women. In a Cox proportional hazards model using baseline characteristics, the hazard of nursing home placement increased significantly with age (hazard ratio = 1.13), urinary incontinence (1.66), impaired peak expiratory flow (3.19), physical disability (1.59) and depression (1.85). The hazard of placement was significantly reduced by alcohol intake (0.55) and female gender (0.55). Socioeconomic factors were not significant. Conclusions: Dementia and disability‐related care burdens rather than other health conditions are the dominant causes of nursing home placement in an unselected elderly community. Risk factors such as incontinence, impaired respiratory function and depression have been identified and these are potentially amenable to intervention.

Impact of smoking, diabetes and hypertension on survival time in the elderly: the Dubbo Study

To study the impact of various risk factors on survival time in a cohort of elderly Australians. A longitudinal, prospective cohort study conducted in Dubbo, NSW. Participants were men and women aged 60 years or over living in the community, first assessed in 1988-1989 and followed for 15 years. Mortality rates; risk factors; survival times. There were 668 deaths in 1233 men (54%) and 625 deaths in 1572 women (40%). Coronary heart disease was the major cause of death, rates being higher in men than women until age group 80+ years; stroke death rates were similar in both sexes; cancer and respiratory death rates were higher in men than women across all ages. In a proportional hazards model, the independent predictors of mortality were cigarette smoking, diabetes, very high blood pressure (BP), impaired peak expiratory flow (PEF), physical disability, and zero intake of alcohol. Over 15 years, the average reductions in survival time associated with various risk factors, in men and women respectively, were smoking, 22 and 15 months; diabetes, 18 and 18 months; very high BP, 16 and 9 months; impaired PEF, 14 and 17 months; physical disability, 16 and 12 months; zero alcohol intake, 9 and 5 months. Combinations of selected risk factors were associated with a multiplier effect. The reduction in survival time in elderly citizens demonstrated in the presence of smoking, diabetes and hypertension highlights a potential benefit to healthy ageing to be gained from prevention and intervention.

An audiological profile of elderly Australians reporting speech affecting stroke

This study examined the audiological profile and hearing rehabilitation of 73 people who reported having had speech-affecting strokes. Participants were drawn from the Blue Mountains Hearing Study (BMHS), a population survey of age-related hearing loss in 2956 members of a representative elderly Australian community. While speech-affecting stroke did not seem to cause greater levels of hearing impairment or handicap than for other participants matched for age and gender, this may be due to a low prevalence of participants with severe effects on speech or language as a result of their stroke. Although 52% of participants self-reported a hearing loss, fewer than 23% had ever worn a hearing aid with only 15% wearing hearing aids for more than 1 hour per day. Pure tone audiometry identified 64% of participants with thresholds considered appropriate for hearing aid fitting when previously established criteria were applied. Questions concerning use of hearing aid/s and self reported hearing loss were not reliab...

Interpreting incidence trends for treated end-stage renal disease: implications for evaluating disease control in Australia.

Five sources of change modify trends in incidence of treated end-stage renal disease (ESRD): (i) demography; (ii) disease control, comprising prevention and treatment of progressive kidney disease; (iii) competing risks, which encompass dying from untreated uraemia or non-renal comorbidity; (iv) lead-time bias; and (v) classification bias. Thus, rising crude incidence of treated ESRD may conceal effective disease control when there has been demographic change, lessening competing risks, or the introduction of bias. Age-specific incidences of treated ESRD in Australia were calculated from Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data by indigenous/non-indigenous status (all causes) and by primary renal disease (non-indigenous only) for two successive decades, 1982-1991 and 1992-2001. We postulate that less competing risks explained much of the increase in treated ESRD in the elderly and Indigenous Australians. The increase in glomerulonephritic ESRD in non-indigenous Australians could be ascribed mainly to immigration from non-European countries. There was no significant change in incidence of treated ESRD in Indigenous or non-indigenous persons aged less than 25 years, in non-indigenous persons aged 25-64 years for ESRD caused by hereditary polycystic disease or hypertension, or in type 1 diabetics aged over 55 years. End-stage renal disease from analgesic nephropathy had declined. The increase in treated ESRD caused by type 2 diabetic nephropathy appeared to be multifactorial. Lead-time/length bias and less competing risks may have concealed a small favourable trend in other primary renal diseases. Whether recent disease control measures have had an impact on incidence of treated ESRD is not yet certain, but seems more likely than implied by previous reports.

'The more things change…': Barriers to community services utilisation in Queensland

Community services are central to the lives of many elderly Australians or Australians with disabilities if they are to remain in the community. Over the past two decades, significant advances have been made in policy and associated programs, significantly improving the standards of service delivery. This research reports on the perceptions of service providers in community services for people with disabilities in six communities in Queensland. It illustrates that significant barriers to service utilisation remain, despite reform. It suggests that continuous efforts to promote service access need to be built in at the program level.