bluuebunny/crossref_metadata_2025 huggingface dataset:
Reasons for Hospital Admission in New Zealand's Oldest Old
Authors: Wilkinson Tim J.
Published: December 2008

Objectives: To determine:

the important causes of morbidity in New Zealand's oldest old, as measured by those conditions requiring hospital admission;

the types of conditions which show continued increases in hospital admission or bed occupancy rates with age;

the types of conditions which have lower admission or occupancy rates among the oldest‐old group compared with the younger‐old groups.

Design: Descriptive survey of all hospital admissions within an entire country over 12 months.

Results: Bed occupancy rates increase with age. Hospital admission rates increase with age but decline for people aged 100 years and over. Admissions due to cognitive/mood disorders and ill‐defined conditions increase with age to over 100 years. The age specific rate of hospital admission due to fractures or accidents peaks for people aged 90–99 years. Admissions due to cancer, ischaemic heart disease or eye disorders peak for people aged 80–89 years. Stroke and cognitive/mood disorders contribute significantly to bed occupancy at all age groups although bed occupancy rates decline for fractures and stroke after the 90–99 year decade. Arthritis, stroke and cognitive/mood disorders contribute to bed occupancy relatively more than to admission rates.

Conclusions: Stroke, cognitive/mood disorders, fractures and arthritis are significant causes of morbidity in New Zealand's oldest old. The rate of admission to hospital with fractures, accidents and stroke peaks for people aged 90–99 years and is less common in centenarians. Less specific presentations of disease occur in the older populations.
Suicide Among Seniors
Authors: Klinger Joan
Published: December 2008

Abstract. Older adults are considered the highest risk group for suicide. Although numbers are smaller, rates equal those of much‐publicised younger age groups. The ratio of attempted to completed suicide is considerably lower among seniors than young adults: seniors who attempt suicide are generally successful. There appears to be little awareness, however, that seniors who are experiencing difficulties in their lives may consider death as a solution. This paper reviews recent literature on suicide among older adults. Factors which are recognised as being predictors of suicidal behaviour among seniors are presented, as well as cultural effects, gender differences, suicide notes, prevention and intervention strategies, and society's role in the suicide of older adults.
Satisfaction With Medical and Allied Health Services Among Aged People in Sydney
Authors: Dent O.F. , Broe G.A. , Creasey H. , Waite L.M. , Cullen J.S. , Grayson D.A.
Published: December 2008

Objectives: To assess satisfaction with medical and allied health services among community‐living aged persons and to determine whether satisfaction had changed over a three‐year period.

Method: An interview survey of a random sample of 320 people aged 75 years and older was conducted in the inner western suburbs of Sydney between August 1991 and September 1993 and repeated between August 1994 and October 1996 with 227 surviving members of the cohort. Questions covered the use of, and satisfaction with, medical and allied health services during the preceding 12 months.

Results: The proportion Very satisfied’ with general practitioner (GP) surgery attendances and house calls over the two surveys ranged between 88% and 100%. The proportion ‘;very satisfied’ with specialist medical services ranged between 87% and 91%. The proportion ‘;very satisfied’ with allied health services ranged from 69% for optometry in 1992 to 93% for audiometry in 1995. There was no significant change over time.

Conclusions: These older people displayed high levels of satisfaction with allied health services and very high levels of satisfaction with medical services.
Understanding conflict: Perception of Female Caregivers
Authors: Rahman Naila
Published: December 2008

Objective: To explore the caring experiences of female caregivers.

Method: In‐depth interviews were conducted on 30 females caring for an older relative at home.

Results: Conflict was a significant outcome of caregiving. Stress, role conflict, imbalance in equity, and imbalance in norms and values emerged as major themes.

Conclusion: This study, along with a few related studies, may help to form a new basis for the study of caregiving with an emphasis mainly on conflict.
Is Hostel Care Good for You? Quality of Life Measures in Older People Moving into Residential Care
Authors: Reberger Caroline , Hall Sonja E. , Criddle R. Arthur
Published: December 2008

Objectives: For many older adults, moving into hostel accommodation can be a stressful and traumatic process. The impact of this move on the quality of life and function after a three‐month adjustment period was evaluated in this study.

Method: A Folstein Mini Mental State Examination (MMSE), Modified Barthel Index (MBI), Short Form 36 (SF‐36) and demographic information was collected prior to entry to hostel accommodation. The SF‐36 was repeated three months after admission. The SF‐36 has eight domains: physical functioning, role physical, bodily pain, role emotional, mental health, vitality, general health, and social functioning.

Results: Fifty subjects met the inclusion criteria and moved into hostel accommodation during the study period. The MMSE had a mean pM sd 26.6 pM 3.29 (highest cognition score = 30) and the MBI 93.4 pM 5.71 (highest level of independence score = 100), with no gender or age effect. The SF‐36 improved in 7/8 domains (p<0.05) after admission to hostel, with only mental health not improving significantly. Despite improving, physical functioning remained below the age and gender matched Australian norm for the SF‐36 in both males and females aged over 75. For women there also continued to be a reduction in social function, general health and mental health.

Conclusions: This study showed that both men and women had an overall increase in their quality of life after admission to hostel care. A comparison of our group to the Australian age and gender matched norms for quality of life illustrated that for many in our group their quality of life compared favourably to people living in the community, and that moving into hostel accommodation had been shown to be a valuable option.
Preventing Falls and Fall‐related Injuries Among Older People
Authors: Norton Robyn
Published: December 2008

Abstract. Deaths and disability from falls are important contributors to the global burden of disease and injury. Consequently, there is a need to identify and implement strategies that have been shown to be effective in preventing falls and falls‐related injuries. As the effects of such interventions are likely to be moderate, the identification of effective interventions can only be provided by randomised controlled trials and their meta‐analyses. Currently, known effective interventions include risk assessment and targeted multi‐factorial interventions, physical activity and, possibly, reductions in psychotropic medication, as well as the use of hip protective underwear, vitamin D and calcium, and alendronate. Substantial progress in reducing the incidence of falls and fall‐related injuries globally is likely to occur if knowledge about currently known effective interventions is widely disseminated and implemented. Further progress will be made if large‐scale randomised controlled trials are conducted, that can both confirm the effectiveness of these promising interventions and examine other interventions suggested from observational studies
Issues in the Development of Robotics Technology for Aged Care in Japan
Authors: Dethlefs Noriko
Published: December 2008

Abstract. Japan is said to be the most rapidly ageing society, with one in four people expected to be over the age of 65 by 2020. In addressing the enormous social and economic challenges to provide adequate care for the increasing aged population, there is considerable research into advanced technology for aged care. This paper introduces robotics technology research to be utilised for care and rehabilitation. The technology may be impressive and may also prove to be economically viable, but how is it to be evaluated and implemented so that the best possible care can be provided? The challenges are discussed.
The Ethnic Aged Population and the Likelihood of Special Needs
Authors: Rowland D.T.
Published: December 2008

Abstract. Although older people from non‐English speaking backgrounds are recognised as comprising a special needs clientele in aged care, many will never require ethno‐specific services or accommodation. A first assessment of the likelihood of ever having special needs is undertaken using census data on duration of residence in Australia together with English language proficiency and usage. The data suggest that about a third of the ethnic aged population are in a ‘;higher probability’ category for whom ethno‐specific support will be most relevant if aged care is ever needed. The majority are in a ‘;lower probability’ category. This reflects that it is common for settlers to become well‐integrated into Australian society, thereby contradicting some expectations based on the concept of multiculturalism.
Over the Hill and Picking up Speed: Older Women of the Australian Longitudinal Study on Women's Health
Authors: Byles Julie
Published: December 2008

Objective: The aim of the Australian Longitudinal Study on Women's Health is to explore the physical, psychological, social and environmental factors that affect the health of women in Australia. In this paper, we identify key health issues for the 12,900 women in the oldest cohort of the study and highlight issues to be explored longitudinally.

Method: Women aged 70–75 years registered with the Health Insurance Commission were sent a postal questionnaire (response rate 40%). The questionnaire included 260 items on health, health related behaviours and health care use, and social circumstances.

Results: Despite the high proportion of women reporting chronic medical conditions and recent symptoms, only 4% of the women rated their health as poor. Scores on the SF‐36 health‐related quality of life measure indicate that while physical health scores were lowest for the older cohort, mental health scores were higher than for the youngest (18–23 years) and mid‐age (45–50 years) cohort. In their comments, the older women emphasised the importance of their homes, social support and their active participation in their community as fundamental to their well‐being.

Conclusion: This analysis highlights areas for follow‐up in the longitudinal study, importantly the older women in the study do not equate disease with poor health and a broader social view of health is justified
Management of Lower Urinary Tract Symptoms in Men
Authors: Pillay Samantha , Marshall Villis , Pinnock Carole
Published: December 2008

Abstract. This clinical update, written for the non‐urologist, aims to highlight the important concepts behind understanding and treating men with uncomplicated lower urinary tract symptoms (LUTS). In the last five years there have been important changes in the preferred terminology and guidelines for managing men with voiding symptoms. In particular, the assessment of a patient's degree of bother is the most important factor when making management decisions for men with uncomplicated LUTS. Although this clinical update does not attempt to address the management of prostate cancer it does include some brief guidelines on prostate specific antigen (PSA) testing. The following information is based on the NH&MRC Clinical Practice Guidelines, published 1996 [1]. It is acknowledged that opinion remains divided among urologists concerning some of these guidelines.
The Clinical Value Compass: Achieving Benchmarking and Quality Improvement in Aged Care
Authors: Woodward Michael , Beer Josephine , Mackay Samantha , Gray Len
Published: December 2008

Abstract. Quality measurement and benchmarking in aged care presents several challenges. A model which addresses this by linking four dimensions of outcomes has been developed ‐ the Clinical Value Compass (CVC). A CVC was developed for stroke rehabilitation and measured across four sites. The CVC was well accepted by the treatment teams and proved practical to measure. The results revealed differences in practices and client groups that led to a closer analysis of processes and subsequent changes in these processes. Remeasuring of the CVC is required to demonstrate improved outcomes arising from these process changes.
Poor Functional Health Literacy: the Silent Disability for Older People
Authors: Tooth Leigh , Clark Michele , McKenna Kryss
Published: December 2008

Abstract. In this information age, people are confronted by verbal, visual and written information. This is especially important in the health field, where information is needed to follow directions, understand prescriptions and undertake preventive behaviours. If provided in written form, much of this information may be inaccessible to people who cannot adequately read. Although poor literacy skills affect all groups in the population, older adults with fewer years of education seem to be particularly disadvantaged by an increasing reliance on written communication of health information. With older age comes a higher risk of illness and disability and a greater potential need to access the health system. As a result, poor literacy skills of older individuals may directly impact their health status. This paper explores the link between functional literacy and health, particularly for the older population, provides strategies to practitioners for the management of this problem, and suggests research initiatives in this area.
Predicting Depression in a Sample of Older Women Living in a Retirement Village
Authors: Rickwood Debra , Rylands Kylie J.
Published: December 2008

Objective: To determine the strength of ‘;accepting the past’ as a predictor of depression in older women.

Method: 73 older women living in a retirement village completed a self‐report questionnaire.

Results: Depression was predicted by lower levels of social support, physical independence and postive affect, and more difficulty accepting the past.

Conclusion: The mental health of older women in residential care may be improved by programs to facilitate accepting the past and improve social support.
Creating a Profile of Residents in a Special Dementia Hostel
Authors: Lefroy Richard B.
Published: December 2008

Abstract. The aim of this study was to demonstrate a method of assembling a profile of residents in a special dementia hostel (SDH) in order to provide information on the characteristics of the residents, the purpose of the unit and its relationship to other residential facilities for people with dementia. The method consisted of gathering information on twelve residents from three sources ‐ rating scales, behaviour mapping and interviews with relatives.
Hitting a Century: Centenarians in Australia
Authors: McCormack John
Published: December 2008

Background: Census data show that people aged 100 years or more are increasing in number. However, there is a dearth of local information on these people as a socio‐demographic group. This paper presents some aggregated quantitative information on these long‐lived people.

Method: The study uses secondary sources of data to compose a preliminary picture of centenarians in Australia. Historical census records and unpublished census data, as well as government departmental data were obtained to present a range of centenarian characteristics.

Results: While historical census data on centenarian counts are available, recent differences in age data recording lead us to estimate the current number of centenarians. This estimate however builds on a strong growth trend, and the number of centenarians appears likely to increase, possibly doubling by the year 2006. The data show heterogeneity in the centenarians' social circumstances such that they do not necessarily fit a frail stereotype.

Conclusion: As centenarians can add considerably to our knowledge of individual and population ageing, further work should be undertaken on this group. A register of centenarians and a return to single year age recording of all people in the census is suggested.
Prevalence of Geriatric ‘;Syndromes' in a Tertiary Hospital
Authors: Nair B. , O'Dea J. , Lim L. , Thakkinstian A.
Published: December 2008

Background: Australia has an ageing population. Older people are more likely to be hospitalised and to consume more health resources. Old age is associated with the ‘;syndromes' of confusion, incontinence, immobility, falls and polypharmacy. Prevalence of these syndromes in an Australian hospital setting is not available.

Aim: To study the prevalence of these syndromes and evaluate the routine practice of health care professionals in an Australian teaching hospital.

Methods: Assessment of 100 consecutive patients above the age of 70 years and 50 doctors and nurses.

Results: The study found a high prevalence of these syndromes. Twenty‐nine percent had cognitive impairment, 54% had had falls, 37% had poor mobility, 40% had urinary incontinence and 43% took more than five medications. Health professionals underestimated the prevalence of these conditions in an inpatient setting and stated that they did not routinely look for these conditions.

Conclusion: Assessment of these prevalent syndromes is suboptimal.
Anthropometric and Laboratory Markers of Nutritional Status in a Large Sample of Older Australians: the ALSA study
Authors: Whitehead C.H. , Giles L.C. , Andrews G.R. , Finucane P.
Published: December 2008

Objectives:

bL To determine which combination of available measures of nutritional status can adequately describe the nutritional status of a large sample of older patients.

bL To describe the prevalence of malnutrition in this large sample of older community dwelling Australians and provide a set of values that could be used as reference data for future studies.

Design: A descriptive study based on the baseline cohort of the Australian Longitudinal Study of Ageing (ALSA) using a principal component analysis and correlations between the variables. The prevalence of malnutrition is estimated using currently available definitions of malnutrition.

Method: 1,404 community living older people (aged 70–103 yrs, mean 77 yrs) underwent measurement of body mass index (BMI), relaxed arm girth, arm muscle area, triceps, abdominal and supraspinale skinfold thicknesses and grip strength together with albumin and total lymphocyte count. All pairwise correlations were calculated between the variables separately for each gender and the relationship between all the variables along with age further explored by principal component analyses.

Results: In both sexes, strong correlations were noted amongst BMI, skinfold thicknesses and arm girth (r values 0.43 to 0.81). Grip strength, albumin and lymphocyte count did not appear to be notably correlated with each other or with any of the other variables (r values 0.00 to 0.37). The principal component analyses indicated that the majority of the variation in the data could be explained in as few as three dimensions. The prevalence of malnutrition varied using available definitions from 0.7% to 17.9%.

Conclusions: We conclude that the strength of correlations between variables is such that nutritional status could be measured with as few as three variables. BMI, albumin and possibly lymphocyte count seem an ideal combination. The prevalence of malnutrition depends greatly on which definition is chosen and the clinically significant level of malnutrition is unclear without more longitudinal prognostic data.
PEG Feeding, Dementia and the Need for Policies and Guidelines
Authors: Cartwright CM , Steinberg MA
Published: December 2008

The use of long term tube feeding solely as a life‐sustaining treatment is controversial, yet frequent, especially in patients with advanced dementia [1, p.379].
Mature Age Employment: Recent Developments in Public Policy in Australia and the UK
Authors: Taylor Philip , Steinberg Margaret , Walley Linda
Published: December 2008

Objective: To examine recent policy developments in mature age employment in Australia and the UK. Method: Recent data and policy statements in the UK and Australia, supplemented by the findings from interviews undertaken with government and industry leaders in the UK in October/November 1998, reflecting similar work in Australia, were analysed and compared.

Conclusions:

•bL Population ageing, a long term decline in activity rates and skills among mature age workers and discrimination against them are important policy issues in both Australia and the UK (as in other countries).

•bL A major policy difference is the use of antidiscrimination and related legislation in Australia; compared with a reliance on education and codes of practice in the UK. Sustained awareness raising is required, together with evaluation of the longer‐term impact on employer practices.

•bL Employer involvement is low and systematic approaches are needed to identify and support good practice by employers towards older workers in both countries.

•bL A comprehensive approach is crucial (whole of government, industry, unions), taking into account industry, occupational, locational and gender differentials.
Community Care of Older Chinese People in Hong Kong: a Selective Review
Authors: Lui May HL. , Lee Diana T.F. , Mackenzie Anne E.
Published: December 2008

Abstract. The paper reviews recent research and publications in order to identify areas of importance for health care providers and professionals to consider in moving successfully towards community care of older Chinese people from a cultural perspective. The Chinese culture is discussed and the particular issues that affect the care of older Chinese are highlighted in the light of proposed changes in health care. Conclusions are drawn about the changing status of elders in Hong Kong and about the implications for both health care professionals and older people themselves.
Rights Focused Advocacy and Elder Abuse
Authors: Cripps David
Published: December 2008

Objective: To study the effectiveness of the Rights Focused Advocacy Model in supporting older people to overcome situations of elder abuse. Method: 100 case records were retrospectively analysed, which represented approximately 20% of total clients over an eighteen‐month period, from November 1997 to June 1999. Data recorded included: type of abuse, risk factors (for older person and abuser) and outcome (ie. whether or not abuse had ended).

Results: 100 older people experienced 267 situations of abuse. The Rights Focused Advocacy Model enabled older people to take steps to stop abuse in 50% of those situations, and to take some action in 34% of situations. No change was recorded in 16% of cases.

Conclusion: Rights Focused Advocacy is a holistic model that is effective in supporting older people to take steps to overcome the abuse that they experience.
Use of Sleeping Medication and Quality of Life among Older Women who Report Sleeping Difficulty
Authors: Hasan Syed , Byles Julie E. , Mishra Gita , Harris Margaret A.
Published: December 2008

Objective: To estimate the proportion of older women who report sleeping difficulties and/or use sleeping medication; and to identify associated factors. Method: Cross sectional survey of Australian women aged 70–75 years. These women were participants in the Australian Longitudinal Study on Women's Health (ALSWH) randomly selected from the Australian Medicare database.

Results: Of the 12,624 women aged 70–75 years who provided data for this analysis (36% response rate), 50%{n‐6,042) reported sleeping difficulty “never/rarely”, 33% (n=3,979) “sometimes”, and 17% (n=2,011) “often”. Approximately 18% (n=2,287) of women reported using sleeping medication within the previous four weeks. Women reporting sleeping difficulty “sometimes ” were over five times more likely to be taking sleeping medications than women who reported “never/rarely” experiencing difficulties (p≤0.0001); while women reporting difficulty sleeping “often” were over 15 times more likely to be using sleeping medications (p≤0.0001). Mean scores for sub‐scales of the SF‐36 health‐related quality of life measure were significantly lower for women reporting sleeping difficulty and women using sleeping medication (p≤0.001). Similarly, there was an inverse relationship between the SF‐36 physical and mental health summary scores and difficulty sleeping or sleeping medication use. Conclusion: Self‐reported sleeping difficulty is significantly related to reduced quality of life, suggesting sleeping difficulty is not a benign complaint. After adjustment for other explanatory variables there were strong, clinically significant differences between the SF‐36 scores of women reporting sleeping difficulty. However, while this association is statistically and clinically significant, it is not clear whether sleeping difficulty reduces quality of life, or whether quality of life interferes with sleep, or whether both problems are a result of other associated conditions. Further longitudinal exploration of this relationship is necessary. Further, issues need to be explored with older women, with a view to identifying acceptable and effective alternatives to sleeping medication use.
Older People's Perceptions of Their General Practitioner
Authors: Keller Judith , Slee Jo‐Anne
Published: December 2008

Objective: As part of a larger study into the health and well‐being of older people, their relationships with health and community service providers were explored. This paper focuses on how older people viewed their relationship with their general practitioner (GP).

Method: 49 older people in metropolitan Melbourne were interviewed using qualitative research, via in‐depth interviews.

Results: Most participants described their relationship with their GP as being very important to them. Many described their GP as a friend and key components of the relationship were faith and trust. Good communication skills, on the part of the GP, were important. Consumerist attitudes were generally not apparent and many of the older people interviewed would find the expectation to behave as a consumer very threatening.

Conclusions: Similar to previous studies, most of the older people preferred a very strong trusting relationship with their GP, and it was one of the most important relationships in their lives.
A jribute to joanna johnson…goodbye to a friend.
Authors: Correll Denys , Jorm Professor Anthony
Published: December 2008

“Joanna was a humanist. She believed in the basic decency of the human race. She eschewed the cult of the selfish, grasping individual to whom the dollar would always be the bottom line, and was motivated by a highly developed sense of community”
A Prospective Study of Falls Following Hip Fracture in Community Dwelling Older Adults
Authors: Hall Sonj E. , Williams Janice A. , Criddle R. Arthur
Published: December 2008

Objectives. This cohort study was designed to determine if the rate of falls, subsequent injuries and the utilisation of health and community care services was higher over one year in a group of community living hip fracture subjects [six‐twelve months post fracture) than in age and gender matched controls. Functional and quality of life measures were assessed as potential predictors of falls. Method. 92 age (mean age 76) and gender (60 females: 32 males) matched subjects had demographic, functional and quality of life measures assessed at baseline. Over the following year datum on the number of falls, trips and stumbles and the circumstances surrounding the event were collected by monthly telephone surveillance. Results. The incidence rate for both falls and events, including where the event occurred, were similar for the groups. The distribution of the type of event was different with the fracture group experiencing more falls and stumbles and the controls more trips. The fracture group had more significant injuries, including fractures, and was more likely to have sought medical attention. The Berg Balance Scale, Frenchay Activities of Daily Living and the physical function domain of the SF‐36 were negatively predictive of falls. Conclusions. The hip fracture patient, living in the community 6–12 months later, is no more likely to fall than their age and gender counterpart, however, they presented with a different and more severe pattern of injury and an increased use of GP services. The fracture group was also noted to be less active, indicating that they may have made lifestyle modifications, which may decrease their risk of falls.
Behaviour rating scales for older people with dementia: Which is the best for use by nurses?
Authors: Neville Christine C. , Byrne Gerard J. A.
Published: December 2008

Abstract
: There is increasing awareness of the importance of disruptive behaviour in people with dementia and the need for rating scales to accurately and reliably measure this behaviour. When rating scales are to be administered by nurses, scale characteristics must take into account the limitations of the nursing role and the nature of the environment in which nurses work. This paper reviews thirty‐one rating scales that have been used to measure behaviour in dementia. From this analysis, five scales were identified as suitable for use by nurses when measuring disruptive behaviour in older people with dementia.
Characteristics of social support in a community‐living sample of older people: The Sydney Older Persons Study
Authors: Edelbrock Dorothy , Buys Laurie R. , Waite Louise M. , Grayson David A. , Broe G. Anthony , Creasey Helen
Published: December 2008

Objectives
: Lower levels of social support have been associated with higher mortality, poor health and lower levels of well‐being. The aim of this study is to describe the characteristics of social support in a sample of community‐living people over the age of 75 years and secondly to identify sociodemographic variables associated with social support. Method: A sample of 647 community‐dwelling elderly (75 or older) were interviewed using a structured instrument assessing social support. Social support was defined as: instrumental support; emotional support including the presence of a confidant; perceived support (perceived availability and perceived adequacy of support) and finally, social involvement or participation. Chi‐squared tests were used to compare levels of social support between males and females. Univariate and multivariate linear regression analyses were conducted in order to examine the relationship between social support and sociodemographic variables.
The cost effectiveness of a pharmacist reviewing medication among the elderly in the community
Authors: Harris Anthony , Gospodarevskaya Elena , Callaghan Jennifer , Story Ian
Published: December 2008

Aims
: The study aims to assess the cost effectiveness of medication review and advice by a consultant pharmacist to elderly people living in the community in Australia.

Method
: The quality of life and cost of health and social services for a cohort of elderly patients seen by an aged care assessment team (ACAT) was measured at initial referral and at one month follow up. Sites in Melbourne and Ballarat were chosen and analysed separately. A second subsequent cohort was assessed by a team, which included a pharmacist who provided advice to the team and the patient's GP. Quality of life was measured using the SF‐36 and the AQoL. Results: Patients seen by an ACAT had a quality of life considerably below full health. Overall there was no significant change in quality of life in either group by either measure. The additional cost of the pharmacist was less than 77 per patient. Compared to no intervention, there was some evidence of an increase in the cost of prescription Pharmaceuticals, and a reduction in home care assistance and medical care costs in Melbourne but not in Ballarat. Cost data were highly skewed however, making statistical tests of cost differences problematic. The addition of a pharmacist may be cost reducing in some settings especially if inpatient episodes for assessment and treatment can be avoided, but the study was not able to demonstrate a statistically significant reduction in overall costs associated with pharmacist review and advice.
Health locus of control, depression and quality of life in people who are elderly
Authors: Bramston Paul , Tomasevic Vilma
Published: December 2008

Objectives
: This study examines the relationship between quality of life, depression and three aspects of health locus of control for people living in retirement villages.

Method
: A total of 101 people who are elderly living in a south Queensland city completed self‐report scales of life quality, depression, and health locus of control. Results and Conclusion: The results revealed that attributing control over one's health to powerful others can be linked with greater helplessness and depression which in turn is linked with lower perceptions of aspects of life quality. Depression was found to be a mediator between locus of health control and quality of life.
Suicide of older people in Asian societies: an international comparison
Authors: Lau Bernard WK. , Pritchard Colin
Published: December 2008

Objective
: To verify in a systematic study if the Chinese tradition of venerating older people results in lower suicide rates compared to other countries. Method: The ratio between suicide rates in the older population and total population were calculated and used to compare 40 countries. Results: The highest male suicide ratios in the world were found in Urban China, Singapore, Rural China and Hong Kong. Singapore, Urban China and Hong Kong had the worst female suicide ratios. The highest rate of suicide among females was in Rural China, which also had the highest suicide rate among older people. Conclusion: These findings raise questions about the adequacy of support to older Asian people. It is surprising that high suicide rates are found in Hong Kong, Korea, Japan and Singapore, which are affluent societies. The possibility of this being the result of ageism is discussed. Country‐specific research is needed to improve suicide prevention measures, especially for older people.
Forward
Authors: Marquis Dr Ruth
Published: December 2008

The Fulbright Symposium 2000 papers provide important selected papers from a range of national and international speakers and academics in a range of discipline areas, addressing the implications of an ageing population from their various perspectives.
Prospects for the prevention of dementia
Authors: Jorm Anthony F.
Published: December 2008

Abstract: Prevention of diseases can involve either: (a) their elimination from the lifespan of the individual, or (b) their postponement until later in the lifespan. The elimination of Alzheimer's disease or vascular dementia is not likely in the near future, although ongoing trials of vaccination against Alzheimer's pathology offer some prospects. Postponement of dementia remains a more likely scenario. Possible ways of postponing Alzheimer's disease include medications such as anti‐inflammatory drugs, oestrogen and antioxidants; and possibly the reduction of occupational risk factors like electromagnetic fields and medical risk factors like head trauma. For vascular dementia, there are lifestyle changes and medications like antihypertensives, antiplatelet drugs, folate and cholesterol lowering drugs. Prevention of dementia is sometimes justified on the basis that it will save government money. However, the situation is complex and in some circumstances, prevention may actually lead to an increase in costs to government.
A checklist for comprehensive health assessment for the over 70's
Authors: Byles Julie E. , Tavener Meredith A. , Fitzgerald Patrick E B. , Hair Balakrishnan R. , Higginbotham Nick , Jackson Claire L. , Heller Richard F. , Newbury Jonathan W.
Published: December 2008

Objectives: To describe the development and performance of an instrument for health assessment of older Australian veterans and war widows, including: (a) the underlying dimensions of the assessment instrument, (b) problems identified and (c) associations with health related quality of life. Method: Participants were randomly selected veterans and war widows aged 70 years and over, living independently in 10 regions of NSW and QLD. The intervention consisted of a series of preventive care home visit health assessments by health professionals using a specially developed 113‐item screening checklist, together with targeted health education materials, telephone follow‐up and computer generated reports to the veteran's local medical officer. Main outcome measures were underlying facets of the checklist, and associations with self reported quality of life. Results: 904 home visit assessments were conducted using the checklist. Problems identified included having no recent hearing check, poor rate of vaccination against pneumonia and tetanus vaccination, and problems with feet. Exploratory factor analysis of the checklist reported four main factors, explaining 31% of the variance. Three out of four checklist scales were significantly associated with both physical and mental component scores of the SF‐36 quality of life measure.

Conclusions: The preventive care checklist proved easy to administer, acceptable to participants, and contained valid items for use with an older veteran population.
Impotence in older men: do geriatricians have a role?
Authors: Granger Andrew S. , Wilkinson Tim J.
Published: December 2008

Background: Impotence, or erectile dysfunction, is the commonest health disorder affecting older men. However, this may be a topic not well addressed by geriatricians focussing on the health care of this group Objectives: To determine how often older male patients presenting to a single geriatric outpatient clinic were questioned about erectile dysfunction. Also to explore the attitudes of the physicians and patients with regard to whether such an assessment should be taking place in this setting.

Method: 121 men aged ≥ 65 years of age, assessed as ‘new outpatients' (1 hour appointments) during the period 1 June ‐ 4 December 1998, were sent written questionnaires enquiring about whether the subject of erectile dysfunction had been discussed at the appointment, and whether the patient felt that this was appropriate. A second questionnaire was sent to the physicians involved in the clinics, asking about their individual practice and opinions relating to the assessment of erectile dysfunction in this setting. Results: Anonymous replies were received from 60 (49.6%) of the 121 patients and 11 (78.6%) of the 14 doctors. Only 5/60 (8.3%) of the respondents recalled having discussed the subject of erectile dysfunction at the appointment, and in all cases the discussion was initiated by the doctor. None of the 5 reported feeling embarrassed or uncomfortable at the question. 44/60 (73.3%) replied that they would have liked the opportunity to discuss this issue, and the same number stated that this should be a routine part of a geriatrician's assessment. 59/60 (98.3%) responded that they would not feel uncomfortable with such a discussion. In contrast, only 1/11 (9.1%) of the doctors routinely asked all new male patients about erectile dysfunction. Furthermore, only 3/11 (27.3%) felt this to be a topic which should be a routine part of a geriatrician's full assessment. This was significantly different (p < 0.01) from the proportion of patients who considered that it should be routine. Conclusion: Erectile dysfunction was a health problem poorly addressed in this outpatient geriatrics clinic. Patients and physicians held divergent opinions on the role of the geriatrician in assessing this common problem. The patients' view, and our recommendation, is that enquiring about erectile dysfunction should become a routine part of a geriatrician's clinical practice.
Quality in aged care: a question of relational ethics?
Authors: Marquis Ruth
Published: December 2008

Objectives: This paper reports on findings from interviews with residents and aged care workers in seven aged care facilities in Western Australia to explore the relational context of aged care environments and how daily relational experiences with staff influenced residents' views on service quality. Method: Twenty‐four residents and eleven aged care workers, who were identified by residents as providing a quality service, were engaged in recurrent in‐depth interviews over a two year period. Data collection and inductive analysis took place simultaneously. Member checks validated findings

Findings: From the analysis of interview data two opposing relational cultures in aged care are discussed and five relational categories commonly experienced by participants described. Findings highlighted the importance of resident/staff relationships in residents' perceptions of receiving a ‘quality’ service and the positive and negative influences these had on their daily lives.

Conclusion: Aged care facilities need to adopt relational ethics as a guiding principle in creating quality services. Relationships with aged care workers may be central in the lives of people living in aged care facilities and their only opportunity for personal validation. Evaluating quality in aged care services needs also to address the daily relational experiences of residents. Recruitment and training of aged care workers need to consider relational competencies as an integral characteristic of quality care. Relational deprivation and abuse is not addressed by current evaluation procedures.
Saving ourselves: gender issues in making provision for one's own retirement
Authors: Gee Susan , Ng Sik Hung , Weatherall Ann , Liu Jim , Loong Cynthia , Higgins Te Ripowai
Published: December 2008

Objectives: This study investigated gender differences in making provision for retirement and the factors associated with a lower likelihood of saving. Method: Non‐retired adults aged between 40 and 62.S years (N = 382) were selected from a larger postal survey of Pakeha/New Zealand European adults over the age of 40 in the greater Wellington region of New Zealand. Results: Overall, women were less likely to save for their own retirement than were men, however this gender difference was no longer significant when income was taken into account. Those less likely to be making provision for their own retirement included individuals with poor health and lower income, and women who had divorced or who provided care. Conclusions: The relative economic position and social roles of women may engender vulnerability to economic dependence in later life.
Determinants of service use among the elderly: the Sydney Older Persons Study
Authors: Broe G.A. , Grayson DA , Waite L.M. , Creasey H. , Edelbrock D. , Bennett H.P. , Brooks W.S.
Published: December 2008

Objectives: To examine the determinants of service use in a community dwelling sample aged 75 or over.

Methods: Subjects (n = 537) were interviewed about use of community and medical services and the provision of unpaid support from their social network. Measures of disease and disability, detailed network support data and factors that may either enable or predispose subjects to service use were obtained and their prediction of service use examined.

Results: Unpaid support and community service use were predicted predominantly by disability, with disease providing little additional prediction. Medical service use was predicted by both disease and disability. With disease and disability controlled for, other variables did not significantly predict medical service use or unpaid support; but did predict small additional variation in some community service use.

Conclusions: Disability and disease are the major determinants of service use with other factors contributing to the use of some community services.
Smoking, alcohol use and engagement in exercise and cognitive performance among older adults
Authors: Bryan Janet , Ward Lynn
Published: December 2008

Objectives: To examine cross‐sectional and longitudinal effects of history of smoking, alcohol use and engagement in exercise on cognitive performance. Method: Health habits and cognitive performance of a large community sample of older adults were assessed at measurement points two years apart.

Results: Past smokers performed more poorly on tests of recall and speed of information processing at times 1 and 2 than those who had never smoked. Past smokers and moderate users of alcohol performed better on confrontation naming and working memory, than those who had never smoked or drank alcohol. Engagement in exercise was related to immediate recall and speed of processing before, but not after, controlling for covariates. Health habits were not related to longitudinal change in cognition.

Conclusions: The results suggest a negative effect of history of smoking on effortful cognitive tasks and a protective effect of alcohol use on more automatic cognitive tasks among older adults.
Predictors of the decision to yield care of a person with dementia
Authors: Bond Malcolm J. , Clark Michael S.
Published: December 2008

Objective: The aim of this study is to determine the relative contributions of caregiver and patient characteristics to the subsequent decision to yield care of a person with dementia.

Method: The sample comprised 158 people with dementia and their spouse caregivers. The inclusion criteria were that the patient had a diagnosis of Alzheimer's disease, the patient and caregiver were both at least 65 years of age, were co‐resident, that the caregiver was the spouse of the patient, and was actively providing care. Caregiver measures were the Geriatric Depression Scale, SF36, Adelaide Activities Profile, self‐rated health, use of respite services and time as a caregiver. Patient measures were the Functional Dementia Scale, Adelaide Activities Profile, and time since diagnosis. Age and sex were also recorded. Data were obtained by personal interview with caregivers. Two years later, all caregivers were re‐contacted by telephone. At this time 60 (38%) were still providing care; the remaining 98 (62%) had yielded their role to formal institutional care, on average 11.2 months previously.

Results: Caregiver characteristics significantly associated with yielding care included greater age, greater use of respite services, less social activities, poorer mental health and greater depression. Patient characteristics significantly associated with yielding care included greater dementia severity, lower activity level, and more frequent incontinence.

Conclusion: Dementia severity was the key predictor of the decision to relinquish care. However, it is important to recognise the full range of factors that might indicate that a caregiver is in need of assistance and might be close to yielding the role.
Fear of crime and protective behaviours in older and younger adults: results of a community survey
Authors: Ranzijn Rob , Howells Kevin , Wagstaff Vicki
Published: December 2008

Objectives: The aim of the present survey was to evaluate the extent of fear of crime and the use of protective behaviours in a community sample.

Method: A total of 287 people aged between 16 and over 90 years in the local government area of Tea Tree Gully, South Australia, were surveyed by means of a short questionnaire.

Results: The level of self‐reported fear of crime was moderately high but there were no differences between older and younger age‐groups. Women felt significantly less safe than men, at all ages. There was no apparent relationship between protective behaviours and fear of crime.

Conclusions: Crime prevention programs may have reduced the incidence of crime but do not appear to have reduced the level of fear. Theoretical issues a*e also discussed.