bluuebunny/crossref_metadata_2025 huggingface dataset:
Exercise in Older People with Type II Diabetes Maintains Bone Density Despite Weight Loss
Authors: Caplan G.A. , Colagiuri R. , Lord S.R. , Colagiuri S. , Ward J.A.
Published: December 2008

A prospective controlled trial to study the effects of 12 months aerobic weight bearing exercise on 8 older diabetic subjects and 10 controls was conducted because although there are no specific data, an appropriate exercise program is recommended for all older persons with diabetes. The trial measures included diabetes control; bone density at the spine; sensorimotor function; risk factors for cardiovascular disease; and well‐being and cognitive function. The mean percent change in lumbar spine bone mineral concentration (SEM) was +0.29(3.0) in exercisers and‐11.2(5.1) in controls (p=0.015). The exercise group also improved their body mass index‐1.9(1.3) vs. +1.7(1.1); p=0.031; weight‐1.9(1.3) vs. +1.8(1.1); p=0.036; and Life Satisfaction Index‐A 51.3(25.7) vs 2.8(2.9); p=0.046, compared to controls. There was no change in sensorimotor function. This study provides encouraging yet tentative evidence of benefit from a twice weekly aerobic exercise program to elderly people with diabetes.
High Risk Prescribing in the Veteran Population
Authors: Parkes A.
Published: December 2008

Concerns about the frequency and consequences of adverse drug reactions have prompted the Department of Veterans' Affairs to establish a ‘quality use of medicines’ program. This involves several approaches, including patient and pharmacist education and prescriber pharmaceutical feedback. The traditional approach, regulatory change, is also used to influence prescribing. The process of prescribing feedback involves the identification of high risk prescribing situations, such as the prescribing of drug combinations known to interact significantly. Analysis of prescribing information for veterans indicates the extent to which these ‘high risk’ situations occur. Increased regulation for the prescribing of certain of the benzodiazepines on the Repatriation Pharmaceutical Benefits Scheme was introduced in April 1993. Analysis of drug utilisation, using the Department of Veterans' Affairs pharmaceutical database reveals, not surprisingly, that this has had a dramatic effect on the prescribing of the newly restricted drugs. The prescribing of all benzodiazepines including restricted and unrestricted drugs however, has dropped by a net of 11% when comparing twelve month periods before and after the introduction of restrictions. Equally importantly, the prescribing of tricyclic antidepressants (TCA) has not significantly changed implying that prescribers are not routinely changing from benzodiazepines to TCAs.
Service to Veterans: Shifting from a Traditional Medical Approach to an Integrated Approach
Authors: Emerson F. , Callioni P.
Published: December 2008

In 1990 the Department of Veterans' Affairs decided to make a paradigm shift in Us service delivery model A comprehensive client focused service delivery area was required and the multiplicity of community and medical support services had to become more accessible for veterans. These pressures led to the development and implementation of an integrated model of service delivery. Although there were some difficulties in its implementation due to a necessary change in culture, many positive outcomes have been achieved in the early stages
Dementia Care Initiatives by the Department of Veterans' Affairs
Authors: Medza S.A.
Published: December 2008

This paper discusses the Department of Veterans' Affairs (DVA) dementia care initiatives and provides forecasts of treatment population projections for veterans and war widow(er)s with dementia to the year 2004. It highlights the DVA focus of using educational strategies as a tool for influencing care outcomes by health providers and carers through acquisition of relevant and up to date knowledge about dementia. The education strategies presuppose that through appropriately targeted education measures, DVA will qualitatively influence the nature and direct care services by health providers and carers to veterans and war widow(er)s with dementia, through increased and reinforced knowledge about the nature, and management of dementia. At the same time the strategies provide an opportunity for personal professional development by health providers and carers.
“You'd be Very Surprised at What the War Has Done to People”: Veterans Talk about the War
Authors: Walker‐Birckhead W. , Davison B.
Published: December 2008

This paper examines how people's war experiences affect their emotional and physical health and sense of identity in old age. It is part of a larger qualitative study into health and independence in old age which involves old people from a variety of Australian and migrant backgrounds, adult children and general practitioners. In this study old people talk about their health and illness experiences, and how they see their lives now and in the future. Most were young adults during the war years. This paper presents case histories of three people whose lives have been affected as soldiers and civilians by war and its aftermaths. It uses narrative and interview material to explore the meanings of wartime experiences in old age, and develops specific themes around pain and survivorship which are associated with these experiences.
Australia Remembers as Veterans Forget: the Care of Veterans with Dementia
Authors: Rosenman L. , Brocque R. Le , Tilse C.
Published: December 2008

Comparisons between veterans and non‐veterans in a sample of 243 older Australians with dementia show that veterans are more likely to be older men being cared for at home by older frail spouses, or are single older women who are those most likely to be institutionalised. Care needs for veterans are shifting from meeting medical needs of a male population to providing support to older female carers and older frail women with no partner.
Risperidone in the Treatment of Agitated and Aggressive Patients with Dementia
Authors: Lipski P.S. , Death J.W.
Published: December 2008

Patients with dementia often present with challenging behavioural disorders. Paranoid delusions, hallucinations and agitated and aggressive behaviour are common and difficult to treat. The currently available drugs to treat such disorders, especially neuroleptic agents, result in a high frequency of complications including extrapyramidal syndromes. Risperidone, a new neuroleptic, is now available for the treatment of schizophrenia in younger patients. This study describes a series of eleven elderly patients with dementia who were successfully treated with risperidone for the control of agitated and aggressive behaviour. Controlled trials over a longer period need to be conducted.
Squalor Syndrome: a Viewpoint
Authors: Shah A.
Published: December 2008

Various features of the squalor syndrome are described with the aid of scanty existing literature. Flaws in drawing inferences from this limited literature are discussed. It is suggested that this syndrome occurs in all age groups (not just the elderly) with a heterogenous range of psychiatric diagnosis.
Australian Society for Geriatric Medicine Position Statement on Elder Abuse
Authors: Kurrle Susan
Published: December 2008

Elder abuse is not a new phenomenon, however until recently it has gone largely unrecognised in Australia, as it is one of the last forms of familial violence to come to public attention.
Carers of Older People: a Study Based on the Response to the Carer Support Kit in NSW
Authors: Ehrlich F. , Poulos R. , Poulos C.J. , Draper B.
Published: December 2008

This paper reports results of a telephone survey undertaken on the carers of older people who contacted the Carers' Association of NSW requesting the Carer Support Kit The survey covered a number of aspects of the caring experience, the strains this may impose and the range of disabilities of the care‐recipients, in addition to the demographic characteristics of the carers and their relationships to the recipients. Comparisons are made between carers of the ‘young’ old and carers of the ‘old’ old, and important differences highlighted and discussed. Despite many government initiatives to assist carers, many require further assistance.
Nursing Home Entry: Meaning Making by Relatives
Authors: Nay R.
Published: December 2008

In‐depth interviews are being conducted with relatives of nursing home residents regarding their experience of nursing home entry. This paper reports on preliminary analysis of the texts generated by interviews with nineteen relatives. Grounded in hermeneutic phenomenology, the study explores and describes these experiences. Seven themes are described which assist understanding of the experience from the decision making through to nursing home entry.
Community Participation in an Australian Retirement Village
Authors: McDonald J.
Published: December 2008

A case study of an Australian retirement village investigated patterns of social participation among residents. Participation was defined in terms of three major dimensions: neighbouring, involvement in organised activities and committees, and friendship. Data from in‐depth interviews, documentary analysis and participant observation were analysed both qualitatively and quantitatively. Neighbouring among residents flourished. Compared to overseas findings, important differences were observed. While the overall rate of involvement in organised social activities was comparable, gender, marital status and health affected the level and type of involvement. Close friendships within the village were fewer and qualitatively poorer than reported for overseas villages. Factors which promote and inhibit participation in village life are identified.
Determinants of Formal Service Use in an Aged Population
Authors: Mawby L. , Clark M.S. , Kalucy E. , Hobbin E.R. , Andrews G.R.
Published: December 2008

The factors distinguishing users of formal services from comparable non‐users were examined using a random sample of 1,799 people aged 70 years and over. One person in eight in the aged population received services from Domiciliary Care and Rehabilitation Services, Royal District Nursing Society, or Meals on Wheels. Service use was associated with greater age, fewer assets, living alone, ADL and IADL problems, poor self‐rated health, more health consultations, and recent hospitalisation. Agencies appeared to be accurately allocating services to those most in need. Longitudinal data will enable refinement of the profile of those people requiring new or ongoing services.
‘Righting’ Wrongs for the Aged: a Bill of Rights?
Authors: Carney T.
Published: December 2008

Opinion is divided about the extent to which the interests of the aged are amenable to rights strategies. It is argued here that rights strategies have a limited contribution. On an educative plane, there is an important place for measures which promote cultural respect for civil participation of the aged: a ‘rights orientation’. The trend towards enunciation of a separate charter of rights for the aged has some attractions, but these are outweighed by the fragmentation entailed: accentuating the processes of segregation and social stereotyping which may be responsible for much of the disadvantaged status of aged people. Universal statements of rights are preferable.

The most fundamental difficulty with rights based approaches, however, is their lack of power in addressing the resourcing, service delivery and other structural issues which undergird the disadvantage experienced by some aged people. This is compounded in a federal system of government, with its rationale of preventing concentration of governmental power. This is not to deny the need for individual case‐by‐case remedies of injustice, or the symbolic and educative role of the law. An inclusive Australian Bill of Rights would advance this agenda as effectively as any measure. But it is neither a panacea nor necessarily the top agenda item. Too much store can be placed in legal remedies for social ills.
Computers Enhancing the Lives of Older People
Authors: Irizarry C. , Downing A.
Published: December 2008

A survey of 312 older people was conducted to ascertain the extent to which they use modern devices, and their attitudes towards modern technology. Although respondents expressed interest in new technology and confidence in learning to use modern devices, few owned or used a computer. Based on these findings, the “Seniors‐On‐Line” program was established with the aim of providing older people with the opportunity to enhance their lives through the use of computers. Participants were aged from 55 to 89. Teaching methods address the particular learning needs of this age group: egalitarian leadership, encouragement of questions, classes consisting of same age students, and freedom to work at one's own pace. Of a total of 369 participants, 98% have completed the course.
Simple Anthropometry During Geriatric Assessments: a Useful Predictor of Malnutrition
Authors: Bruce D.G
Published: December 2008

Arm muscle area (AMA) has been suggested as a diagnostic technique for malnutrition. In this study AMA was measured during routine geriatric assessments in order to determine whether: (a) malnutrition was common, and (b) low AMA was associated with excess mortality. AMA was obtained in 186 consecutive subjects (114 women, 72 men; age range 53–102) and compared with published control data. AMA consistent with malnutrition was found in 39.4% of the women and 18.1% of the men. After 12 months, the mortality rate in the malnourished women was 42.2% compared with 7.3% in the women with normal AMA (p < 0.001), In contrast, AMA status did not affect the mortality rate of the men (38.5% mortality in those with tow AMA versus 23.7% in the others), Low AMA consistent with severe malnutrition is common in subjects referred for nonurgent geriatric assessment and is associated with an excess mortality in elderly women.
The Dysfunctional Behaviour Rating Instrument: Utility in an Australian Population
Authors: Kneebone I. , Clarnette R. , Frendin L.
Published: December 2008

This report examines the validity and reliability of the Dysfunctional Behaviour Rating Instrument (DBRI), designed for completion by caregivers of individuals with dementia residing in the community. Randomly selected carers completed the instrument and scores were compared to scores on measures of ADL, cognition and caregiver burden. The DBRI correlated weakly with cognition, r = ‐0.20 (p < .05), but moderately with burden r = 0.49 and ADL r = 0.33 (both p < 0.001), The DBRI is considered to be both valid and reliable for use with an Australian population.
Therapy: Who Benefits?
Authors: Sherman B.
Published: December 2008

The paper critically evaluates the inclusion of psychological type therapy as a routine activity in dementia care programs.
Podiatric Problems on a Stroke Rehabilitation Unit
Authors: Jordan E. , Lekkas C. , Roscioli D. , Russell M. , Finucane P.
Published: December 2008

Podiatric problems were sought in 88 of 90 patients consecutively admitted to a stroke rehabilitation unit to determine their prevalence and nature and the ability of a podiatry service to alleviate them. In all, 65 (74%) had one or more podiatric problems. Though most problems detected were simple and easily treatable, they still had the potential to adversely effect the stroke rehabilitation program. We believe that a podiatric assessment is essential for all patients undergoing stroke rehabilitation and may also be valuable in other rehabilitation settings.
Alzheimer's Disease: Unravelling the Genetic and Environmental Pathways Towards Pathogenesis
Authors: Masters C.L. , Beyreuther K.
Published: December 2008

An understanding of theβA4/APP metabolic pathway is recognised as vital to the elucidation of the nature of Alzheimer's disease. This paper overviews early shrdies of the Alzheimer's disease plaque amyloid the subsequent identification of the amyloid protein precursor (APP) and its gene, and the description of the structure and function of APP and βA4.
Comprehensive Strategies for Health Promotion for Older People: Past Lessons and Future Opportunities
Authors: Nutbeam Don
Published: December 2008

Abstract. This paper highlights the need for comprehensive health promotion strategies to meet the specific needs of older people. It traces the recent history of efforts in Australia to promote the health of older people, concluding that currently there is no comprehensive, nationally agreed strategy with a significant resource allocation directed towards this end. It is argued that a population‐based strategy is needed, which is built on an analysis of health priorities for older people, and which is comprehensive in scope, acknowledging the importance of economic, social and environmental determinants of health. A health outcomes framework for the development of strategy is presented. This incorporates the broad range of determinants of health among older people and provides a mechanism for linking health outcomes to health promoting actions. The paper concludes that progress in promoting the health of older people in Australia will be best achieved by governments working effectively in partnership with older people, particularly through existing non‐government organisations; by adoption of an expanded framework for analysing priorities and taking action; and through improved networking and sharing of information on the special needs and priorities for action with this population group.
Symposium on Work, Retirement and Wealth: Current Data and Future Needs: an International Perspective
Authors: Burkhauser Richard V. , Clark Robert , Suzman Richard
Published: December 2008

Abstract. This symposium brought together a unique set of scholars who are both actively involved in ageing research and in the creation of the new generation of multiperiod social science‐based longitudinal datasets for research. The symposium provided a description of the new data and examples of its use with respect to the work, retirement and wealth of older persons. The datasets discussed included: the US Health and Retirement Study, the Netherlands Household Panel Study, the German Socioeconomic Panel, the US Panel Study of Income Dynamics, and several East and Southeast Asian datasets.
Contributions of Longitudinal Studies to Epidemiology and Disease Prevention: an Overview
Authors: Fozard James L.
Published: December 2008

Abstract. Longitudinal studies characterise changes with respect to initial levels and rates of changes. They help to identify transitions between normal ageing and disease; to identify persons at risk for age associated diseases and to plan interventions. The future usefulness of longitudinal studies will depend increasingly on the preservation of biological specimens.
Positive Contributions of the Elderly to Society: a Multidisciplinary Perspective
Authors: Hoyer William J.
Published: December 2008

Abstract. The primary aim of this paper is to provide an overview and integration of the papers presented as part of an invited symposium titled, Positive Contributions of the Elderly to Society, at the 1997 World Congress of Gerontology. One of the main points of this symposium was to suggest that issues of costs and contributions to society for any targeted age group are best conceptualised from a multi‐dimensional and life‐long perspective. The paper by Greene reported that costs are best understood in relation to current and life‐long contributions in the economic sphere. The paper by Wells illustrated the worth of the positive contributions of older adults as caregivers. Another main point was the suggestion that the assessment of cognitive and personality dimensions in later life indicates continued growth and the emergence of unique and effective cognitive and adaptive skills. The papers by Smith, Hoyer and White, and Schaie and Willis described the positive nature of the cognitive contributions of older individuals in everyday settings. These papers emphasised the mutual benefits that accrue for society and for older individuals when meaningful roles are maintained in later life. These papers were illustrative of successful ageing, but also addressed the limits and age‐related constraints on effective functioning in later life. The findings of the papers in this symposium provide a basis for developing a more balanced discourse regarding the positive contributions and burdens of an ageing population, and for developing new multi‐disciplinary and multicultural perspectives in gerontology.
Energy Metabolism, Nutrition and Ageing
Authors: McCarter Roger J.M.
Published: December 2008

Abstract. Energy metabolism and nutrition have long been suggested to play a role in ageing processes, in age‐related disease and in the health of the elderly. This review addresses new insights arising from selected studies of the interplay of these factors. Data on overfeeding and underfeeding in young versus elderly men and women demonstrate a deficit with age in the ability to regulate energy balance. They also indicate that current values of Recommended Daily Allowances of caloric intake underestimate the needs of the elderly. The studies suggest that diminished capacity of energy metabolism with age may have a nutritional component and the involvement of the central nervous system. The contribution of peripheral tissues is suggested by studies of mitochondrial DNA isolated from tissues of humans and rodents. The studies demonstrate age‐related and disease‐related increases in rates of mutation in some but not all tissues. The further involvement of mitochondrial dysfunction in ageing is suggested by data on oxidative free radical production in mitochondria of birds versus rodents. These elegant studies indicate greatly reduced rates of free radical production in mitochondria of long‐lived ‐ birds versus short‐lived rodents. They further demonstrate that Complex I of the respiratory chain may be a major factor in these species‐specific effects. Restriction of caloric intake (dietary restriction, DR) is the only manipulation known to consistently extend lifespan in a wide variety of species. Previous work shows that extension of lifespan in DR is not necessarily related to reduced metabolic rate per unit metabolic mass. More recent work in exercising DR rats demonstrates consistently high daily metabolic rates together with extended lifespan. Other studies also show altered characteristics of fuel use in DR, indicating the ability of DR rats to maintain appropriate rates of fuel use under conditions less damaging to the organism. All of these new approaches to the interaction of nutrition, energy expenditure and ageing suggest that regulation of energy balance and the characteristics of fuel use play significant roles in ageing and in age‐related disease.
Ageing and Memory: Mechanisms Underlying Age Differences in Performance
Authors: Park Denise C.
Published: December 2008

Abstract. Although it is widely believed that memory generally declines with age, in fact, age decrements occur for most, but not for all, types of memory. Age differences are always found for free and cued recall but are rarely found for picture recognition, implicit memory and measures of verbal ability. Understanding the conditions under which age differences occur and when they do not across memory domain is a challenging puzzle for cognitive ageing researchers. The hypothesis adopted here is that the magnitude of age‐related decrements in memory function across different domains of memory can be accounted for by the amount of processing resource or mental effort required to encode and retrieve information. Different conceptualisations of processing resource are explored and supporting data are reviewed.
The Economics and Financing of Long‐Term Care
Authors: Schulz James H.
Published: December 2008

Abstract. Population ageing does not mean unaffordable care costs for the elderly, given economic growth. But current wide variations in financing chronic care in old age need to be reassessed. Major options discussed in the paper are: community care, home equity conversion, and private insurance.
Bridging the Gap: Maintaining Information Exchange on Ageing
Authors: Troisi Joseph
Published: December 2008

Abstract. As pointed out in Article 106 of The Vienna International Plan of Action on Aging, the exchange of information and experience at the international level is an effective means of stimulating progress and encouraging the adoption of measures to respond to the economic and social implications of population ageing. Research, which will inform policy and planning for an ageing population, is becoming more and more a priority if we do not want events to overcome history. This is the more so in developing countries where the majority of the world's elderly live. Moreover, there is a growing awareness in favour of cross‐national research. The very motto of the 1997 IAG World Congress of Gerontology, namely: Ageing Beyond 2000: One World One Future, clearly stresses the growing need of overcoming cultural, economic, social and political boundaries in all matters concerning ageing. In this context, research, and particularly the widest dissemination of research, is of paramount importance. Consequently, it needs to be better co‐ordinated and more focused. More attention needs to be given to the design of programs and their evaluation against specific and objective criteria and within the framework of relevant internationally agreed instruments. In spite of this, however, researchers are becoming more and more aware of the existence of a number of conceptual and practical barriers in the gathering, analysis and dissemination of research results both at the national and international levels. There exists a lack of standardised definitions, terminologies and research methodologies. This gap needs to be bridged.
The Positive Impact of the United Nations Declared International Year of Older Persons on Perceptions of Ageing
Authors: Andrews Gary R.
Published: December 2008

Abstract. This paper outlines the evolution of the United Nations' approaches to ageing issues, culminating in the 1999 international Year of Older Persons. It explains facets of ageing identified for exploration and debate during the Year, and describes some of the activities undertaken.
Future Directions for Residential Care
Authors: Howe Anna
Published: December 2008

Abstract. In looking to future directions in residential care, this paper considers a number of factors that make for stability and others that are likely to see a continuation of present trends before turning to sources of new development. While recent policy measures to integrate nursing homes and hostels have focused attention on higher levels of residential care, the scope for change here is seen to be limited by funding and other constraints. Instead of a return to the continuum view of residential care, a redrawing of the paradigm is proposed that builds on initiatives that promote more varied combinations of care and accommodation, more flexible funding arrangements, and more interaction with community care across a range of housing settings. Support for this paradigm of diversification is found in current international developments.
Development of a Training Program in Clinical Geropsychology
Authors: Helmes Edward , Gee Susan
Published: December 2008

Abstract. Psychologists in Australia have not been closely involved in clinical work with older adults until very recently. There has been speculation that one reason for the present state is that training standards have not provided psychologists with adequate information about ageing processes and methods that can assist older people. This article describes the development of the geropsychology program at Edith Cowan University and some of the difficulties involved in that process since its introduction in 1996. The program has now achieved a degree of stability and recognition through accreditation with the Australian Psychological Society as a specialty of the clinical training course. Students who have completed the course are now working in a variety of settings and are able to demonstrate the utility of psychologists trained to have a broad perspective on the problems and strengths of older Australians.
Immunisation Rates in Older Veterans and War Widows
Authors: Nair Balakrishnan , Byles Julie , Tavener Meredith , Heinze Robin
Published: December 2008

Aim: To study the immunisation rates of veterans and war widows aged 70 years and above in New South Wales and Queensland, as part of the Preventive Care Trial.

Method: A trained health care worker assessed subjects at home regarding health, illness and immunisation status.

Results: Suboptimal immunisation rate for influenza (72%) and poor rates for pneumococcus (14%) and tetanus (43%) were detected.

Conclusion: Subjects in this study were not immunised according to recommended guidelines. Further education campaigns are warranted to improve immunisation rates in older people.
Participation in, and Barriers to, Training: the Experience of Older Adults
Authors: Cully Mark , Heuvel Adriana Vanden , Curtain Richard , Wooden Mark
Published: December 2008

Abstract. It is widely recognised that older workers are less likely to gain access to job‐related training than younger workers. This article reviews evidence on the extent of age‐based training differentials in Australia and the main barriers that inhibit older workers from accessing training. It is concluded that governments in Australia need to do far more to ensure that older workers are not denied access to training opportunities.
Knowledge and Beliefs of Older Australians about Sexuality and Health
Authors: Minichiello Victor , Plummer David , Loxton Deborah
Published: December 2008

Objective: To report on the relationships between a range of demographic and social variables of a sample of older Australians and their answers to six questions concerning sexuality and health in later life

Method: A self‐completed questionnaire was returned by 844 randomly selected older persons. Two questions were included as indicators of older Australians' knowledge of the impact of health on sexuality in later life; two questions examined beliefs about the possible physical and psychological benefits of sexuality; and two questions examined older people's expectations of sexuality as people age

Results: Regression analysis was performed to test for associations between sexual ‘awareness’ and gender, age, relationship status, marital status, number of sexual partners and spirituality. Responses were combined into what we have called a ‘Sexual Health Knowledge and Beliefs Index’ (SHKB Index). The results show that males and those currently in sexual relationships have significantly higher scores on this index. There were, however, significant differences for individual item scores by gender, age, being in a sexual relationship, and number of sexual partners

Conclusions: The study discusses how the SHKB Index can be used to identify people who have poorer knowledge and less positive attitudes towards sexuality in later life so that education and services can be planned accordingly.
Acopia‘: a Useful Term or Not?
Authors: Obeid John L. , Ogle Susan J.
Published: December 2008

Background: ‘Acopia’, meaning inability to cope, is increasingly used by Australian public hospital emergency departments to describe frail older patients. This raises concerns among geriatricians that significant medical illnesses in older people are being misdiagnosed or under diagnosed

Objective: An audit was conducted to determine the medical status and outcomes of patients admitted with ‘acopia’ at two Sydney teaching hospitals.

Methods: A retrospective audit of medical records of patients admitted with ‘acopia’ from July 1996 to June 1998 at Royal North Shore Hospital and Nepean Hospital NSW was carried out.

Results: A total of 109 patients were assigned the ‘diagnosis’ of ‘acopia’ in the emergency department. 64% were female. 104 files were available for review. The 100 patients aged 65 years or more were reviewed in detail. Mean age was 80 +/‐ 10 years. The term ‘acopia’ was used mostly by senior emergency department staff. Multiple medical problems were present, especially gait disorder and dementia. The average number of medical diagnoses per patient was 8.0. Most patients were independent in activities of daily living (52%) and were living in the community (74%) prior to becoming medically unwell. The main reasons for admission were the geriatric syndromes of gait disorder, falls, confusion and incontinence. Average length of stay was approximately 13 days. Only 50% of patients were able to return home; 25% required nursing home placement. Three percent died in hospital and advanced cancer was newly diagnosed in 5%.

Conclusions: We conclude that ‘acopia’ is not a useful term in that most patients labeled as such have multiple medical problems as the reason for their admission. The use of the term may result in reduced awareness of the need to seek out and treat reversible pathology in older patients. This study highlights the need for ongoing training for emergency department staff in the recognition and management of patients with geriatric syndromes.
Elder Abuse among Clients and Carers Referred to the Central Coast ACAT: a Descriptive Analysis
Authors: Livermore Patrick , Bunt Robert , Biscan Katrina
Published: December 2008

Objective: To examine elder abuse on the Central Coast of New South Wales by focusing on the prevalence, types of abuse, victim and abuser characteristics, recommended interventions and the identification of abuse at the time of referral for clients and carers referred to the Central Coast Aged Care Assessment Team (ACAT). Method: A descriptive study of elder abuse within the population referred to the Central Coast ACAT (Wyong and Gosford Local Government Areas, New South Wales) between November 1996 to November 1997. Clients were identified retrospectively from Area Health records for three months and prospectively for nine months. The methodology was derived from research conducted by Kurrle et al. in 1997. Results: The data indicated an elder abuse prevalence of 5.4%. The prevalence identified prospectively was more than double that identified retrospectively. Psychological abuse was the most common type of abuse. 75% of cases were identified as client abuse and 25% identified as carer abuse. The type of abuse and abuser characteristics differed markedly between cases where the client was abused and cases where the carer was abused. Differences in abuser characteristics were also apparent when comparing financial abuse cases with non‐financial abuse cases. Conclusion: These results in relation to prevalence and types of abuse are comparable to those found in previous Australian research based around ACAT populations. The study indicates that there are differences between cases where the client is abused and cases where the carer is abused and that differences also exist between cases of financial abuse and non‐financial abuse. The authors consider that an examination of these differences provides further insight into the complex and diverse nature of elder abuse. The study confirms elder abuse as a significant issue of concern and indicates the need for a coordinated response to the issue.
Qualitative Aspects of Productive Ageing
Authors: Ranzijn Rob , Grbich Carol
Published: December 2008

Objectives
. This paper reports on the proceedings of six focus groups, in both metropolitan and regional areas in South Australia, that were conducted to explore qualitative dimensions of productive ageing.

Method
. A total of 33 individuals aged between 55 and 84 years participated in loosely structured discussions of issues around the contributions they made towards their immediate families, their local communities, and society at large. Results. As well as providing rich and passionately told stories of productive involvement, the groups shed light on the ability of older people to identify and fulfil unmet needs, their eagerness to remain involved in life, and the complexity and individual nature of each person's involvement in productive activities. Conclusions. To simply list an inventory of productive activities trivialises the nature and depth of involvement. There is a need for further study into the relationship of older adults to their larger social network, by means of which older adults remain able to contribute in useful and meaningful ways.
Dementia with Lewy Bodies: A Review with an Illustrative Case Report
Authors: Chong Robert , Evans Louisa , Chan Daniel KamYin
Published: December 2008

Abstract: Dementia with Lewy Bodies (DLB) is being diagnosed more frequently but the diagnosis can be difficult especially when evidence for other causes of cognitive decline is present. It is important, however to recognise the condition as it has significant management and prognostic implications for the clinician and the patient. This review outlines the clinical features of the disease and presents the consensus criteria that can be used to make a diagnosis. A case will be presented to illustrate the difficulties that faced by clinicians in diagnosing the condition and to caution the use of traditional antipsychotics when the condition is suspected.
Vancomycin Resistant Enterococcus in Geriatric hospitals and Long Term Care Facilities: Implications for practitioners
Authors: Anpalahan Mahesan , Darzins Peteris
Published: December 2008

Abstract: Bacterial resistance to antibacterial agents is a growing problem in geriatric institutions. Australian data on Vancomycin Resistant Enterococci (VRE) in geriatric hospitals and Long Term Care Facilities are scanty and there is limited evidence that could inform development of guidelines for VRE prevention and control. The management of patients with VRE in a new purpose‐built geriatric hospital is described. The cases demonstrate some of the practical problems posed by VRE including difficulties in interpreting the infection control guidelines.
Bookshelf
Authors: Devaus David
Published: December 2008

The Myth of Generational Conflict: The Family and State in Ageing Societies

Sara Arber and Claudine Attiias‐Donfut, Routledge, London, 2000. 150.00 ISBN 0–415–20770–3 (hardcover).

Early Diagnosis of Alzheimer's Disease

Leonard F.M. Scinto and Kirk R. Daffner (eds). Totowa, New Jersey, Humana Press, 2000. ISBN 0–896–03452–6, $US125.00 (hard cover)

This would be a useful book to have at a memory clinic and would also be of value on the shelves of an aged care assessment team, an outpatient neurology clinic or a neuropsychiatry service. Those active in dementia research may want to have access to a copy, but I doubt whether individual private practitioners would find the investment worthwhile.

Associate Professor David Ames

Associate Professor of Old Age

University of Melbourne, Department of Psychiatry

Royal Melbourne Hospital

Parkville, Victoria

Beyond Gender Differences: Adaptation to Aging in Life Course Perspective

L. R. Hatch. New York, Baywood Publishing Company, 2000. ISBN 0–89503–210–4. US44.00 (hard cover).

Dr Deborah Setterlund

Senior Lecturer

School of Social Work and Social Policy

The University of Queensland

Neuroimaging and the Psychiatry Of Late Life

David Ames & Edmond Chiu (eds.) Cambridge University Press, 1997. ISBN 0–521–49505–9 (hardback). 150.00.

Michael Woodward

Director, Aged Care Services

Austin & Repatriation Medical Centre, Heidelberg West, Victoria

Psychosocial Intervention In Long Term Care: An Advanced Guide

G.W. Hartz and D.M. Splain. New York, Haworth Press,. 1997. ISBN 0–7890–0114–4 (hardcover). US60.00 (hardcover), US28.00 (softcover).
Intergenerationai curriculum: A two stage primary school project for promoting positive images of ageing
Authors: Feldman Susan , Mahoney Dr Helen , Seedsman Prof Terence
Published: December 2008

Education for and about ageing provides an opportunity for children to gain continuity in their lives by recognising the naturalness and realities of growing old in a multicultural Australia.
Innovations in Aged Care: Hip protectors: promising but no panacea
Authors: Cameron I.D. , Kurrle SI. , Quine S. , Lockwood K. , Cumming R.G.
Published: December 2008

Abstract: Interest in hip protectors to prevent hip fractures in older people is increasing rapidly with their use suggested to many older people. Research indicates that almost all hip fractures occur after a fall onto the hip region and a number of hip protectors have been designed to reduce the force of the fall. Wearing of hip protectors has been shown to be effective in randomised trials in nursing homes with residents at high risk of hip fracture. However, adherence with use of hip protectors is incomplete and hip fracture can still occasionally occur while wearing hip protectors. No published studies have examined the effectiveness of hip protectors in people living in the community rather than in residential aged care facilities.
Evidence based medicine for older people: available, accessible, acceptable, adaptable?
Authors: Nair Balakrishnan R.
Published: December 2008

Despite the wealth of evidence concerning interventions in older people from properly conducted randomised controlled trials the profession has been slow to implement these findings. Gains in life expectancy with resulting greying of the patient base has not been accompanied by interest and motivation to provide the best quality evidence based care for older people.
Spatial equity in the distribution of aged care services in Australia
Authors: Gibson Diane , Braun Peter , Liu Zhibin
Published: December 2008

Geographic characteristics and social conditions in rural and remote areas often mean greater difficulty and costs in terms of providing aged care services. This, in turn, inevitably causes concern over spatial equity in the distribution of aged care services. This paper analyses the distribution of aged care services by four geographic categories: capital cities, other metropolitan areas, rural areas and remote areas.
A survey of general practitioners' attitudes to older drivers on the New South Wales Central Coast
Authors: Lipski Peter S.
Published: December 2008

Objective: To investigate the attitudes of General Practitioners to older drivers on the New South Wales Central Coast.

Method: Postal survey.

Results: 275 General Practitioners (GP's) were surveyed, with a response rate of 173 (63%). 61% of GP's allowed an older driver with mild Alzheimer's disease to still drive a motor vehicle. 21% of GP's would allow the frail, medically unfit driver to still drive with a restricted licence locally if there was no public transport near by. Only 41% of GP's thought they had enough training to make an appropriate medical driver assessments. Only 29% of GP's routinely asked about driving habits and medical fitness to drive in all of their older patients. 55% of GP's felt that there should be another medical body to oversee all medical driver assessments rather than the GP.

Conclusions: These survey results suggest that not all GP's are aware of the regulations for medical driver assessments, are not routinely screening older drivers, are not adequately trained in medical driver assessments, allowing medically unfit drivers to continue to drive, are concerned about the consequences of cancelling an older driver's licence and are unhappy in dealing with these issues.
Older people and substitute decision making legislation: limits to informed choice
Authors: Setterlund Deborah , Tilse Cheryl , Wilson Jill
Published: December 2008

Objective: To explore older people's knowledge and experience of the law relating to assisted and substitute decision making in Queensland.

Method: The sample (N=377) comprised older people and their families living in metropolitan Brisbane (n=242) and South West rural Queensland (n=29) and residents living in aged care facilities and retirement villages and their family carers in Brisbane (n=106). The data collection involved 48 focus groups and 29 individual interviews. A thematic analysis of the data sought to make links to a range of social variables used to draw the sample.

Results: In the majority of focus groups and individual interviews, older people had a limited or low understanding of the law relating to substitute decision making. Structural factors of lower income, cultural background, disability, rural location, nursing home residence and gender can limit ability to make informed choices and are likely to increase the risk of financial abuse.

Conclusion: There is a need to raise community awareness about the advantages and disadvantages of substitute decision making arrangements and to provide educative strategies to address commonly held misconceptions about the nature of enduring powers of attorney provisions.
Cognitive screening of older patients in a teaching hospital: the impact of the Rapid Assessment Medical Unit (RAMU)
Authors: Anpalahan Mahesan , Holms Caroline
Published: December 2008

Background: The Rapid Assessment Medical Unit (RAMU) is a short stay processing ward for general medical patients.

Aim: To evaluate the impact of the RAMU on cognitive screening of older medical patients.

Method: Audit of documentation of cognition using a validated screening tool in the medical records of 500 patients aged 70 years and older. Their admission records under general medicine in the preceding 12 months were also reviewed.

Results: Administration of the Abbreviated Mental Test (AMT) was attempted in 81% of patients. In 64.6% it was completed. 29% had impaired cognition on screening. A validated screening tool for cognitive assessment was recorded only in 7.6% of patients before the RAM U was opened.

Conclusion: The work practice and procedural changes in the RAMU appear to have a positive impact on cognitive screening. This observation may suggest that evidence based clinical guidelines could be successfully implemented in a model similar to the RAMU.
Factors Influencing the well‐being of family members of aged care facility residents
Authors: Toye Christine , Kristjanson Linda J. , Helmes Edward
Published: December 2008

Objective: To identify key predictors of well‐being in aged care facility residents' family members.

Methods: An Australia‐wide cross‐sectional survey, in which 213 residents' family members provided data for testing/refinement of a model.

Results: Family members' well‐being was predicted by their physical health, pressures from competing commitments, and residents' adjustment.

Conclusions: Interventions should target residents' family members at risk of poor well‐being.
Quality of life measures for residents of aged care facilities: a literature review
Authors: Courtney Mary , Edwards Helen , Stephan Joyce , O'Reilly Maria , Duggan Cate
Published: December 2008

Abstract

With increases in life expectancy and concomitant utilisation of residential aged care, there is a need to improve quality of long term care for older people. An essential outcome of such care is optimum quality of life (QoL), but it is difficult to define and measure, particularly within the context of residential aged care. The majority of QoL measures available either do not measure issues relevant to residents of aged care facilities or they measure areas that are not appropriate. Further, an over‐emphasis on health and physical function might produce a more negative picture of quality of life than actually experienced by this group of people. This paper explores available QoL measurement tools and argues for the utilisation of a standard instrument that can adequately measure QoL in residential aged care. Data from such a tool might assist policy makers in their decision‐making, if used on a national basis.