bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relation between unpaid support and the use of formal health services: the Sydney Older Persons Study
Authors: Edelbrock Dorothy , Waite Louise M. , Broe G. Anthony , Grayson David A. , Creasey Helen 
Published: December 2008

Objectives: To examine the inter‐relationships between formal and informal unpaid services in an elderly population.Methods: 537 community‐dwelling elderly (75 or older) were interviewed about use of community and medical services and the provision of unpaid support. Disease and disability were assessed by medical practitioners. The relationship between service use and unpaid support among persons with the same disease/disability profile was examined.Results: Unpaid network support for instrumental activities of daily living (IADL) needs was utilised when community services were not. Unpaid ADL and IADL network support is used in conjunction with medical services. Higher socioeconomic status, female gender and having fewer coresidents predicted higher use of community services. Males spent more days in hospital.Conclusions: Community IADL services and unpaid IADL network support work in a compensatory fashion. In contrast, higher users of medical services were greater users of unpaid network support.
Resident‐staff interactions: a challenge for quality residential aged care
Authors: Edwards Helen , Gaskill Deanne , Sanders Fran , Forster Elizabeth , Morrison Paul , Fleming Rosanne , McClure Sandra , Chapman Helen 
Published: December 2008

Objectives: This paper describes one facet of a study to develop and implement a “best practice model” of residential care for older people. The purpose of this facet of the larger study was to describe the current interactional context of a residential aged care facility.Method: A total of 2,848 observations of resident‐staff interactions were made and coded according to Baltes' observational schedule. Coder inter‐rater reliability was maintained at 90% (Cohen's Kappa).Results: Residents were alone 40% of the time they were observed. The dominant pattern of staff interaction with residents was to not engage in direct verbal or nonverbal communication or physical contact. The dominant response by staff to resident independence was to make no response. The dominant staff response to resident dependence was to support that dependence.Conclusions: Residential aged care practice continues to be focused on technology, and tasks and interactions between residents and staff continue to be dependency‐supporting.
Leah Wilson
Authors: Kirby Neil 
Published: December 2008

Objective: To survey resident, joint resident/staff, family and staff committees in South Australian aged care hostels.Method: The managers of all 159 South Australian aged care hostels were surveyed concerning different types of committees, with 106 hostels participating.Results: Ninety percent of hostels had resident information meetings, 75% had staff committees but only 65% had resident committees and only 12% had joint resident/staff and/or family committees. While nearly all managers thought that their hostels provided adequate means for residents to express their wishes and concerns, some also indicated that additional committees would be beneficial. Greater participation of committee members was the most common suggestion for improvement.Conclusion: There is scope for more resident, joint resident/staff and family committees in aged care hostels. There is also a need for research to determine the relative benefits of each kind of committee and their optimum combination, and to identify ways of increasing participation in such committees.
Does the résumé open the door to age discrimination for older workers?
Authors: Bennington Lynne , Wein Ruth 
Published: December 2008

Objective: This exploratory study examined the amount of information provided in résumés that could form the basis for unlawful discrimination.Method: The covering letters and résumés of secretarial job applicants were examined and coded under strict ethical guidelines.Results: Substantial information upon which unlawful discrimination could be based was provided by applicants, particularly by older applicants.Conclusion: Applicants may reduce their chances of an interview and aid and abet unlawful discrimination by including personal information in their résumés. Suggestions to minimize this problem are offered.
Promoting mental health in rural elders: a pilot program
Authors: Gattuso Suzy 
Published: December 2008

Objective: This paper reports on the development and trial of a mental health promotion program for older people in rural north‐east Victoria entitled Healthy & Wise. The objective of the program was to increase mental health literacy among older adults referred to Aged Psychiatry who were not diagnosed with a psychiatric disorder but who were experiencing difficulties in dealing with the stresses of later life. A further objective of the program was to assist older adults develop skills in adapting to these stresses.Method: Delivery of the program was in a small‐group format. Evaluation utilised both quantitative and qualitative assessment of outcomes. In this report the focus is on assessment based on the Geriatric Depression Scale self‐administered to participants before the program began, post program, and at a 6‐month follow‐up.Results: There was a significant reduction in GDS score over time (pre/post) which was maintained at follow up. The program was successful in attracting participants experiencing a number of risk factors associated with poorer mental health (e.g. chronic illness).Conclusion: Adoption of Healthy & Wise, a trialed and evaluated community mental health program for older adults, could extend the delivery of mental health services in rural areas in an economic and effective way. At a time when smaller rural communities are ageing more rapidly than Australia as a whole, and funding constraints continue, it is recommended as a valuable addition to current programming. Because the study does not include a control group and because participants self selected for the program, generalisation to other populations and settings needs to be cautious. However, because of the success of this trial, it is recommended that the program be tested with other populations. Target groups might include hostel residents and carers of people with dementia.
Using a driving simulator to identify older drivers at risk of traffic infringements
Authors: Lee Hoe C. , Lee Andy H. , Cameron Don 
Published: December 2008

Objectives: To determine the internal consistency of assessment criteria measuring the simulated driving performance of older drivers and the criterion validity of the assessment protocol related to traffic infringements.Method: One hundred and twenty‐nine older drivers residing in metropolitan Perth volunteered to participate in the study. Using a driving simulator, specific driving tasks were devised to test the participants, whose performances were measured by ten assessment criteria. Logistic regression analysis was then undertaken to determine those criteria that may be related to the event of incurring at least one demerit point during the previous two years.Results: As expected, driving skill of older drivers was found to decline with age. The Cronbach alpha coefficient among the assessment criteria was 0.742. Forty six participants incurred at least one demerit point within the previous two years. Adjusting for age in the logistic regression, the functional abilities associated with traffic infringements were decision and judgement under pressure of time, confidence in driving with high speed and compliance to traffic regulation.Conclusions: For the present study sample, the identified assessment criteria measuring the simulated driving performance of older drivers were shown to be reliable, and their significant association with the event of incurring a demerit point further confirmed the criterion validity of using the laboratory‐based driving simulator to identify older drivers at risk of traffic infringements incurring demerit points.
The economic consequences of introducing deep brain stimulation for the treatment of advanced Parkinson's disease in Australia
Authors: Hollingsworth Bruce P. , Harris Anthony H. 
Published: December 2008

Objectives: Parkinson's disease is a debilitating condition, which is increasing in prevalence as elderly populations increase in the developed world. As such, resource consumption will also increase. For advanced Parkinsons, where drug therapy is no longer effective, there are two surgical options ‐ ablative surgery, a one‐off procedure which destroys part of the brain, and deep brain stimulation (DBS), which uses electrodes to stimulate part of the brain. The specific question to be answered here is what the costs to the community of DBS are compared to ablative surgery (thalmotomy or pallidotomy) in potentially relieving the symptoms of advanced Parkinson's disease, and if there is any improvement in patients' quality of life.Design: A cost effectiveness study is undertaken. UK and Australian data are made use of and cost‐effectiveness estimated in terms of cost per change in functional ability.Setting: Hospital, community and home care.Patients: Those with advanced Parkinson's Disease.Main outcome measures: Frenchay index of functional ability.Results: It is estimated that the incremental extra cost for a small change in ability to undertake daily tasks is at least 23,559.Conclusions: As outcomes evidence is of low quality, at this stage it is not possible to establish that Deep Brain Stimulation offers substantial improvements in quality of life. Extra costs over ablative surgery are estimated to be in the range of 17,830 to 51,385 per patient over a five year period.
Evaluation of donepezil in Alzheimer's disease ‐Experience from an Australian memory clinic
Authors: Mador Julie , Hecker Jane , Clark Michael 
Published: December 2008

Objectives: To describe our experience using cholinesterase inhibitors for mild‐moderate Alzheimer's disease in a memory clinic. In particular we reviewed response in cognition, activities of daily living and quality of life for patients.Design: A prospective descriptive study with patients and carers being assessed before and 3–6 months after commencing treatment with a cholinesterase inhibitor. Setting: Memory clinic at Repatriation General Hospital, Adelaide.Subjects: Sixty‐four consecutive patients with mild‐moderate Alzheimer's disease commencing treatment with a cholinesterase inhibitor and their carers.Outcome Measures The primary outcome was a change in cognition as measured by the Mini‐Mental Status Examnination (MMSE). Secondary outcomes were The Alzheimer's Disease Functional Assessment and Change Scale (ADFACS), patient self‐assessed measures of quality of life (Dementia Quality of Life Instrument (DQOL) with sub‐scales in self‐esteem, positive affect, negative affect, belonging and aesthetics, and a five point likert scale of overall quality of life (QOL)) and carer assessed proxy direct scaling of patient quality of life.Results: All patients were commenced on Donepezil. Fifty‐four (84%) patients remained on drug treatment and completed the study with follow‐up at an average of 13 weeks. Ten patients (16%) stopped treatment due to side‐effects or non‐compliance. There was a mean change of 1.1 points on the MMSE (p< 0.05) and a small but significant (p<0.05) improvement in the positive affect sub‐scale of the DQOL. There were no improvements in other sub‐scales of the DQOL or overall quality of life. A similar number of patients improved 14 (26%) in activities of daily living as those who deteriorated 12 (22%) with the majority 28 (52%) remaining unchanged.Conclusion: Donepezil has a beneficial effect on cognition and affect when used in the setting of a memory clinic. There was little evidence to suggest an improvement in activities of daily living and overall quality of life.
Falls in older persons in Australia: screening instruments for general practitioners
Authors: Westwood Barbara , Westwood Geoff 
Published: December 2008

Falls are a relatively common problem in older people in Australia causing significant morbidity including restricted activities of daily living and increased mortality. Falls may initiate institutionalisation and will increase in significance with the rapidly ageing population profile.Falls in older people are attributed to multiple factors and are potentially preventable with early detection and intervention. General practitioners, as the primary community medical care providers, are in an ideal position to screen all older patients for falls risk. A detailed history to identify falls risk factors should be complemented by screening with a simple and easy to use screening instrument.The requirements of a reliable and validated falls screening instrument are explored along with a review of available instruments. Although the literature is inconclusive, a suitable falls screening instrument is identified for use by general practitioners.
Survey of New Zealand older driver assessment practices
Authors: Ciesionik Anita , Alpass Fiona M. , Pachana Nancy A. 
Published: December 2008

Objectives: Data on current practices regarding assessment of fitness to drive in older adults in New Zealand were collected, including current instruments, decision processes and referral sources employed by GPs when assessing fitness to drive.Method: In order to examine GPs' assessment strategies in older driver assessment, a national survey using a randomly selected subset of 350 GPs was conducted.Results: Results indicate a wide range of evaluative processes and referral procedures among GPs in their management of older drivers.Conclusions: Standardised evaluative processes and referral procedures are lacking in the driver assessment process among New Zealand GPs.
Why do physicians choose to train in geriatric medicine?
Authors: Hilmer Sarah N. , Naganathan Vasi , Couteur David G. Le 
Published: December 2008

Objective: There is a shortage of geriatricians in Australia and a need for more trainees in geriatric medicine but training positions are difficult to fill. To address this issue, we investigated when and why current trainees in geriatric medicine chose the subspecialty.Method: A survey was conducted on advanced trainees in geriatric medicine in Australia in 2001.Results: Current trainees chose geriatric medicine at stages extending from undergraduate training to post‐Fellow of the Royal Australian College of Physcians (FRACP) with 35% deciding on the sub speciality after passing their FRACP exams. Major influences in choosing geriatric medicine include exposure to the term as a registrar, specialist geriatrician role models, interest in general medicine, holistic medicine and teamwork, and the lifestyle and flexibility associated with a career in geriatric medicine.Conclusion: This study has identified some of the issues that influence the decision to undertake geriatric medicine training and the time that such decisions are made.
Reducing abuse of older people with dementia and their carers
Authors: Koch Susan , Nay Rhonda 
Published: December 2008

Objectives: The objective of this study was to identify and investigate the issue of elder abuse amongst older people with dementia and their carers.Methods: An expert reference group was established and a comprehensive literature review was undertaken. Discussion forums and in‐depth interviews were held with interested stakeholders to identify issues regarding abuse, and any related strategies that are ‘currently in place, being developed or required.Results: Attempting to develop one concise definition of abuse can be unhelpful, and cases should instead be assessed in relation to their unique contexts. Participants expressed a need for better education and availability of information about elder abuse related to dementia. Strategies to reduce abuse were identified.Conclusion: Participants clearly identified that a preventative approach is integral in the successful reduction of abuse and that any formal intervention needs to reflect the unique set of circumstances pertaining to abuse of each person with dementia and/or their carers.
The future aged: new projections of Australia. ‘s elderly population
Authors: Booth Heather , Tickle Leonie 
Published: December 2008

Objectives: To use new methodology to forecast mortality for use in projections of the elderly population of Australia and to compare them with official projections.Method: The Lee‐Carter method is applied to data for Australian females and males for 1968–2000 to forecast mortality to 2031. These forecasts are used with standard population projection methods to produce projections of the elderly population.Results: By 2027, forecast life expectancy is 88.1 and 82.9 years for females and males, compared with official projections of 85.4 and 81.4 years. Over the period to 2031, the populations aged 65+ and 85+ are forecast to increase by factors of 2.3 and 3.4 respectively. Compared with official projectrons, the forecast elderly population is substantially larger and has higher old‐age dependency ratios, higher proportions aged 85+ and lower sex ratios.Conclusion: Official projections underestimate the size of the future elderly population especially the female and ola'est‐old populations.
Discharge summaries in aged care: improving communication between an aged care unit and general practitioners
Authors: Johnstone Kevin , Bagnall Felicity , Chan Daniel Kam Yin 
Published: December 2008

Objective: Discharge summaries (DSs) allow communication between hospitals and general practitioners and are essential for continuity of patient care. Despite this important function, the most junior doctor on the medical team usually writes them. An internal audit and survey of general practitioners (GPs) and aged care facilities within the Bankstown sector of the South Western Sydney Area Health Service revealed significant shortcomings with DSs from the aged care unit at Bankstown‐Lidcombe HospitalMethod: A new DS form was designed specifically for aged care patients, and junior medical officers (JMOs) received training at the beginning of term with regular review and feedback throughout the term.Results: After three months a second survey was performed which revealed a significant improvement in the quality of DSs from the unit. Satisfaction with the pre‐intervention DS form compared to the post‐intervention form increased from 22% to 79%. JMOs benefited from extra education and the development of a problem based approach to writing DSs.
Driving and dementia: a prospective audit of clients referred to an aged care assessment team
Authors: Bunt Robert , Lipski Peter S. 
Published: December 2008

Objective: Many people with dementia or cognitive Impairment continue to drive. Given Australia's ageing population, this raises safety concerns for the driver in the community. This paper presents data collected by the NS W Central Coast Aged Care Assessment Team (ACAT), outlining the extent of the problem on the Central Coast and offers some suggestions about dealing with this issue.Method: A prospective audit of clients referred to Central Coast ACAT over a seven month period. Data describing the clients' cognitive state and also their driving habits were collected during routine ACAT assessments.Results: 1203 people were referred to ACAT during the study period. 100 (8%) of these were driving and 34% of those driving had some form of cognitive impairment. In some cases the impairment was quite severe. Most of these drivers were male. In a majority of the cases, concerns were expressed by someone familiar with the person, regarding their capacity to drive safely.Conclusion: The results support findings from other studies, which suggest there is a small but significant number of elderly people with cognitive impairment who are still driving. We propose that a safety first policy should be adopted and where there is doubt about the persons ability to drive safely, an Occupationul Therapy driving test in conjunction with a detailed cognitive assessment needs to be performed.
Management of Erectile Dysfunction in General Practice
Authors: De Berardis Giorgia , Pellegrini Fabio , Franciosi Monica , Pamparana Franco , Morelli Patrizia , Tognoni Gianni , Nicolucci Antonio 
Published: December 2008

ABSTRACT

Introduction
In recent years, the availability of effective oral pharmacological treatment for erectile dysfunction (ED) has revolutionized its management; however, it is still unclear how everyday clinical practice has changed in response to this evolving scenario.

Aim
The aim of this study is to describe general practitioners’ (GPs) beliefs and attitudes toward the management of ED.

Methods
Each GP was asked to recruit consecutive men aged ≥18 years and sexually active, with already known erectile problems or with newly diagnosed ED.

Main Outcomes Measures
A written questionnaire was used to investigate GPs’ sociodemographic characteristics and their beliefs toward the management of ED.

Results
Overall, 127 GPs (53.4%) returned the questionnaire and 124 enrolled patients for the study. Only 9.5% of the GPs reported routinely inquiring about ED of patients &gt;40 years of age, whereas 45.7% did it only when the patient raised the problem. GPs’ gender and age were associated with their beliefs about ED treatment and referral to specialist care. Overall, 932 patients were enrolled, of whom 38% had newly diagnosed ED. The problem came to light for initiative of patient in 80% of cases, and 84.8% of men were prescribed a treatment. Patients who on their own initiative discussed of their condition had an almost 3-fold increased probability to be treated than those whose GP began the discussion about ED (odds ratio [OR] = 2.6, confidence interval [CI] 95% 1.5–4.5). Patients followed by female physicians were significantly more likely to be referred to a specialist than those followed by male physicians (OR = 3.3, CI 95% 1.4–5.0).

Conclusions
The management of ED has become an integral component of clinical practice in primary care. Nevertheless, barriers in addressing sexual issues still persist. Appropriate training is needed for a proactive approach to ED screening and management in men over 40s.