This paper undertakes a comprehensive review of the growing international literature on age-friendly communities. It examines a range of approaches and identifies the key attributes associated with creating a sustainable environment for seniors. The authors critically evaluate emerging policy trends and models and suggest directions for future research attention. The discussion provides important information and insights for the development of ageing policy and planning in Australia.
ObjectiveTo systematically assess the effects of exercise interventions on body composition and functional outcomes in older adults with sarcopenia. MethodsPubMed/Medline, Embase and Cochrane Library were searched from 2006 to 2017 for exercise randomised controlled trials and controlled clinical trials in adults 60 years and older with sarcopenia. Preferred Reporting Items for Systematic Review and Meta-Analysis protocol (PRISMA-P) and Physiotherapy Evidence Database (PEDro) scale assessed internal validity. Meta-analysis and sensitivity analysis were performed. ResultsSearches retrieved 1512 titles. Thirty-two full texts were evaluated, and six trials were included. Methodological quality was 5.5 (0-10). Meta-analysis revealed that knee-extension strength (P 0.01), timed up and go (P < 0.0001), appendicular muscle mass (P = 0.04) and leg muscle mass (P = 0.04) significantly improved in response to exercise interventions. ConclusionsExercise interventions significantly improved strength, balance and muscle mass. However, the number of trials was small and the training effect was inconsistent due to heterogeneity in exercise mode, duration and intensity. Lack of detailed description makes it impossible to reflect on the progressive resistance training approaches used. More research is needed to confirm these findings.
Aim: To evaluate the association between loss of fat‐free mass and mortality among older people. Methods: Information of healthy Chilean older people evaluated by dual energy X‐ray absorptiometry was used, identifying those who died in a period of 12 years. A Cox proportional hazards model was used to identify mortality predictors. Life tables were constructed calculating survival using predictive variables. Results: Information from 1413 participants aged 74.3 ± 5.6 years (1001 women), was obtained. During the follow‐up (median 1594 days), 221 participants died. The Cox model identified age and appendicular fat‐free mass as predictors of death (hazard ratios 1.08 and 0.85, respectively). According to life tables, participants in the lower sex‐specific quartile for appendicular fat‐free mass/height had significantly higher mortality. This association was significant among participants aged over 73 years. Conclusion: A low fat‐free mass was predictive of mortality in older people.
Aim: This study investigated the attitudes and preferences of staff, residents and relatives of residents in a retirement village towards a health‐care robot. Methods: Focus groups were conducted with residents, managers and caregivers, and questionnaires were collected from 32 residents, 30 staff and 27 relatives of residents. Results: The most popular robot tasks were detection of falls and calling for help, lifting, and monitoring location. Robot functionality was more important than appearance. Concerns included the loss of jobs and personal care, while perceived benefits included allowing staff to spend quality time with residents, and helping residents with self‐care. Residents showed a more positive attitude towards robots than both staff and relatives. Conclusions: These results provide an initial guide for the tasks and appearance appropriate for a robot to provide assistance in aged care facilities and highlight concerns.
ObjectivesThere are growing concerns that social isolation presents risks to older people's health and well-being. Thus, the objective of the review was to explore how technology is currently being utilised to combat social isolation and increase social participation, hence improving social outcomes for older people. MethodsA systematic review of the literature was conducted across the social science and human-computer interaction databases. ResultsA total of 36 papers met the inclusion criteria and were analysed using a four-step process. Findings were threefold, suggesting that: (i) technologies principally utilised social network services and touch-screen technologies; (ii) social outcomes are often ill-defined or not defined at all; and (iii) methodologies used to evaluate interventions were often limited and small-scale. ConclusionResults suggest a need for studies that examine new and innovative forms of technology, evaluated with rigorous methodologies, and drawing on clear definitions about how these technologies address social isolation/participation.
To investigate functional limitations and life satisfaction among Asian-born migrants and Australian-born participants in the Household, Income and Labour Dynamics in Australia (HILDA) study. Information on 10 167 Australian-born participants and 650 Asian-born migrants from Waves 6 to 16 (2006-2016) of HILDA was analysed using multivariate linear regressions, adjusting for baseline covariates. Middle-aged and older Asian-born migrants had a lower decline in functional limitations compared to the Australian-born participants (-1.74 vs -4.47 during the 5-year period and -5.66 vs -8.50 during the 10-year period). Decline in life satisfaction scores was relatively stable among older Australian-born participants, but there was a steeper decline among Asian-born migrants in the 5-year period. Notably, relative change was not statistically significant for both outcomes. This study reveals that middle-aged and older Asian-born migrants had less decline in physical health but not in life satisfaction. Monitoring health and well-being of migrants as they age could help to minimise health disparities in Australia.
To explore influences on referral for fall prevention from general practitioners (GPs) to allied health professionals (AHPs) to better equip AHPs engage with GPs regarding fall prevention. Qualitative, semi-structured interviews with GPs (n = 24), practice nurses (n = 3) and AHPs (n = 15) and field notes were analysed inductively using constant comparative methods. Three main themes regarding influences on GP referral to AHPs for fall prevention were identified as follows: GPs' knowledge of AHPs; The "reliable and good" AHP; and Patient feedback-Patient choice. Three-way communication and trust between GP, patient and AHP underpinned each of these themes. Strategies for encouraging GP referral include AHPs personally contacting GPs to explain their services; writing to GPs about every patient seen; and being aware that interprofessional relationships are based on trust and take time to develop. GPs and AHPs are encouraged to communicate directly rather than relying on patients to convey verbal information.
High immigration has resulted in a culturally diverse ageing population. This study aims to examine the meaning of successful ageing among late-life immigrants ageing in a new cultural environment. Semi-structured interviews focused on the subjective experience of ageing well were conducted with 11 Chinese older adults who had moved to Australia in later life. Interviews were conducted in participants' native language and analysed using thematic analysis. Eleven themes were identified. A collectivist cultural ideal relating to avoiding burden to children underpinned a number of themes, including the importance of good health and financial security. Preferences regarding retaining or relinquishing traditional cultural expectations of dependence on adult children varied between participants, suggesting some postmigration shift in values. This study provides insights into the nuances of ageing from a novel cultural perspective, and highlights the role of postmigration adaptation in cultural values.
This study aimed to determine the prevalence of falls, fear of falling (FOF) and related factors in individuals aged 80 and over living in the Balçova district of Izmir. One thousand and seventy-five individuals aged 80 years or older participated. The dependent variables were falls and fear of falling. The independent variables were socio-demographic and socio-economic characteristics, health-related characteristics and 'safety status of home' features. The participants' mean age was 84.1 ± 3.7 (range, 80-101) years, and 60.8% were female (n = 582). The prevalence of falls was 35.4% in the last year, and fear of falling was 86.6%. The risk factors for falls were number of chronic diseases, moderate and high fall risk, sleep disturbance and slippery bathroom floors, whilst for fear of falling they were number of chronic diseases, female gender, living alone and moderate or high fall risk. A monitoring program is indicated to address high fall and fear of falling prevalence among people aged 80 and over.
This study aims to determine the psychometric properties of the Bahasa Malaysia (BM) version of the 6-item De Jong Gierveld Loneliness Scale (DJGLS) among older adults in Malaysia. A total of 200 participants aged 50 years and older completed the questionnaire in which 81 participants completed in BM. A subsample of 30 participants was retested after a period of 2 weeks. The DJGLS showed good internal consistency (Cronbach's alpha 0.71) and high test-retest reliability (r = 0.93). Convergent validity was demonstrated by moderate positive correlation between total DJGLS loneliness score and UCLA loneliness scale (ULS-8) (r = 0.56, n = 81, P < 0.001). Significant associations were found between loneliness and sex, ethnicity, geographic area and marital status. The BM version of the 6-item DJGLS is a reliable and valid loneliness measure for use among older adults in Malaysia.
To describe perioperative geriatric medicine services in Australia and New Zealand, and to explore geriatricians' views on the need for and challenges in providing perioperative care. An electronic questionnaire was sent to heads of geriatric medicine departments. Sixty-seven (83%) of 81 identified geriatric medicine departments responded. Twelve (18%) departments provide a proactive surgical-geriatric medicine service. Their most common features were regular geriatric medicine ward rounds (100%), medication review (92%) and attendance at multidisciplinary meetings (83%). All respondents thought there was a need for geriatric medicine to provide greater input into the care of older surgical patients. Lack of funding (88%) and not enough geriatricians (58%) were the major perceived barriers. Although geriatricians believe they should provide proactive collaborative care for older surgical patients, only a few hospitals currently provide these services. Funding streams for these services and further research to determine the best models of care are needed.
To design, test (pilot) and implement a study to estimate the point prevalence of cognitive impairment (CI) and delirium in a multi-site health service. Clinicians were trained to use the 4 A's Test (4AT) to screen for cognitive impairment and delirium, and the 3-minute Diagnostic Interview for the Confusion Assessment Method (3D-CAM) to detect delirium in those with abnormal 4AT results. Outcomes of interest were as follows: (a) rates of cognitive impairment and delirium and (b) feasibility of the approach measured by participation rate, "direct survey activity" time, cost and surveyor preparation. The rates of cognitive impairment and delirium were 43.8% (245/559) and 16.3% (91/559), respectively. 90.5% (563/622) of eligible adult patients from 25 acute and subacute wards were seen. "Direct survey activities" averaged 14 minutes (range 2-45) and cost $11.48 per patient. Training evaluation indicated additional education in the 4AT and 3D-CAM was needed. Health services could use this streamlined, inexpensive method to estimate the point prevalence of cognitive impairment and delirium.
Objective To evaluate sedentary behaviour and physical activity levels in independently mobile older adults with and without dementia living in residential aged care. Methods Sedentary behaviour and physical activity were measured in 37 residents of an aged care facility using an accelerometer worn during waking hours for five days. Results Participants with valid accelerometer data (n = 28) spent 85% of the time sedentary, and 12% in low-intensity, 2% in light-intensity and 1% in moderate-to-vigorous-intensity physical activity. Over half of sedentary time was accumulated in bouts of greater than 30 minutes. Physical activity at any level of intensity was performed in bouts of less than 10 minutes. Conclusion Residents were highly sedentary and inactive. In particular, the short duration of each bout of activity amongst lengthy periods of sedentary behaviour was a substantial finding. The study suggests the need to develop innovative ways of breaking up sedentary behaviour in residential aged care.
Objective To review studies published in the Australasian Journal on Ageing (AJA) about the aged care workforce, and to identify influences on quality of care and potential policy directions. Methods Articles in the AJA on the aged care workforce published from 2009 to 2018 were identified, grouped into themes and rated for quality. Results Twenty-eight articles were identified. Articles fell into four themes: (i) staff knowledge, skills and attitudes; (ii) staff well-being and workforce stability; (iii) environmental factors that influence staff capacity; and (iv) interventions to improve staff capacity. Studies reinforced the importance of staff-consumer, staff-relatives and staff-staff relationships and a supportive workplace culture for staff work ability and capacity to provide high quality care. Conclusions It is possible to improve practice in community and residential aged care, given: (i) enough staff; (ii) better training in person-centred practice; and (iii) a supportive staff culture that encourages staff to put their training into practice.
Objective To analyse the factors associated with low health-related quality of life (HRQoL) in older people living in Brazil. Methods In this cross-sectional study of the Jewish community residing in Sao Paulo, Brazil, we extensively evaluated the characteristics - including clinical, functional and sociodemographic - of 496 older people. Quality of life was assessed using the World Health Organization Quality of Life-BREF (WHOQOL-BREF), while the Geriatric Depression Scale (GDS) was used to measure depressive symptoms. Results After adjusting for potential confounders, we found that GDS score (beta = -0.07; P = 0.04) and cancer (beta = -0.47; P = 0.05) were associated with a low WHOQOL-BREF score. Conclusion Depressive symptoms and cancer were independently associated with low HRQoL among older people living in Brazil.
Guided by the unified theory of acceptance and use of technology (UTAUT), the study explored information and communications technology (ICT) use and anticipation among middle-aged adults in urban China. Path analysis was performed on data from 401 participants aged 45-65 to examine the associations between anticipated ICT support and the acceptance and adoption process of ICT. For the late middle-aged adults, those who had greater belief in ICT usefulness and received more social support for ICT use were more likely to anticipate greater ICT support in old age. These associations were not found in the early middle-aged group. The frequency of ICT use may be the key explanation for different ICT predictors and patterns. The constructs of UTAUT are sequential steps. Middle-aged adults may believe in ICT usefulness even though they have not witnessed it in person.
To assess the effect of Saturday allied health services on a geriatric evaluation and management ward. A controlled before-and-after trial at two wards. Allied health services were added to usual weekday staffing on Saturdays for 6 months on the experimental ward. Length of stay, functional independence, readmissions, discharge destination and costs were evaluated at pre-intervention (N = 331) and intervention (N = 462). Relative to the comparison ward, the experimental ward had longer length of stay (mean 7.8 days, 95% CI 4.7-10.8), fewer readmissions (mean 3.1 days, 95% CI 0.6-5.7) and no difference in the proportion discharged home. Cost-effectiveness demonstrated no significant difference in cost ($2639, 95% CI $-386 to $5647) and functional independence gain (3.6 units, 95% CI 0.8-6.5) favouring the experimental ward. These findings do not support the provision of additional Saturday allied health services in geriatric evaluation and management to reduce length of stay.
To develop and evaluate an organisational culture change intervention for residential aged care settings. This study was undertaken in five residential aged care facilities (RACFs). All staff working within participating RACFs were invited to take part. Participatory action research was used to develop a structured approach, supporting small workgroups of staff in each facility to undertake change cycles, focusing on improved leadership, teamwork and communication. Qualitative data were gathered from reflection and evaluation sessions with facility work team focus groups, interviews with managers and other staff who were not engaged in the work team, field journals and reflective discussion with research team members. Staff and management both positively evaluated the intervention and process, and there were perceived cultural shifts in communication, teamwork and staff empowerment. An organisational culture change intervention that engages work teams through brief change cycles appears to be feasible for use in RACF.
To gain insights into the experience and challenges faced by Australasian geriatricians who have recently made the transition from advanced trainee to consultant. An interpretative exploratory qualitative study. Geriatricians with five or less years of experience as consultants were recruited by email. Data were collected through semi-structured interviews, with themes identified through open axial coding. Respondents (n = 20) experienced a transition period in which they adjusted to the roles of final decision-maker and manager. Respondents felt relatively confident with their clinical skills, but under-prepared for non-clinical roles associated with becoming a consultant. Most respondents described challenges with career planning. Support networks were considered critical. This is the first study in Australasia exploring the transition from trainee to consultant geriatrician. Training programs should endeavour to create "consultant-like roles" during advanced training and address non-clinical competencies. Participants perceived that there should be more emphasis on career planning and mentorship.