INTRODUCTION:Older people face higher risks of medicine-related harm due to polypharmacy and the use of potentially inappropriate medicines. Current treatment guidelines rarely specify when to stop medicines, leading to medicines often being continued indefinitely without a clear deprescribing plan. While deprescribing guidelines exist for some medicine classes, limited guidance is a major barrier to deprescribing. These new guidelines address this gap by providing structured recommendations that complement more detailed drug-specific deprescribing guidance, disease-specific therapeutic guidelines and non-pharmacological management resources. These guidelines were developed by a team of 72 experts, including consumer representatives, and were further shaped by feedback from public consultation and independent reviewers. MAIN RECOMMENDATIONS:The guidelines are intended for all healthcare professionals involved in prescribing, dispensing or administering medicines to older people. The guidelines specifically address polypharmacy and medicines commonly dispensed for regular use in people aged ≥ 65 years, as well as other medicines where there is evidence to consider deprescribing in this cohort. The guidelines provide 185 consensus-based recommendations and 70 good practice statements, covering both specific medicine categories and general deprescribing principles. The guidelines are structured into four areas: (1) when to deprescribe; (2) ongoing treatment needs; (3) how to deprescribe; and (4) monitoring requirements. CHANGES IN CARE AS A RESULT OF THE GUIDELINE:This guideline emphasises deprescribing as an integral part of the prescribing continuum. Applying a deprescribing approach encourages prescribers to consider the ongoing need for a medicine each time a prescription is re-issued, to balance benefits and harms as they evolve over time, and to ensure treatment decisions reflect an individual's goals through shared decision-making. The guideline was developed based on currently available evidence for deprescribing and expert multidisciplinary and consumer input. It supports health professionals in reviewing regular medicines, minimising harm and planning ongoing treatment or monitoring. The detailed guideline is available at https://deprescribing.com.
Aged care staff are exposed to workplace risk factors that have the potential to considerably impact mental health. This study aimed to explore mental ill health, burnout, and associated occupational factors in a nationwide sample of residential aged care workers in Australia (N = 1085). Cross-sectional online survey data were collected. Rates of depression, anxiety, wellbeing, burnout, and turnover intentions were explored using descriptive statistics. Regression models were used to analyse occupational factors associated with mental ill health, wellbeing, and burnout. One quarter (24%) of participants reported symptoms indicating a probable depressive disorder, and over one third (35%) reported symptoms consistent with an anxiety disorder. Over half (56%) reported burnout at elevated levels. Lower perceived supervisor support and previous assault by a resident/client were associated with significantly higher anxiety, depression, and burnout. These findings suggest there is an urgent need for evidence-based interventions to improve conditions for residential aged care workers, including preventing staff assaults and upskilling managers in supporting the mental health of staff.
Providing informal care to a person with dementia can substantially affect carers’ quality of life. Existing generic preference-weighted measures (e.g. EQ-5D-5L) may not fully capture the caring experience, while carer-specific measures (e.g. CarerQol), although preference weighted, cannot be used to derive quality-adjusted life-years for cost-utility analysis. The COCOON project aimed to develop a new preference-weighted quality-of-life measure for carers of people living with dementia that is suitable for cost-utility analysis. Development of the descriptive system was informed by: (1) a literature review; (2) qualitative interviews with carers of people with dementia to assess face validity of candidate items; (3) an online survey of carers to evaluate psychometric performance (including missing data, distributions, known-group validity, convergent validity, exploratory factor analysis and item response theory analysis); and (4) consultation with an advisory group. An initial pool of 60 candidate items was reduced to 44 items for qualitative testing. Following interviews, the item set was refined to 35 items. Based on psychometric analyses and final advisory group consultation, the final descriptive system comprised seven items: emotional health, physical health, loss and grief, loss of freedom, loneliness, support and financial burden. Each item is measured using a five-point frequency scale from ‘never’ to ‘always’. The COCOON measure is grounded in the lived experiences of carers of people living with dementia, capturing the multidimensional facets of dementia caregiving and offers a conceptually robust and policy-relevant measure for assessing carers’ quality of life in economic evaluations.
BACKGROUND AND OBJECTIVES:Shared-site intergenerational programs, which co-locate services to enable interaction across generations, have gained attention for their potential to enhance psychosocial wellbeing in later life. However, evidence explaining how and under what conditions these programs are effective remains limited. This study examined how one of Australia's few shared-site intergenerational programs supported older adults' psychosocial wellbeing, staff experiences, and program sustainability. RESEARCH DESIGN AND METHODS:A realist evaluation was used to develop, test, and refine program theories explaining how contextual conditions interact with underlying mechanisms to generate outcomes. Data included realist interviews with residents, aged care staff, early childhood educators, and senior managers; organisational policy and procedure documents; and staff observation notes. Data were analysed using inductive, deductive, and retroductive reasoning to develop context-mechanism-outcome configurations. RESULTS:Seven program theories were developed from twenty context-mechanism-outcome configurations. Psychosocial wellbeing was enhanced when intergenerational engagement occurred in safe and accessible environments, supported by skilled facilitation and organisational leadership, enabling participation to be experienced as meaningful and valued. These conditions activated mechanisms of belonging, reciprocity, and purpose, improving emotional wellbeing, social connection, and identity continuity. Staff experienced professional fulfilment and motivation when supported to facilitate quality engagement, while strong organisational culture contributed to sustainability. Outcomes varied where contextual supports were constrained. DISCUSSION AND IMPLICATIONS:Shared-site intergenerational programs function as complex relational and organisational interventions. Psychosocial benefits for residents, alongside staff wellbeing and program sustainability, depend on alignment between facilitation practices, organisational culture, and everyday institutional conditions.
INTRODUCTION:The absence of guidance on pharmacological management of urinary incontinence (UI) for individuals with dementia may lead to potentially avoidable medication-related harm. This systematic review aimed to evaluate efficacy and safety of medications for managing UI in people living with cognitive impairment, dementia, or in long-term care. METHODS:Four bibliometric databases were searched for randomized control trials (RCTs) from inception to March 2026. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for RCTs. Efficacy, adverse events (ADEs), and cognitive effects were synthesized. RESULTS:Nine RCTs (N = 310 participants) were included (all had possible risk of bias). Efficacy of oral anticholinergics ranged from no significant effects to 17% greater reduction in UI symptoms compared with placebo, while oral estrogen demonstrated no significant effects compared with placebo. Dry mouth was the most common ADE for oral anticholinergics (n = 61/194 participants in intervention vs. 26/194 in control across 4 trials). Oral anticholinergic effects on cognition (reported in three trials) ranged from no significant effects to statistically significant short-term declines in attention/alertness compared with placebo. CONCLUSIONS:UI medications for people with cognitive impairment or dementia should be prescribed cautiously, with consideration of possible benefits and harms. PROSPERO:https://www.crd.york.ac.uk/PROSPERO/view/CRD420251270946.
