OBJECTIVE:There appear to be no definitive guidelines on optimal prevention and management of acute phase responses (APRs) following intravenous bisphosphonates (IVBP) for osteoporosis. Our objective was to identify physician prescribing practices for supplementary therapy aimed at managing APRs and whether these were thought beneficial. METHODS:An online survey was distributed to members of key Australian societies for geriatrics, rheumatology and endocrinology (membership n ≈ 2900) with questions assessing if respondents prescribed IVBP, their experience managing APRs including medications used and whether these were beneficial. RESULTS:Seventy-five responses were collected from geriatricians, endocrinologists and rheumatologists, with 68 respondents prescribing IVBP for osteoporosis. Overall, 84% (57/68) of those using IVBP previously managed a post-IVBP APR and 24% (16) reported risk of APR could influence their prescribing. Eighty-eight percent (60) of those using IVBP reported using paracetamol for APR management, whereas 41% (28) used NSAIDs and 53% (36) used corticosteroids. There was considerable variability in reported prescribing plans. Only 50% (30) of clinicians using paracetamol and 42% (11) of those using NSAIDs reported finding these beneficial for APR management, whereas 92% (33) of those using corticosteroids reported observing benefit. Ninety-four per cent (34) of clinicians prescribing corticosteroids did so on a case-by-case basis. CONCLUSIONS:Despite limited numbers, the results of this pilot work indicated clinicians used various medications to offset post-IVBP APRs and some reported that they had observed benefit in terms of APR prevention or treatment, supporting the need for further clinical trials to establish which, if any, are associated with improved clinical outcomes.
Established in 2014, the Melbourne Ageing Research Collaboration (MARC) was designed to close evidence-to-practice gaps in care of older people by bringing together consumers, clinicians, policymakers, advocates and researchers in a co-designed program of work. MARC's collaborative model combines bottom-up co-design with top-down systems influences, engaging the diverse membership as active partners in research. MARC has convened cross-sector events, undertaken targeted research, embedded co-production and invested in capacity building through grants, forums and masterclasses. Examples of policy and practice impacts include evaluation of the use of language translation technologies, enabling equitable access to end-of-life care services, and guidelines for implementing technology in home-based aged care. Evaluations have demonstrated strengthened inter-organisational relationships and enhanced knowledge exchange amongst partners. MARC offers a scalable model for collective impact. Its shared agendas, consumer and community-informed approach, co-design, transparent governance and acknowledgement of real-world challenges have contributed to achieving partner organisation goals of improving care and outcomes for older people.
OBJECTIVE:With a growing older population, there is an increased need for aged care services. Care staff are a critical factor in delivering these services. The aim of this study was to identify the key components of a well-being program for staff caring for older people with responsive behaviours in rural aged care homes. METHODS:A single co-design session based on the seven integrated principles of World Café was hosted. Facility staff, organisational representatives and consumers were identified through purposive and snowball sampling. Facilitators led scenario-based discussion on three topics: leadership, peer support and workplace practices. The academic literature synthesis conducted by researchers of the key components generated through co-design identified those with evidence of benefit and local feasibility. RESULTS:Twelve participants attended the co-design session. Key components identified were early 'check-ins' by management, ad hoc peer debriefing, regular scheduled whole-of-facility debriefing, peer-based rewards, conveying behaviour expectations, greater information on care recipients, fun workplace activities, team building and staff training. Two meso-level components considered feasible to implement and evidence-informed were: a peer supporter program and a structured all-of-facility debriefing. CONCLUSIONS:A co-design process involving consumers and staff identified two evidence-informed and feasible components of a well-being program for rural aged care staff: peer support and a structured all-of-facility debriefing. This process, blending co-design and evidence, has laid the foundation for a well-being program that could achieve sustained, positive change.
OBJECTIVE:The study aimed to examine the relationship between dynapaenic abdominal obesity (D/AO) and fall risk in Chinese middle-aged and older adults. METHODS:We analysed data from 9364 participants in the China Health and Retirement Longitudinal Study (CHARLS 2011-2018). Participants were categorised into four groups: non-dynapaenia and non-abdominal obesity (ND/NAO), only abdominal obesity (ND/AO), only dynapaenia (D/NAO), and D/AO. Cox regression, sensitivity, subgroup and geographic analyses were conducted. RESULTS:During follow-up, 2989 falls were reported. After full adjustment, D/NAO and D/AO significantly increased fall risk by 44% (HR = 1.44, 95% CI: 1.25-1.65) and 28% (HR = 1.28, 95% CI: 1.05-1.57), respectively. Stratified analysis revealed significant sex differences: among males, the association between D/AO and fall risk was most pronounced (HR = 2.26, 95% CI: 1.58-3.23); among females, the risk was primarily driven by D/NAO (HR = 1.32, 95% CI: 1.07-1.62). Diabetes significantly interacted with D/AO status (p < 0.05), intensifying the risk. Geographically, Northeast China exhibited high D/AO-associated fall risk despite having the optimal baseline muscle strength. CONCLUSIONS:Both D/NAO and D/AO are important risk factors for falls in middle-aged and older adults. The effect of abdominal obesity on fall risk differs significantly by sex and diabetes status, demonstrating a notable synergistic pathogenic effect. Fall prevention strategies should focus on comprehensive body composition management. In particular, for men and individuals with diabetes, greater emphasis should be placed on muscle strength training and the control of central obesity. For high-risk regions (e.g., Northeast China), in addition to physiological interventions, multidimensional public health prevention strategies should be developed that take into account local environments.
OBJECTIVES:To determine whether recorded aspiration pneumonia in older adults with dementia was associated with subsequent high inpatient use and to estimate its associations with all-cause mortality, any hospital admission and cumulative length of stay. METHODS:This single-centre retrospective cohort study examined electronic medical records from a single tertiary hospital to identify 500 adults aged 65 years and older with Alzheimer's disease, vascular dementia or mixed dementia. Participants were followed for up to 36 months (median 20 months). Recorded aspiration pneumonia was analysed as an exposure available in the analytic dataset. Multivariable Cox, logistic and negative binomial models were adjusted for age, sex, dementia subtype, baseline dementia severity and baseline Mini-Mental State Examination (MMSE) score. Exact aspiration-event dates and clinically important domains including frailty, functional status, residence before admission, swallowing assessment, oral-health measures, medication burden and comorbidity burden were not available in the dataset. RESULTS:Recorded aspiration pneumonia occurred in 24% of participants. After adjustment, the cohort-level mortality signal remained imprecise (HR 1.65, 95% CI 0.85-3.21). In contrast, aspiration pneumonia was independently associated with higher odds of hospitalisation (OR 2.02, 95% CI 1.29-3.16) and greater cumulative length of stay among those admitted (IRR 1.54, 95% CI 1.17-2.01). CONCLUSIONS:In this dementia-specific cohort, recorded aspiration pneumonia was common and consistently associated with greater subsequent inpatient use. The findings support interpreting recorded aspiration pneumonia as a pragmatic clinical marker of heightened service dependence within a broader frailty and illness context and underscore the value of multidisciplinary review and anticipatory care planning after such events.
OBJECTIVES:This study describes the perspectives of aged care staff on when and how they communicate with families to plan end-of-life care. METHODS:This qualitative descriptive study sought the perspectives of aged care staff about end-of-life care conversations with families, using interviews, focus groups and inductive thematic analysis. RESULTS:Interviews were conducted with 64 aged care staff, predominantly females, representing 14 different aged care sites. Participants included registered nurses, enrolled nurses, care managers and support workers. Five key themes were identified: (1) timing as a staged and adaptive process, (2) building expectations over time prepares families for decision-making, (3) clear communication helps manage mismatch in family perceptions of decline, (4) family dynamics and cultural context shape the communication process, and (5) confidence, role clarity and medical endorsement influence communication. CONCLUSIONS:Aged care staff are committed to engaging with families early but often face barriers when talking about end-of-life. When there is no prognosis or families are reluctant to discuss end-of-life plans, staff use various strategies to describe symptoms and changes in an older person's functions, with experienced clinical staff being more direct about deterioration. Findings highlight the need for training to build staff confidence to initiate early and ongoing communication with families. Resources for both staff and families may facilitate discussions and enhance the quality of end-of-life communication and care outcomes in aged care settings.
OBJECTIVE:Calcium supplementation is widely used in older adults, but its long-term effects on cognitive function remain unclear. This study assessed the association between pharmacological calcium supplementation and cognitive decline over 7 years in cognitively healthy older women. METHODS:This prospective cohort study included 227 women (mean age 79.9 ± 3.6 years) from the Toulouse centre of the EPIDOS study. Cognitive function was assessed using the Short Portable Mental Status Questionnaire (SPMSQ) at baseline and after 7 years. Cognitive decline was defined as a decrease of at least one point in SPMSQ score. Calcium supplement use at baseline was recorded. Multivariable logistic regression was used to evaluate the association between supplementation and cognitive decline, adjusted for age, obesity, physical activity, instrumental activities of daily living (iADL) score, education level, dietary calcium and vitamin D intake, number of comorbidities and selected chronic conditions. RESULTS:Cognitive decline occurred in 26% of participants. Calcium supplementation was reported by 12% of patients and was independently associated with an increased risk of cognitive decline (OR = 3.64; 95% CI: 1.47-9.01; p = 0.005). Obesity and comorbidity burden were also significant risk factors. CONCLUSIONS:Calcium supplementation was associated with a threefold increased risk of cognitive decline in older women over a 7-year follow-up. These results suggest caution in prescribing calcium supplements and underscore the need for further research on their neurological safety in ageing populations.
OBJECTIVES:The aim of this study was to assess the longitudinal association between transitioning to adult caregiving, grandparent childcare and mental health outcomes (depressive symptoms, life satisfaction and cognitive functioning) and physical health outcomes (pain interference) in South Africa from 2015 to 2022. METHODS:We used information from three waves of the 'Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)'. To evaluate within-person changes over time, symmetric and asymmetric linear fixed-effects (FE) regressions were employed and also stratified by sex. RESULTS:Adjusted FE regression analysis found a positive association between the change in grandchild care and beginning to provide grandchild care and depressive symptoms in the total sample and among women. Onset of adult caregiving, change in grandchild care and beginning to provide grandchild care were negatively associated with life satisfaction and positively associated with pain interference, while ceased grandchild care was positively associated with life satisfaction and negatively associated with pain interference. Onset of adult caregiving was negatively associated with cognitive functioning, and change in grandchild care and beginning to provide grandchild care were positively associated with cognitive functioning. CONCLUSIONS:Transitions into caregiving-both for grandchildren and adults-are associated with poorer well-being, including higher depressive symptoms (especially among women), lower life satisfaction and greater pain interference, supporting a role-strain perspective. However, initiating or changing grandchild care is linked to better cognitive functioning, suggesting potential stimulation benefits. In contrast, ceasing grandchild care is associated with improved life satisfaction and reduced pain.
OBJECTIVE:The study aimed to examine the impact of a mobile application-based self-management and chronic disease platform in transitional care for older adults with diabetes. METHODS:A prospective non-randomised concurrent controlled clinical trial was adopted from May to November 2023. Participants were allocated based on their scheduled appointment times, received routine outpatient care or 12-week transitional care information and support intervention including chronic disease management platform and Slow Health. Changes in anxiety, depression, diabetes self-management, self-efficacy and the perceived social support scores of the two groups after 1-month and 3-month intervention were compared. RESULTS:A total of 124 participants were enrolled. The experimental group demonstrated a more pronounced decrease in anxiety, exhibited lower levels of diastolic blood pressure (DBP), showed significantly lower levels of depression, higher levels of diabetes self-management and self-efficacy, and comparable levels of perceived social support compared to the control group. CONCLUSIONS:The program has the potential to improve transitional care in older adults with diabetes, warranting further promotion.
OBJECTIVE:The Frailty Related Index of Comorbidities (FRIC) and Functional Independence Measure (FIM) determine activity-based funding in Australian Geriatric Evaluation and Management (GEM) units. We examined associations between the FRIC, FIM and the Rockwood Clinical Frailty Scale (CFS) with length of stay (LOS) and discharge destination. METHODS:A retrospective observational cohort study of all older adults discharged from GEM at an Australian quaternary hospital between October and December 2024 was undertaken. Demographics, the FRIC score, the FIM score and CFS were extracted from medical records. Associations with LOS and discharge to residential aged care (RAC) were examined using Spearman correlation and regression modelling. RESULTS:Among 201 adults (mean age 82.3 ± 7.5 years), the FRIC demonstrated the strongest correlation with LOS (ρ = 0.387, p < 0.001) and was independently associated with LOS. Adults with longer LOS (≥ 18 days) had a higher FRIC score than those discharged earlier (6.2 vs. 3.1, p < 0.001). Each one-point increase in the FRIC score (range 0 to 22.9) was associated with an additional 1.8 days of hospitalisation (p < 0.001). The FIM and CFS were not statistically significantly associated with LOS (p = 0.13 and p = 0.85). Higher FRIC scores were associated with increased likelihood of discharge to RAC (OR 1.15 per point increase, 95% CI 1.08-1.24, p < 0.001). CONCLUSIONS:The FRIC demonstrated a stronger association with LOS than FIM and CFS. The FRIC showed potential as a pragmatic marker of frailty and discharge complexity. Further prospective and multi-centre validation is required to explore the role of the FRIC in informing LOS and activity-based funding.
OBJECTIVE:The aim of this study was to investigate the effects of a moderate-intensity multicomponent training (MCT) program on body composition, physical function, glycaemic control and lipid profiles in overweight and obese older people. METHODS:This single-arm quasi-experimental study included 48 male (n = 10) and female (n = 38) overweight (n = 27) and obese (n = 21) older individuals (69.2 ± 4.3 years; 76.4 ± 12.3 kg; 1.60 ± 0.1 m; 30.3 ± 4.7 kg·m2) who were subjected to a 36-week moderate-intensity MCT intervention, including strength, stretching, endurance and balance exercises, twice a week, along with nutritional counselling and psychoeducation. Body composition, physical function (upper- and lower-body strength endurance, lower-body flexibility and dynamic balance), fasting plasma glucose, total cholesterol (TC), low-density lipoprotein (LDL-c) and high-density lipoprotein (HDL-c) levels were assessed before and after 12, 24 and 36 weeks of intervention. Food consumption was evaluated at baseline and after 36 weeks. RESULTS:Except for TC (p = 0.58; W = 0.014), a significant improvement was detected in LDL-c (p < 0.001; W = 0.132) and HDL-c (p < 0.001; W = 0.195), as well as in fasting glucose (p < 0.001; W = 0.556). Upper- and lower-body strength endurance (both p < 0.0001, W = 0.447 and W = 0.175, respectively), lower-body flexibility (p = 0.02; W = 0.068) and dynamic balance (p = 0.04; W = 0.060) also improved in response to MCT. However, all body composition outcomes remained unchanged throughout the MCT intervention (all p > 0.05). Similarly, no significant differences were identified in the food intake variables (all p > 0.05). CONCLUSIONS:Our moderate-intensity MCT program effectively improved physical function, glycaemic control and lipid profile, but not body composition, in overweight and obese older adults.
OBJECTIVE:With the trend of population ageing, cognitive frailty in older adults is an increasingly pressing public health issue. Identifying early-stage risk factors has become a key priority for researchers with the goal of preventing disability. This study aimed to test a conceptual model and elucidate the pathways leading to cognitive frailty using Structural Equation Modelling (SEM). METHODS:We conducted a cross-sectional design with data from outpatient departments within a tertiary medical centre in southern Taiwan. Participants (n = 208) were aged 65 years or older and able to communicate independently with the researchers. Demographic factors, extant health conditions, and psychosocial factors were collected. Structural Equation Modelling (SEM) was used to construct a path model. RESULTS:Olfactory function was significantly positively correlated with nutritional status and significantly negatively correlated with depressive symptoms, resilience, and cognitive frailty. Nutritional status was significantly negatively correlated with sarcopenia. Resilience was significantly positively correlated with social support but negatively correlated with sarcopenia. Sarcopenia was significantly positively correlated with cognitive frailty. Social support was significantly negatively correlated with cognitive frailty. Despite these associations, in this model, only one specific serial indirect pathway-via resilience and social support-demonstrated a statistically significant mediating effect between olfactory function and cognitive frailty. CONCLUSIONS:The findings suggest that the association between olfactory function and cognitive frailty may involve a limited, pathway-specific serial mediation through resilience and social support. Clinically, this pathway may help to inform the early identification of older adults with olfactory impairment who may benefit from targeted supportive strategies aimed at strengthening resilience and social support.
Objective Hospitalisation provides an opportunity to deprescribe (withdraw inappropriate medications), however, safe and effective deprescribing relies on good communication between relevant stakeholders. The aim of this study was to explore the perspectives of Australian hospital and community pharmacists on communicating information about deprescribing at transitions of care and their role in the deprescribing process.Methods A diverse group of hospital and community pharmacists was purposively recruited. Data were collected via individual semi-structured interviews and focus groups that were audio-recorded and transcribed verbatim using NVivo. Each transcript was thematically analysed using an inductive coding approach, performed by two independent coders.Results Thirty-two pharmacists were recruited between June and August 2023. Seventeen participants worked in hospitals, 10 in community pharmacies, and five across both settings. Four themes with 12 subthemes were identified, pertaining to (i) how pharmacists communicate about deprescribing on hospital discharge, (ii) how pharmacists collaborate with other healthcare professionals and patients to optimise deprescribing, (iii) how the role of the pharmacist in deprescribing at transitions of care can be optimised, and (iv) how pharmacists feel about their current and future role in deprescribing.Conclusions Challenges in communicating deprescribing recommendations and ensuring continuity of care when patients transition between care settings were identified. Development of new tools (e.g., templates and guidance on how and what should be communicated) and processes to support communication at the transition of care from hospital to the community are needed to support deprescribing activities.
OBJECTIVE:To examine whether self-reported motor difficulties (walking, stair climbing and rising from a chair) are independently associated with self-reported osteoarthritis (OA) risk among older European adults, utilising propensity score matching (PSM). METHODS:This work utilised data from Waves 1, 2 and 4-9 of the large cross-national Survey of Health, Ageing and Retirement in Europe (SHARE) dataset representing 127,372 adults aged 50 years and older. Osteoarthritis and motor difficulties were self-reported based on participants' reports of physician diagnosis and functional limitations. Propensity score matching was applied to balance covariates and try to improve causal inference. RESULTS:Individuals with motor difficulties had extensively higher OA prevalence (28.4% vs. 10.8%), with prevalence increasing in a dose-dependent manner. PSM score-adjusted analysis showed motor difficulty was associated with a 17.1 percentage points (OR = 3.1) higher prevalence of OA, a stronger association than traditional models. We also confirmed higher OA and motor difficulties in women, older age and people with obesity, low handgrip strength, chronic conditions and reduced quality of life. CONCLUSIONS:Self-reported motor difficulties are strongly associated with self-reported OA in older European adults. These findings highlight the close link between lower-limb functional limitations and OA reporting in population-based surveys. Given the cross-sectional and self-reported nature of the measures, the results should be interpreted as associations rather than evidence of temporality or causality.
OBJECTIVE:The aim of this study was to estimate the prevalence of sarcopenia and examine its associations with glycaemic control, blood pressure and lifestyle behaviours among older adults in Korea. METHODS:We conducted a secondary analysis of the 2023 Korea National Health and Nutrition Examination Survey that included 1394 adults aged 65 years or older. Sarcopenia followed Asian Working Group for Sarcopenia 2019 criteria (low appendicular skeletal muscle mass index and low handgrip strength). Complex-sample descriptive tests and multivariable logistic regression identified independent correlates adjusting for sociodemographic, behavioural and clinical covariates. Blood pressure was measured per standard protocol; fasting glucose and haemoglobin A1c (HbA1c) were assayed in a central laboratory. RESULTS:Sarcopenia prevalence was 14% (n = 199). Age 76 years or older (OR 3.19, 95% CI 2.27-4.49) and poor glycaemic control (HbA1c ≥ 7.0%; OR 1.89, 95% CI 1.16-3.08) were associated with higher odds of sarcopenia. Protective factors included body mass index ≥ 25 kg/m2 (OR 0.32, 95% CI 0.21-0.48), meeting the World Health Organization physical activity guideline (OR 0.50, 95% CI 0.28-0.90) and alcohol consumption in the past year (OR 0.58, 95% CI 0.41-0.82). Hypertension diagnosis and smoking were not significant. Diastolic, but not systolic, blood pressure was lower among participants with sarcopenia. CONCLUSIONS:In a nationally representative Korean sample, sarcopenia was common and linked to modifiable factors-glycaemic control and physical activity. Findings support integrating HbA1c monitoring, resistance and aerobic exercise promotion, and nutrition counselling into community and primary care to reduce sarcopenia risk and support healthy ageing.
OBJECTIVE:Delirium, an acute medical emergency, significantly impacts older adults, increasing morbidity, mortality and healthcare costs (estimated at $8.8 billion annually in Australia). Environmental modifications in hospital wards are underexplored despite their potential to mitigate delirium's effects. This study evaluated a multidimensional occupational therapy environmental checklist's impact on functional and service outcomes for hospitalised delirium patients compared to standard care. METHODS:A quasi-experimental design was employed, collecting pre- and post-intervention data from 100 electronic medical records (50 comparison, 50 intervention) on a Geriatric Evaluation and Management ward in Melbourne, Australia. The checklist, implemented by occupational therapists and allied health assistants, targeted orientation, object accessibility, daily routines and safety. Outcomes included length of stay, adverse events (e.g., falls, pressure injuries) and Functional Independence Measure (FIM) scores. Descriptive statistics, t-tests and χ2 tests were conducted using SPSS Statistics 28 (p < 0.05). RESULTS:The intervention group showed a 27% reduction in total adverse events (comparison: n = 37; intervention: n = 27) and significantly higher FIM scores at discharge (motor: t = -2.38, p = 0.02; cognitive: t = -2.62, p = 0.01; total: t = -3.24, p < 0.001). However, length of stay (comparison: M = 28.2 days; intervention: M = 29.36 days; t = -0.20, p = 0.84) and adverse event rates (χ2 = 1.48, p = 0.22) did not differ significantly. The intervention group had a higher fall admission rate (36% vs. 2%; χ2 = 20.38, p < 0.001). CONCLUSIONS:The checklist enhances functional recovery in older adults with delirium, reducing adverse events. Larger, multi-site studies are needed to confirm efficacy and generalisability, supporting occupational therapy's role in delirium management.
OBJECTIVE:Accurate estimation of skeletal muscle mass is a key component in the screening for sarcopenia. Anthropometric parameters provide a non-invasive, cost-effective alternative, yet their predictive capability can be enhanced with machine learning. This study aimed to develop and evaluate machine learning models to predict skeletal muscle mass measured by bioelectrical impedance analysis (BIA) in individuals aged 70 years and older using anthropometric measurements and demographic data. METHODS:Anthropometric data from 984 older adults aged 70 years and older were obtained from the 8th Size Korea Human Body Measurement Survey. Data preprocessing included removing missing values, applying Min-Max scaling and selecting relevant features. Machine learning models were developed, optimised using a tuning framework and evaluated through error metrics, residual analysis and feature importance interpretation. RESULTS:Among the machine learning models, XGBoost achieved the highest predictive accuracy (RMSE = 1.29, R2 = 0.92) while using the fewest predictors (18), demonstrating efficiency and effectiveness. Key features included calf circumference, gender, weight, height and waist circumference. SHapley Additive exPlanations analysis emphasised the dominant role of calf circumference, reinforcing its predictive capability for skeletal muscle mass. CONCLUSIONS:This study highlights the potential of machine learning for predicting skeletal muscle mass using non-invasive anthropometric measurements. These findings support the proposed model as a scalable and cost-effective tool for estimating skeletal muscle mass, which is a key quantitative component of sarcopenia screening.
OBJECTIVE:This study examined how changes in activities of daily living (ADL) and instrumental activities of daily living (IADL) relate to living arrangement transitions among older adults in China, and whether associations differ by urban and rural settings. METHODS:Data came from the 2008-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) of adults aged 65 years and older. Cox two-state regression models assessed associations between functional transitions and living arrangement changes, stratified by community type. RESULTS:Among 12,560 respondents, 81% lived with household members. Decline in ADL was associated with a higher hazard of transitioning to co-residence (Hazard ratio (HR) = 1.16, 95% confidence interval (CI): 1.10-1.23) and a higher hazard of remaining in co-residence (HR = 1.09, 95% CI: 1.01-1.17). The association with transitioning was observed in both urban (HR = 1.13) and rural (HR = 1.19) areas, while the association with remaining in co-residence was significant only among rural older adults (HR = 1.23). CONCLUSIONS:Functional decline is longitudinally associated with a higher likelihood of transitioning to and remaining in co-residence. This association is more pronounced in rural areas. Although ADL decline appears to be associated with subsequent changes in living arrangement, future research should explore its potential bidirectional nature to better inform community-specific interventions.
Objective Diabetes and frailty pose a significant issue for society. Previous research has shown a mixed relationship between diabetes and frailty in older people, indicating a complex interrelationship. The aim of this study was to examine the association between routinely collected HbA1c testing data and frailty in a large cohort from Western Sydney.Methods Data from the Western Sydney Frailty Registry Study were linked to the Blacktown and Mount Druitt hospital HbA1c testing datasets. These datasets include information on patient outcomes, pathological metrics, hospitalisation indicators, and a range of morbidity and demographic information. This was then analysed in Stata using multivariable regression.Results Diabetes was more common in frail patients than in pre-frail or non-frail patients. Those with both diabetes and frailty did not have an increased risk of death or rehospitalisation in age and sex corrected analyses (OR: 0.66, 95% CI: 0.36-1.21 and 0.90, 95% CI: 0.37-2.17, respectively) compared to those with frailty alone. There was a reduced risk of death associated with higher HbA1c for frail people (OR: 0.58, 95% CI: 0.37-0.90).Conclusions There is a complex interrelationship between diabetes and frailty. For frail people with diabetes, there are important lessons for management. These include the possibility that HbA1c is not a useful metric and that overtreatment with hypoglycaemic agents must be considered.
OBJECTIVE:This study examined the role of urban parks in fostering a sense of community among older people. This aligns with Sustainable Development Goal (SDG) 3, which emphasises supporting the environment to foster health and well-being. METHODS:We surveyed 123 individuals aged 70 years and older in Brisbane, Australia. Through the application of Structural Equation Modelling (SEM), we investigated the interplay between the attractions and barriers to parks and the sense of community and social networks. RESULTS:Our findings showed that park visiting among older people is associated with a heightened sense of community. When parks have more attractive facilities, older adults visit more often. More attractive facilities are also associated with a heightened sense of community. However, we found no relationship between park facilities or park visits and social network size, although women reported larger local social networks than men. CONCLUSION:Our findings underscore the critical importance of parks for fostering a sense of community among older adults. These insights highlight the need for urban environments that are not only physically accessible but also perceived as safe, attractive and supportive of activity preferences.
