OBJECTIVES:There has been growing attention to understanding and preventing the abuse of older adults in Australia. Several inquiries, commissions and research reports have been undertaken to understand the prevalence and characteristics of elder abuse in community and institutional settings, and to develop recommendations to alleviate and prevent this problem. This study sought to map the recommendations regarding the prevention of the abuse of older adults from the last 15 years. METHODS:This research project reviewed 22 Australian federal and state-based elder abuse inquiries, reports and commissions. RESULTS:Three hundred and eighty-one recommendations around elder abuse were identified across eight themes. Consistent recommendations were made around financial abuse, legal responses and staff training. CONCLUSIONS:The utility of new inquiries on elder abuse may be questionable given consistent findings across existing inquiries. These consistent recommendations provide direction for government action, identify gaps that require further attention and necessitate follow-through on implementation.
OBJECTIVE:Providing inaccurate narratives of events (confabulation) is a commonly reported difficulty for people with brain injuries and dementia. We aimed to capture staff perceptions on the frequency and cause of confabulation, as well as interventions they find acceptable and effective. METHODS:We surveyed staff in dementia and brain injury services using convenience sampling. We developed a bespoke survey capturing staff views on confabulation prevalence, context, causes, the acceptability and effectiveness of interventions, and staff demographics such as education and experience. RESULTS:The survey was completed by direct care staff, nurses and allied health professionals supporting people with dementia (n = 46) and people with brain injuries (n = 40). Application of χ2 tests showed that staff in dementia care reported interventions to be less effective and 'playing along' as more acceptable than did staff working with clients who had brain injury. Approximately 20% of each group were not confident in addressing confabulation. Dementia staff witnessed more confabulation about who and where the confabulating person was, and brain injury staff witnessed more confabulation about why the confabulating person was receiving care. CONCLUSIONS:Our findings showed that there is a difference between how staff in brain injury and dementia services perceive the effectiveness and acceptability of interventions for confabulation. Findings suggest that capturing practice-generated knowledge might lead to further empirical demonstrations of effective interventions for confabulation and that there is a need for more support and training of direct care staff in managing confabulation.
OBJECTIVES:The World Health Organization's (WHO) Global Network of Age-Friendly Cities and Communities (AFCCs) promotes the development of urban environments, policies and services that support the health and participation of older adults. This systematic review examined contemporary evidence concerning associations between WHO AFCC conditions and directly measured health and physical activity outcomes among older residents. METHODS:The registered review adhered to the PRISMA protocol for systematic reviews and meta-analyses and applied the Downs and Black quality criteria for randomised and non-randomised research. RESULTS:Structured Boolean searches of five research repositories identified 17 peer-reviewed studies published between 2017 and 2025 based upon original research conducted in WHO AFCC signatory cities. Although most studies reported positive associations between age-friendly features and domains, such as accessible transport, walkable environments, outdoor infrastructure and self-rated health or physical activity, the strength of evidence was limited by methodological inconsistency, variable study quality and reliance on self-reports. Barriers to evaluation included limited use of longitudinal or quasi-experimental designs, heterogeneous outcome measures, subjective response data and the challenge of establishing appropriate comparison conditions in complex municipal settings. CONCLUSIONS:Strengthening evaluation frameworks for AFCC initiatives is essential for evidence-based urban health policy and governance in rapidly ageing societies. A research agenda is proposed to strengthen AFCC evaluation through standardised measurement, community-based and mixed-methods research, and a greater commitment to co-designed assessment frameworks.
OBJECTIVES:To examine system-level changes in influenza vaccination coverage in residential aged care homes (RACHs) following the introduction of the Aged Care On-site Pharmacist (ACOP) funding initiative, and to explore the experiences of RACH managers and pharmacist immunizers. METHODS:A convergent mixed methods study was conducted in the Hunter New England Local Health District (HNELHD), Australia. Publicly available Australian Immunization Register (AIR) influenza vaccination coverage data for RACH residents were compared at baseline (June 2024) and one-year post-ACOP implementation (August 2025). Semi-structured interviews with RACH managers (n = 10) and pharmacist immunizers (n = 12) explored experiences of vaccination delivery and ACOP implementation. Quantitative and qualitative data were analyzed separately and integrated during interpretation. RESULTS:The proportion of RACHs achieving ≥ 80% influenza vaccination coverage increased from 29% in 2024 to 64% in 2025. However, attribution to ACOP alone was not possible, and variability in implementation was evident. Five key themes were identified in the semi-structured interviews: (1) strengthening partnerships to improve vaccination in aged care, (2) enhancing workflow and vaccination through access to an on-site pharmacist, (3) overcoming operational and logistical barriers, (4) access to comprehensive data, and (5) funding issues impacts sustainability. CONCLUSIONS:A system-level increase in influenza vaccination coverage occurred following introduction of funding to ACOPs providing immunization services in RACHs. Qualitative findings suggest embedded pharmacists may strengthen vaccination coordination, data monitoring, and multidisciplinary collaboration within aged care. Sustainable funding, role clarity and improved data systems are essential to maintain these gains.
OBJECTIVE:Depression is increasingly common among older Australians receiving home care, yet symptoms are often under-recognised and access to evidence-based psychological treatment remains limited. This paper introduces EMBED, a new model of care designed to improve detection, escalation and management of depression within routine home care service delivery. METHODS:We describe the development of an evidence-informed model of care for the Australian home care setting. The model draws on clinical guidelines, published evidence on late-life depression and psychological treatment, implementation evidence from aged care and consultation with frontline staff, managers, senior leaders and consumer representatives. RESULTS:The EMBED model comprises four integrated components: (i) workforce training to improve the knowledge, attitudes and self-efficacy of home care workers; (ii) routine screening to support early identification of symptoms and deterioration; (iii) structured clinical assessment to guide escalation and treatment planning; and (iv) tailored psychological intervention using lifestyle therapy and behavioural activation. The intervention was designed to be stratified according to symptom severity, responsive to older people's preferences and feasible for delivery within aged care services and through health service collaboration. CONCLUSIONS:The EMBED model offers a practical approach to addressing a major gap in current home care practice by embedding mental health capability into usual aged care service delivery. Further research is required to determine its effectiveness and cost-effectiveness, as well as implementation requirements in the Australian home care context to enable providers to better support the growing population of older people with symptoms of depression.
OBJECTIVES:To obtain insights into the needs and experiences of older people with dementia or mild cognitive impairment (MCI) regarding health professionals' management of driving cessation. METHODS:A qualitative descriptive approach within an interpretive paradigm was used to study people in their own context. Semi-structured interviews with 12 people aged 65 years or older with dementia/MCI were conducted, recruited from a memory clinic at a South Australian tertiary hospital. Data were analysed using reflexive thematic analysis. RESULTS:Themes identified driving cessation as a process involving four potential phases: (1) Preparation: Value of early and ongoing discussions about driving cessation, (2) Navigating fitness to drive decisions: Desire for information, options and guidance, (3) Receiving a driving cessation recommendation: Importance of clear and compassionate communication, and (4) Adjusting to life without driving: Feelings of loss of independence and loneliness. Participants identified specific communication needs from health professionals across the first three phases. In the fourth, post-cessation phase, all who had ceased driving received emotional and/or practical support from family; however, none reported receiving support from health professionals. CONCLUSIONS:Findings highlighted the need for a structured and comprehensive communication approach over phases, from preparation to driving cessation, and increased post-cessation support for people with dementia/MCI and their families.
OBJECTIVES:Falls among older people are a significant health issue. Exercise reduces falls, yet many older people do not meet physical activity guidelines. Digital health platforms may improve access to fall prevention programs, but limited research has explored how these platforms meet older people's needs. This study aimed to use co-design principles to develop a website supporting delivery of the TOP UP program in aged care. A secondary aim explored older people's experiences of participating in the co-design process. METHODS:A three-phase co-design study was conducted. Phase 1 used interviews, focus groups and heuristic evaluation to inform development of a prototype website. Participants included 14 older people receiving aged care services (median age 84 years), 10 care staff and six physiotherapists. Phase 2 used think-aloud usability interviews with 11 older people, including Likert scale ratings, to assess navigation, clarity and functionality and refine the prototype. Phase 3 explored participants' experiences of the co-design process. RESULTS:Thematic analysis identified eight design themes highlighting priorities related to simplicity, accessibility, relatability, safety, customisation and engaging features that supported motivation while minimising staff burden. Feedback on the website was positive and informed improvements in readability, navigation and credibility. Participants reported positive co-design experiences and valued contributing to the development of a digital fall prevention resource. CONCLUSIONS:Co-design is valuable in developing user-centred digital health solutions for aged care. Findings highlight the importance of aligning digital platforms with older people's needs to improve accessibility, engagement and scalability, supporting implementation of programs such as TOP UP.
OBJECTIVE:Despite more than two decades of implementation, there is limited peer-reviewed evidence evaluating whether the multipurpose service (MPS) model effectively meets the contemporary health and aged care needs of rural and regional communities. This gap is particularly significant given recent government inquiries highlighting persistent inequities in rural health service access. The objective of this scoping review was to examine whether the key recommendations of the Royal Commission into Aged Care Quality and Safety and the New South Wales Parliamentary inquiry into Health outcomes for rural, regional and remote New South Wales support whether the multipurpose service model (MPS) is effective as a model of care for service delivery. METHODS:A scoping review of five databases was undertaken. The first stage included title and abstract review followed by full text reviews. A thematic analysis was undertaken, informed by Braun and Clarke. RESULTS:Nine articles met the criteria for review. Themes that were derived from the data that aligned with the two independent government reports were: MPS model and its infrastructure; funding; staffing and skill mix; and community engagement and needs. CONCLUSIONS:Overall, this scoping review established that the MPS model of care is an appropriate model to meet the recommendations of the two government reports. However, there needs to be further investment in staff development to extend scopes of practice when working in rural, regional and remote New South Wales.
OBJECTIVE:Ambulance services are increasingly relied upon to provide a vital emergency point-of-care health service to adults who fall while living in Residential Aged Care Facilities (RACFs). This study examined patterns of ambulance attendance to falls-related cases among people aged 65 years and over living in RACFs. METHODS:We conducted an exploratory, descriptive, retrospective case series study of Queensland Ambulance Service (QAS) response data within a regional area of Queensland, Australia between 1 January 2021 and 31 December 2023. We analysed demographic data, triage category and patterns of QAS attendance. RESULTS:There were 6663 QAS falls-related attendances during the study period for 3545 unique patients. Attendances increased significantly for the 3 years from 2021 (n = 1916) to 2023 (n = 2528), χ2(df = 2) = 84.35, p < 0.001. Forty-three per cent of residents experienced two or more fall-related events, and 88% of attendances resulted in transport to hospital. Attendance numbers were similar across the days of the week. There were significant differences in when calls were received during the 24 h for all years combined (χ2(df = 23) = 489.62, p < 0.001) and for 2021 (χ2(df = 23) = 182.15, p < 0.001), 2022 (χ2(df = 23) = 154.04, p < 0.001) and 2023 (χ2(df = 23) = 195.22, p < 0.001). CONCLUSIONS:The findings of this study identified an urgent need to address health system optimisation and resource allocation to provide timely and appropriate services to people living in RACFs. Future studies could provide further evidence about the increasing demands on ambulance resources and strategies to improve high-quality, person-centred care.
OBJECTIVES:To systematically examine the prevalence of, and factors associated with, benzodiazepine, Z-drug and melatonin use in Australian residential aged care facilities (RACFs). METHODS:MEDLINE, Embase, CINAHL, PsycINFO, Scopus and International Pharmaceutical Abstracts were searched from January 2000 to February 2025 for studies reporting benzodiazepine, Z-drug and/or melatonin prevalence in Australian RACFs. Overall, regular and pro re nata (PRN) medication use was considered. Screening, data extraction and quality assessment were performed independently by two authors. The primary outcome was overall prevalence (regular and PRN) of benzodiazepines, Z-drugs and/or melatonin. Secondary outcomes included regular prevalence, PRN prevalence and medication class prevalence. RESULTS:Fifty-two studies (n = 658,585 residents) were included. Overall prevalence of benzodiazepines and/or Z-drugs was 33% (95% confidence interval [CI]: 30.4%-34.7%, 30 studies) when assessed over periods from point prevalence to one-year prevalence. Prevalence was highest when assessed using prescribing (35%) rather than dispensing (32%) or administration (28%) data. Findings were similar when limited to studies published in the last 10 years (31%), studies of 100 or more residents (32%) and when excluding studies conducted in subsets of residents (33%). Benzodiazepine prevalence (35% [95% CI: 32.5%-36.9%], 24 studies) was higher than Z-drug prevalence (0.4% [95% CI: 0.1%-1.1%], three studies). No published studies reported melatonin prevalence, and unpublished regular prevalence ranged 1%-9% (four studies). CONCLUSIONS:One in three Australian residents in RACFs use benzodiazepines and/or Z-drugs. Targeted interventions are needed to ensure their use is consistent with evidence-based practice and residents' clinical needs.
OBJECTIVE:To review evidence on the type, characteristics and effect of digital health interventions (DHIs) on medication adherence among older people. METHODS:Articles were searched from inception to May 2025 in PubMed, Embase, CINAHL, Scopus and Web of Science. Randomised and non-randomised studies were included if they: involved older people aged 65 years or older; applied any DHI(s); compared the intervention with a comparator group or baseline; and reported medication adherence as an outcome. Risk of bias was assessed using the Cochrane risk of bias tools, and certainty of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). A narrative synthesis was conducted. RESULTS:A total of 35 articles were included, most of which were randomised controlled trials (n = 22). Risk of bias ranged from low to high, and certainty from very low to moderate. Nearly half of the studies (n = 17) reported DHIs improved medication adherence compared with control or baseline. Mobile apps (3/5), electronic reminders (3/3), social assistive robots (1/1), telenursing (1/1) and combined DHIs (2/2) showed the most promise. Interventions that used multiple functionalities or strategies to support behaviour change (reminders or prompts) were most likely to improve adherence. The other DHIs had mixed results or no significant effects. CONCLUSIONS:While findings across DHIs varied, interventions incorporating tailored reminders, multicomponent features and interactivity may have the potential to be more effective in improving medication adherence among older adults. Further research is needed to identify usage patterns and investigate the factors underlying differences in effectiveness.
OBJECTIVE:This study examined the associations between hearing loss (HL) and other modifiable dementia risk factors in adults aged 50 years or older living in Tasmania and explored the effects of corrected versus uncorrected HL on these factors. METHODS:A cross-sectional study design using an online survey categorised participants as No-HL, HL-corrected or HL-uncorrected. Logistic regression estimated the odds of being in higher dementia risk categories. RESULTS:The HL-corrected group was more likely to be in the low-risk alcohol group (OR = 0.567, 95% CI: 0.468-0.687), 28% less likely for high cholesterol (OR = 0.722, 95% CI: 0.571-0.913) and 26% less likely for diabetes (OR = 0.743, 95% CI: 0.582-0.948). They also had lower odds than the HL-uncorrected group for alcohol risk (OR = 0.652, 95% CI: 0.508-0.837). CONCLUSIONS:Corrected HL is associated with reduced odds of higher-risk categories for diabetes, alcohol use and high cholesterol.
Objective Australia has an ageing population, with an increasing number of older people needing to live in residential aged care facilities (RACFs). There are more Emergency department (ED) presentations by older people living in Australia, including those that are from RACF, and many die in hospital. The aim of this study was to perform a descriptive analysis of hospital deaths, comparing the characteristics of patients from Residential Aged Care Facilities (RACFs) to those from non-RACF accommodation.Methods This study examined data from the In-Hospital Death Database for a major metropolitan tertiary hospital. De-identified data from 2015 to 2022 were extracted and included in the analysis. Data for patients over the age of 16 were collected. Data were matched on age and sex between the two groups.Results Compared with non-RACF patients, patients from RACFs who died in hospital were more likely to have died from a respiratory illness, more likely to die in the ED, no more likely to have been a 28-day readmission, more likely to have been admitted under Geriatrics, less likely to have been a coroner's case, and had a shorter length of stay. A large proportion of deaths of RACF patients (15%) were in the ED. Approximately 40% of patients from RACFs who died in hospital had Advance Care Plans (ACPs) in place prior to hospitalisation.Conclusions The relatively large percentage of RACF patients that die in the ED is concerning and raises the question of whether their end-of-life care may have been more appropriately delivered within the RACF. The rate of ACP among RACF patients was low but comparable to other studies, and higher than among non-RACF patients.
OBJECTIVES:The global population of people aged 60 years and above is growing. With this, there is a rising need for home care services and demand for online health information to facilitate the decision-making among older adults and promote consumer-directed care. This exploratory study aimed to examine how aged care provider websites present and structure information about Home Care Packages (HCPs) to support consumer decision-making. METHODS:A web-based content analysis of Australian provider websites was conducted by accessing websites using Google Chrome in incognito mode and using an evaluation tool that assessed language readability (Flesch Reading Ease and Flesch-Kincaid Grade Level scores), usability features Web Content (Accessibility Guidelines V2.0) and the relevance and depth of HCP information. Descriptive statistics were calculated using SPSSv.29. Qualitative data were analysed using deductive content analysis. Data were extracted into Microsoft Excel and deductively coded using the structured evaluation tool developed for this study. Coded content was then narratively synthesised, augmented by researcher notes and illustrative quotes. RESULTS:From 25 systematically sampled websites, the median Flesch Reading Ease score was 52.5 (IQR 12.52) corresponding to a high school reading level of 10th-12th grade. Most sites featured small text (n = 21) and inconsistent information regarding services, pricing and case management. None of the websites in this analysis was found to be both user-friendly and comprehensive in their HCP content. CONCLUSIONS:Poor usability and inconsistent information may limit older adults' ability to access and understand HCP details, reducing engagement with these online resources.
OBJECTIVE:This study investigated the extent to which frailty is currently considered, measured and managed in clinical practice, quality improvement and research in Australia. METHODS:A cross-sectional electronic survey was developed and promoted to clinicians, health service managers and researchers involved in the provision or study of health care for older people across Australia (August 2024 to March 2025). RESULTS:Of the 155 responses analysed, 88% (n = 136) were from clinicians. Over half of the respondents, 57% (n = 55/97) reported that frailty screening occurred regularly in their health service. Screening was performed by clinicians with allied health, nursing and medical backgrounds, with the Clinical Frailty Scale (CFS) the tool reported most commonly (61%). Free text responses indicated that although frailty screening often informed individual clinical care, system-level models of care to manage people who were screened as frail were rare. Respondents viewed management of frailty as the most important research area (management 41%, prevention 34%, screening 25%). Free text responses on priority research questions highlighted knowledge and implementation gaps in all domains. Of those who responded to the question on research (n = 154), 75% indicated that there was no ongoing research on frailty in their health service and 43% indicated willingness to be involved in frailty research. CONCLUSIONS:Frailty screening in practice was reported by over half of the respondents, with opportunities identified to implement models of care for patients with frailty. There is an appetite for further research on frailty in health services across Australia, with management of frailty a priority.
