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.
