OBJECTIVE:Aboriginal and Torres Strait Islander peoples experience high rates of dementia, cognitive impairment not dementia (CIND) and associated risk factors. The objective of this paper is to outline baseline audit results of documented dementia, CIND and associated risk factors in patients attending Aboriginal Community-Controlled Health Organisations (ACCHOs). METHODS:Twelve ACCHOs in urban, regional and remote locations across Queensland, New South Wales, Victoria and Western Australia participated in the study. A specialised audit tool identified documented CIND, dementia and risk factors. Medical record audits of 1655 clients aged 50 years or older for the period from 1 September 2016 to 31 January 2019 were completed. RESULTS:The mean age of patients was 60.3 ± 8.2 years, and 57% were female. The overall prevalence of documented CIND or dementia was low, noted for only 67 (4%) patients. The prevalence of risk factors was high, with over two thirds (71%, n = 1168) of the cohort having ≥4 risk factors associated with dementia and CIND. These included high rates of hypertension (56%), diabetes (45%), dyslipidaemia (48%), obesity (40%) and current smoking (42%). CONCLUSIONS:There was a low detection of CIND and dementia accompanied by a high prevalence of associated risk factors in this primary health-care setting. These findings highlight the need to improve dementia and CIND detection in Aboriginal and Torres Strait Islander patient groups across varied geographical settings. The findings also provide insights into risk factor prevalence to inform management strategies. Responsive models of cognitive care that are culturally appropriate and co-designed with ACCHOs are required to address this need.

INTRODUCTION:To better tailor prevention and care strategies, there is a need to identify modifiable factors associated with functional impairment in older Aboriginal people, and related service needs.OBJECTIVE:To investigate the prevalence and associated factors for functional impairment in older Aboriginal people, and related service needs.DESIGN:Cross-sectional survey of 289 Aboriginal people aged ≥45 years living in the remote Kimberley region of Western Australia. Factors associated with functional impairment were explored with logistic regression.FINDINGS:41.2% (95% CI 35.6%-47.0%) of participants required assistance with at least one I/ADL, and 26.0% (95% CI 21.2%-31.3%) required assistance with two or more I/ADLs. A core activity limitation (required assistance with showering, dressing or cooking) was reported by 15.9% (95% CI 12.1%-20.6%). In multivariable logistic regression analyses, older age, diabetes, difficulty walking, head injury, higher depression score and worse cognition were associated with needing help with two or more I/ADLs, while older age, history of stroke, higher depression score and worse cognition were associated with the presence of a core activity limitation. The proportion of participants receiving support with I/ADLs ranged from 71.2% to 97.6%. Support was generally provided by family and friends rather than service providers.DISCUSSION:The key modifiable factors associated with functional impairment in older Aboriginal people living in remote regions are diabetes, depression and cognitive impairment. Services required are transport and socio-cultural activities, and ensuring support for family providing the majority of care.CONCLUSIONS:This study highlights the need for holistic prevention strategies and care for older Aboriginal people with functional limitations and their families.

OBJECTIVE:To assess intrinsic capacity, an important component of ageing well, in older Aboriginal people living in remote Western Australia. STUDY DESIGN:Longitudinal cohort study; secondary analysis of survey and clinical assessment data. SETTING:Kimberley region of Western Australia (six remote communities, and the town of Derby). PARTICIPANTS:Aboriginal people aged 45 years or older, initially recruited 15 July 2004 - 17 November 2006. MAIN OUTCOME MEASURES:Intrinsic capacity (assessed in each participant by questionnaire and review by a consultant specialist), overall and by domain, and presence of core activity limitations, at baseline and follow-up (8 February 2011 - 6 June 2013); risk of death by follow-up; preservation of intrinsic capacity at follow-up. RESULTS:The mean age of the 345 participants at baseline was 60.2 years (standard deviation [SD], 11.6 years; range, 45-96 years); 152 were men (44.1%) and 193 were women (55.9%). Intrinsic capacity was unimpaired in all five domains for 55 participants (15.9%; 95% confidence interval [CI], 12.4-20.2%). Capacity in the vitality domain was unimpaired in 325 respondents (94.2%), in the psychological/mood domain in 318 (92.2%), and in the cognition domain in 289 people (83.8%); the locomotion domain was unimpaired in 174 people (50.4%), and the sensory domain in 117 people (33.9%). The proportion of men with full capacity in all five domains (32 of 152, 21.1%) was larger than for women (23 of 193, 11.9%). Of the 274 people included in follow-up analyses, intrinsic capacity was lower than at baseline for 66 people (24.1%), it was unchanged or improved in 111 participants (40.5%; 95% CI, 34.8-46.5%), and 97 people had died (35.4%). Thirty-seven of the 177 surviving participants for whom complete data were available had full capacity in all domains (20.9%; 95% CI, 15.5-27.6%). After adjustment for age, the number of unimpaired intrinsic capacity domains at baseline was inversely associated with having a core activity limitation at baseline (per domain: adjusted prevalence ratio, 0.43; 95% CI, 0.34-0.55) and follow-up (adjusted risk ratio, 0.62; 95% CI, 0.44-0.88), and with risk of death by follow-up (adjusted risk ratio, 0.83; 95% CI, 0.71-0.96). CONCLUSIONS:Impaired intrinsic capacity in older Aboriginal people living in the Kimberley was most frequent in the sensory and locomotion domains. Reduced capacity in these domains could be highly amenable to treatment that would ensure that Elders can continue to take part in activities important for quality of life.

Background Rates of dementia for Aboriginal and Torres Strait Islander peoples are three to five times greater compared to non-Indigenous Australians, with earlier age of onset. However, the risk and protective factors that drive these higher rates vary across existing cohort studies, with minimal findings on the role of vascular risk factors beyond stroke. Harmonisation of data across studies may offer greater insights through enhanced diversity and strengthened statistical capabilities. This study aims to combine three landmark cohort studies of Aboriginal and Torres Strait Islander participants to better understand the determinants of cognitive health and dementia. Methods/design Three cohort studies - the Kimberley Healthy Adults Project (KHAP, N = 363), Koori Growing Old Well Study (KGOWS, N = 336) and Torres Strait Dementia Prevalence Study (TSDPS, N = 274) - share a similar research methodology with demographic, medical history, psychosocial factors, cognitive tests and consensus clinical diagnoses of cognitive impairment and dementia. Associations between risk and protective factors of interest and the presence of dementia and/or cognitive impairment diagnoses will be evaluated by univariable and multivariable logistic regression in a harmonised cross-sectional cohort of 898 participants. Factors associated with incident dementia and/or cognitive impairment will be assessed in a subset of KHAP ( n = 189) and KGOWS participants ( n = 165) who were available in longitudinal follow-up, after exclusion of those with baseline dementia or cognitive impairment. Analyses in relation to outcome measure of death or dementia will be conducted to account for the competing risk of death. Logistic regression will be used to evaluate the association between the individual components of the 16-component Kimberley Indigenous Cognitive Assessment (KICA) tool and the presence of dementia and cognitive impairment determined by independent consensus diagnoses. Multivariable binary logistic regression will be used to adjust for the effect of confounding variables. Results will be reported as odds ratios (OR) with 95% confidence intervals (95% CI). Discussion Greater understanding of risk and protective factors of dementia and cognitive impairment relevant to Aboriginal and Torres Strait Islander peoples may improve approaches across the life course to delay cognitive decline and reduce dementia risk.

OBJECTIVE:To articulate how Aboriginal community-controlled art centres support the role of Elders and older people within an ontologically situated, intergenerational model of care.METHODS:In this paper, we draw on stories (data) generated through interviews involving 75 people associated with three Aboriginal community-controlled art centres and field notes taken during a Participatory Action Research (PAR) study. The study was undertaken in collaboration with three community-controlled art centres and two aged care providers over almost 4 years, in diverse Indigenous sovereignties, all located in geographically remote Australian locations.RESULTS:Engaging with decolonising and Indigenous theoretical frameworks, our analysis identified three interwoven meta-themes. These include connection to law and culture; purpose; and healing. Each theme had important subthemes, and all were central to upholding the well-being of older people and their families, as well as the art centre workforce, Country, and their broader communities.CONCLUSIONS:Our analysis articulates an ontologically situated model of care within Aboriginal community-controlled art centres. The model sees that older people receive care from art centres and provide care to each other, to younger generations, to art centre staff, to Country, and to their broader communities. In this model, those in receipt of care, many of whom are older people, art centre directors, and important artists, govern how care is conceptualised and delivered.

Aim Prevalence of potentially suboptimal prescribing and associated risk factors were investigated among older patients attending primary care via Aboriginal Community Controlled Health Services (ACCHSs). Methods Prescription medications were audited for 420 systematically selected patients aged ≥50 years at three ACCHSs in urban, rural, and remote settings. Polypharmacy, potentially inappropriate medications (PIMs), and anticholinergic burden (ACB) were estimated and associated risk factors explored with logistic regression. Results The prevalence of polypharmacy, use of PIMs, and ACB score ≥3, was 43%, 18%, and 12%, respectively. In multivariable logistic regression analyses, polypharmacy was less likely in rural (OR=0.43, 95% CI=0.24-0.77) compared to urban health service patients, and more likely in those with heart disease (OR=2.62, 95% CI=1.62-4.25), atrial fibrillation (OR=4.25, 95% CI=1.08-16.81), hypertension (OR=2.14, 95% CI=1.34-3.44), diabetes (OR=2.72, 95% CI=1.69-4.39), or depression (OR=1.91, 95% CI=1.19-3.06). PIMs were more frequent in females (OR=1.88, 95% CI=1.03-3.42), and less frequent in rural (OR=0.41, 95% CI=0.19-0.85) and remote (OR=0.58, 95% CI=0.29-1.18) patients. Factors associated with PIMs were kidney disease (OR=2.60, 95% CI=1.37-4.92), urinary incontinence (OR=3.00, 95% CI=1.02-8.83), depression (OR=2.67, 95% CI=1.50-4.77), heavy alcohol use (OR=2.83, 95% CI 1.39-5.75) and subjective cognitive concerns (OR=2.69, 95% CI=1.31-5.52). High anticholinergic burden was less common in rural (OR=0.10, 95% CI 0.03-0.34) and remote (OR=0.51, 95% CI 0.25-1.04) patients, and more common in those with kidney disease (OR=3.07, 95% CI 1.50-6.30), or depression (OR=3.32, 95% CI 1.70-6.47). Conclusion Associations between potentially suboptimal prescribing and depression or cognitive concerns highlights the importance of considered medication review and deprescribing for these patients.

INTRODUCTION:Dementia is an emergent health priority for Indigenous peoples worldwide, yet little is known about disease drivers and protective factors. METHODS:Database searches were conducted in March 2022 to identify original publications on risk, protective, genetic, neuroradiological, and biological factors related to dementia and cognitive impairment involving Indigenous peoples. RESULTS:Modifiable risk factors featured across multiple studies include childhood adversity, hearing loss, low education attainment, unskilled work history, stroke, head injury, epilepsy, diabetes, hypertension, hyperlipidemia, depression, low BMI, poor mobility, and continence issues. Non-modifiable risk factors included increasing age, sex, and genetic polymorphisms. Education, ex-smoking, physical and social activity, and engagement with cultural or religious practices were highlighted as potential protective factors. There is a paucity of research on dementia biomarkers involving Indigenous peoples. DISCUSSION:Greater understanding of modifiable factors and biomarkers of dementia can assist in strength-based models to promote healthy ageing and cognition for Indigenous peoples.

BACKGROUND:Aboriginal and Torres Strait Islander people are ageing with high rates of comorbidity, yet little is known about suboptimal prescribing in this population. AIM:The prevalence of potentially suboptimal prescribing and associated risk factors were investigated among older patients attending primary care through Aboriginal Community Controlled Health Services (ACCHSs). METHODS:Medical records of 420 systematically selected patients aged ≥50 years attending urban, rural and remote health services were audited. Polypharmacy (≥ 5 prescribed medications), potentially inappropriate medications (PIMs) as per Beers Criteria and anticholinergic burden (ACB) were estimated and associated risk factors were explored with logistic regression. RESULTS:The prevalence of polypharmacy, PIMs and ACB score ≥3 was 43%, 18% and 12% respectively. In multivariable logistic regression analyses, polypharmacy was less likely in rural (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.24-0.77) compared to urban patients, and more likely in those with heart disease (OR = 2.62, 95% CI = 1.62-4.25), atrial fibrillation (OR = 4.25, 95% CI = 1.08-16.81), hypertension (OR = 2.14, 95% CI = 1.34-3.44), diabetes (OR = 2.72, 95% CI = 1.69-4.39) or depression (OR = 1.91, 95% CI = 1.19-3.06). PIMs were more frequent in females (OR = 1.88, 95% CI = 1.03-3.42) and less frequent in rural (OR = 0.41, 95% CI = 0.19-0.85) and remote (OR = 0.58, 95% CI = 0.29-1.18) patients. Factors associated with PIMs were kidney disease (OR = 2.60, 95% CI = 1.37-4.92), urinary incontinence (OR = 3.00, 95% CI = 1.02-8.83), depression (OR = 2.67, 95% CI = 1.50-4.77), heavy alcohol use (OR = 2.83, 95% CI = 1.39-5.75) and subjective cognitive concerns (OR = 2.69, 95% CI = 1.31-5.52). High ACB was less common in rural (OR = 0.10, 95% CI = 0.03-0.34) and remote (OR = 0.51, 95% CI = 0.25-1.04) patients and more common in those with kidney disease (OR = 3.07, 95% CI = 1.50-6.30) or depression (OR = 3.32, 95% CI = 1.70-6.47). CONCLUSION:Associations between potentially suboptimal prescribing and depression or cognitive concerns highlight the importance of considering medication review and deprescribing for these patients.

INTRODUCTION:There are approximately 90 Aboriginal and Torres Strait Islander community controlled art centres across Australia, the majority in geographically remote locations. This survey explored how these centres are supporting older people, including people living with dementia, if and how they are collaborating with aged care services and what challenges and opportunities they identify in these arrangements.METHODS:An online survey was developed by a team of Aboriginal and non-Aboriginal researchers, art centre staff and art centre consultants. The survey was distributed in 2018 to art centres across Australia via their four art centre peak bodies: Desart; the Association of Northern, Kimberley and Arnhem Aboriginal Artists; the Indigenous Art Centre Alliance - Far North Queensland and Torres Strait Islands; and the Aboriginal Art Centre Hub - Western Australia. The survey was also conducted face-to-face with participants at art centre annual events; and on field trips to North Western and Central Australia, conducted as part of an overarching study.RESULTS:There were 53 completed surveys, with the highest proportion of responses (43%) from art centre managers. The survey generated 330 qualitative responses to the 13 questions that provided this option. The results showed that art centres play a wide ranging and vital role in supporting the health and wellbeing of older artists, many of whom are considered Elders within their communities, and that this reaches far beyond the production of art. The results showed that art centres are a safe place providing older people with the purpose and means to generate income, to enact governance, and to share cultural knowledge through intergenerational connection. Additionally, the results indicate that art centres provide a significant amount of direct care for older people, and that relationships are fundamental to delivering this social, emotional, spiritual and physical care. Furthermore, they showed a great deal of collaboration between art centres and aged care services, although little of this is formally documented or resourced.CONCLUSION:The survey results demonstrate that art centres play a significant and previously unexplored role in supporting the wellbeing of older people and people living with dementia in remote Aboriginal and Torres Strait Islander communities across Australia. Respondents shared diverse examples of providing physical, social, emotional, spiritual and cultural care, assistance with navigating health and aged care systems, as well as examples of collaborations with aged care and health providers. The results demonstrate opportunities to recognise and resource this vital work. These findings are particularly important in the context of Australia's recent Royal Commission into Aged Care Quality and Safety, which found that systemic change is urgently required. Additionally, Indigenous scholars have called for a swell of system reform to address inequities in health and aged care systems. They advocate for a fundamental shift from biomedical and siloed models of care to integrated models that centralise culture, intergenerational connection and the cultural determinants of health. The results show that art centres could bring their expertise to this conversation.

INTRODUCTION:Unpaid carers have a crucial role in supporting older people with cognitive impairment and disability, but their own health and wellbeing are often impacted. There are limited data on how carer strain, depression and empowerment may be improved for carers.METHODS:This was a cluster randomised controlled trial to compare the effect of a carer support program developed with a community-based participatory action research (PAR) approach to the delivery of information sessions to 100 carers of people aged 45 years or more living in four remote Aboriginal communities in Western Australia.RESULTS:The mean age of carers was 38.3±14.9 years, 76% were female and 77% were children or grandchildren of the care recipient. Carer strain and empowerment measures did not change significantly between baseline and follow-up. A statistically significant decrease in depression scores was observed in the PAR group. However, decreases were observed in both the PAR and control groups, and the change in scores did not differ significantly between groups. Depression scores decreased most in those who had not attended high school. Overall, the proportion of participants meeting criteria for depression decreased from 18.8% at baseline to 8.3% at follow-up.CONCLUSION:A carer support program was of equivocal benefit, although this research demonstrates that the wellbeing of carers in remote Aboriginal communities can potentially be markedly improved by outreach strategies.

BACKGROUND:Pain is a growing public health problem associated with significant health and functional implications. Limited data exist for Aboriginal Australians. AIMS:To describe the prevalence, severity and sites of pain, analgesic use and associated factors, including depression and disability, in remote-living Aboriginal Australians. METHODS:Cross-sectional study of 263 Aboriginal Australians aged ≥45 years from six remote Indigenous communities and the town of Derby in the Kimberley region of Western Australia between 2011 and 2013. Pain was assessed using a culturally adapted pain scale. Factors associated with pain were investigated with binary logistic regression. RESULTS:One hundred and seventy (64.6%) participants reported having pain and 53 (20.2%) reported persistent pain. Of those reporting pain, 61 (35.9%) rated it as moderate and 70 (41.2%) as severe. The most common sites of pain were back and knee, and 38 (22.4%) participants with pain indicated three or more sites of pain. Only 70 (41.2%) participants with pain were on some type of analgesic medication. After adjustment, poor vision (odds ratio (OR) = 2.21; 95% confidence interval (CI) 1.22-4.00), hypertension (OR = 1.89; 95% CI 1.03-3.45) and heart problems (OR = 2.05; 95% CI 1.01-4.14) were associated with pain. Higher depression scores were associated with more persistent pain, but pain was not significantly associated with clinically relevant depressive symptoms, or requiring assistance with two or more personal and/or instrumental activities of daily living. CONCLUSION:High levels of pain were reported, although the prevalence of persistent pain was comparable to the general population. Identifying risk factors, improving pain recognition and assessment and evaluating culturally tailored management approaches should be a priority.

Australasian Journal on AgeingVolume 39, Issue 4 p. 391-392 PARTNER NEWS AAG’s ATSIAAG 2019 Workshop Report Summary: ‘Integrated culturally sensitive services for older Aboriginal and Torres Strait Islander people: Practical solution or pipe dream?’ Roslyn Malay, Roslyn Malay Centre for Medical Research, University of Western Australia, Perth, WA, AustraliaSearch for more papers by this authorGraham Aitken, Graham Aitken Aboriginal Community Care, Davoren Park, SA, AustraliaSearch for more papers by this author Roslyn Malay, Roslyn Malay Centre for Medical Research, University of Western Australia, Perth, WA, AustraliaSearch for more papers by this authorGraham Aitken, Graham Aitken Aboriginal Community Care, Davoren Park, SA, AustraliaSearch for more papers by this author First published: 30 December 2020 https://doi.org/10.1111/ajag.12885 Correspondence Sue Gherdovich, Australian Association of Gerontology, Suite 8, 322 St Kilda Road, St Kilda, Vic. 3182, Australia. Email: sgherdovich@aag.asn.au Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume39, Issue4December 2020Pages 391-392 RelatedInformation

Objective: To describe demographic features and well-being of carers of Aboriginal Australians aged ≥45 years in remote Western Australia. Method: Carer burden, empowerment, and depression were assessed in 124 Aboriginal carers in four remote Aboriginal communities. Results: Carers were aged 38.8 ± 15.0 years, 73.4% were female, and 75.8% were children or grandchildren of the person cared for. The mean Zarit-6 score was 3.7 ± 3.6. Attending high school (odds ratio [OR] = 0.3; 95% confidence interval [CI] = [0.1, 0.7]) and feeling empowered (OR = 0.2; 95% CI = [0.1, 0.8]) were inversely associated with carer burden; female carers were less likely to feel empowered (OR = 0.4; 95% CI = [0.2, 0.9]); and empowerment was inversely associated with depression (OR = 0.3; 95% CI = [0.1, 0.7]). Discussion: Aboriginal carers in remote communities are relatively young and most are children or grandchildren. Carer burden was lower than anticipated. However, existing tools may not adequately measure Aboriginal perspectives. Education and empowerment are key factors which support programs must consider.

AbstractBackgroundRates of dementia and cognitive impairment in Australian Aboriginal and Torres Strait Islander populations are 3‐5 times higher than in the overall population. In addition, under‐detection of these conditions has been consistently confirmed, particularly in primary care. A national co‐design project called the Let’s CHAT (Community Health Approach To) Dementia aims to optimise detection rates and management of dementia and cognitive impairment in Indigenous primary care contexts. This will occur through the co‐development of a model of care, and outcome measures include data profiling the dementia risk of older Indigenous persons and current management of patients with confirmed or suspected cognitive impairment or dementiaMethodSix‐monthly medical record audits of patients aged 50 and over recording: basic demographic information, presence of dementia risk factors, current care practices in relation to dementia and co‐morbid conditions of ageing.ResultAudits were conducted on patients (n=1675) in 12 primary health services across Australia. The mean age of patients was 60.3 (8.3). The top ten risk factors documented overall were: hypertension (50.9%), polypharmacy (46.7%), current smoking (43%), diabetes (42.9%), dyslipidaemia (41.1%), obesity (35%), depression (30%), mental health concerns (25.9%) cardiovascular disease (25.6.%) and low physical activity (19.1%), but there was some inter‐service variation in risk factor profiles. Documented evidence of health service assessment for, and investigation of, cognitive impairment was limited. Use and type of diagnostic tools varied widely between services (e.g. MMSE used with 0.6%‐45.9% of sample, KICA (culturally appropriate cognitive assessment tool) used with 0.0%‐5.0% of sample). Diagnoses of dementia and cognitive impairment (combined = 3.8%) are well below known prevalence rates in these populations (∼20%), although there is variation from service to service (range = 0.8% ‐8.9%).ConclusionThe audit data confirm low rates of detection and low levels of assessment activity for cognitive impairment and dementia in Indigenous primary care contexts, while the population displays a high risk for developing these conditions. These findings underscore the need for more focus on detection activities in primary health care, as well as reinforcing the importance of preventive health care strategies.

In this cross-sectional study of 141 Aboriginal Australians aged ≥45 years living in the remote Kimberley region of Western Australia, we explored whether glycated haemoglobin (HbA1c) levels were associated with frailty. Sixty-four participants (45.4%) had a HbA1c level ≥6.5% and 84 participants (59.6%) were frail. A significant trend was observed with regard to HbA1c levels and frailty, with those having HbA1c levels ≥6.5% having the greatest prevalence of frailty (70.3%). In binary logistic regression analyses, having a HbA1c level ≥6.5% was associated with being frail after adjustment for age, sex, and education. This association was attenuated after further adjustment for body mass index (BMI). Poorer glycaemic control is very common and a potential risk factor for frailty in remote-living Aboriginal Australians, and appears to be partly mediated by BMI, a known risk factor for diabetes mellitus. Obesity and diabetes mellitus are potentially important modifiable risk factors for frailty.

BACKGROUND:Little is known about urinary incontinence in older Aboriginal Australians. AIM:To describe urinary incontinence assessment, prevalence, incidence and associated conditions in older Aboriginal Australians. METHODS:Wave 1 consisted of 363 Aboriginal participants aged ≥45 years from Western Australia; 289 participants participated in Wave 2, with 184 included at both time points. Urinary incontinence was assessed by self-report, family report and the modified International Consultation on Incontinence Questionnaire (ICIQ). We investigated factors associated with incontinence with binary logistic regression. Sensitivity and specificity analyses of incontinence measures were undertaken using the ICIQ score ≥2 as the reference standard. RESULTS:Participant mean age was 61.2 ± 11.2 years. Prevalence of incontinence at Wave 2 (n = 289) using self-report was 24.6%; using ICIQ ≥2 was 22.5%; and family report 14.2%. Incidence after follow-up of 6.7 years was 33 (23.6%), higher than estimates of 5-20% in other populations. Cross-sectional associations with incontinence include female sex (odds ratio (OR) = 6.82; 95% confidence interval (CI) 2.98-15.57), stroke (OR = 3.55; 95% CI 1.43-8.77), head injury (OR = 3.15; 95% CI 1.54-6.45) and depressive symptoms (OR = 1.07; 95% CI 1.01-1.14). Longitudinal associations were age (OR = 1.05; 95% CI 1.01-1.09) and female sex (OR = 2.37; 95% CI 0.99-5.67). Sensitivity (81.5%) and specificity (93.5%) of self-report were high. CONCLUSION:The prevalence and incidence of urinary incontinence in Aboriginal Australians is high with risk factors of older age and female sex. The modified ICIQ and self-report appear to be appropriate incontinence screens. Further research to understand causes and treatments within this population is urgently required.

Objectives: To investigate the prevalence of polypharmacy, under-prescribing and potentially inappropriate medicine use among Aboriginal Australians living in remote Western Australia. Design: Cross-sectional study. Setting: Six remote communities and the town of Derby in the Kimberley, Western Australia. Participants: Aboriginal people aged 45 years or more with complete medication histories. Main outcome measures: Proportions of patients with medicine histories indicating polypharmacy, potential under-prescribing of indicated medicines, or potentially inappropriate prescribing (including potential prescribing cascades or drug interactions). Results: Complete medicine histories were available for 273 participants. The mean number of prescribed medicines was 5.1 (SD, 3.6). At least one form of suboptimal prescribing was identified for 166 participants (61%), including polypharmacy for 145 (53%), potential under-prescribing of at least one indicated medicine for 33 (12%), and potentially inappropriate prescribing for 54 participants (20%). Potential prescribing cascades or drug interactions were identified for 12 participants (4%). Conclusions: Potentially suboptimal prescribing affected more than half the participating older Aboriginal Australians from the Kimberley. If generalisable to other remote Indigenous Australians, the prevalence of polypharmacy, potentially inappropriate prescribing, and under-prescribing of indicated medicines is problematic, and suggests that older Indigenous people in remote areas are at risk of medicine-related harm.

This team has previously demonstrated substantial rates of dementia in remote Indigenous communities in the Kimberley region of Western Australia, with reported high levels of carer strain. We aimed to develop a carer strain scale for Indigenous Australians, and to determine the effectiveness of our Strong Carers, Strong Communities project to reduce carer strain through empowering Indigenous caregivers. These projects were conducted in remote Indigenous communities in the north-west of Western Australia. The KICA Carer Strain scale was adapted from the 6-item Zarit Burden Interview. The Strong Carers, Strong Communities study is a clustered randomised trial, mixed methods design, involving Community A caregivers receiving a health education program and usual care. Community B is engaged in a participatory action research (PAR) process where caregivers meet to decide ways caregiver lives can be improved, facilitated by Indigenous caregiver champions and researchers. Measurement tools include KICA Carer Strain, Growth Empowerment Measure, KICA Depression and workshops and interviews. The KICA Carer Strain scale was completed by 197 Indigenous caregivers. The scale was readily accepted by caregivers. The mean score was 2.4, with 112 (56.9%) scoring >8/24. It has good internal consistency (α= 0.825). In the first communities involved in the Strong Carers, Strong Communities study, 62 carers completed baseline, mean age of 42 (range 18-83yrs), 71% were women. KICA Carer Strain scores differed at baseline with Community A mean score of 2.4, community B mean of 3.5. Community B caregivers identified improving the respect between generations as their key goal, and the breadth of activities, leading up to a community wide expo celebrating elders will be described. The protocol and results on the effect of the program on carer strain, empowerment, and mood in the first paired communities will be reported. The KICA Carer Strain scale appears to be a useful measure for caregiver strain with Indigenous Australians. Further research into the validity of the tool is also required. The Strong Carers, Strong Communities study will provide evidence based knowledge on methods to empower family caregivers of Indigenous peoples living with dementia and other aged care conditions.