Frailty and use of health and community services by community-dwelling older men: the Concord Health and Ageing in Men Project

Background: frailty is a concept used to describe older people at high risk of adverse outcomes, including falls, functional decline, hospital or nursing home admission and death. The associations between frailty and use of specific health and community services have not been investigated. Methods: the cross-sectional relationship between frailty and use of several health and community services in the last 12 months was investigated in 1,674 community-dwelling men aged 70 or older in the Concord Health and Ageing in Men study, a population-based study conducted in Sydney, Australia. Frailty was assessed using a modified version of the Cardiovascular Health Study criteria. Results: overall, 158 (9.4%) subjects were frail, 679 (40.6%) were intermediate (pre-frail) and 837 (50.0%) were robust. Frailty was associated with use of health and community services in the last 12 months, including consulting a doctor, visiting or being visited by a nurse or a physiotherapist, using help with meals or household duties and spending at least one night in a hospital or nursing home. Frail men without disability in activities of daily living were twice more likely to have seen a doctor in the previous 2 weeks than robust men (adjusted odds ratio 2.04, 95% confidence interval 1.21-3.44), independent of age, comorbidity and socio-economic status. Conclusion: frailty is strongly associated with use of health and community services in community-dwelling older men. The high level of use of medical services suggests that doctors and nurses could play a key role in implementation of preventive intervention

Industry-Informed Workshops to Develop Graduate Skill Sets in the Circular Economy Using Systems Thinking

Increasing demand for chemicals worldwide, depleting resources, consumer pressure, stricter legislation, and the rising cost of waste disposal are placing increasing pressure on chemical and related industries. For any organization to survive in the current arena of growing climate change laws and regulations, and increasing public influence, the issue of sustainability must be fundamental to the way it operates. A sustainable manufacturing approach will enable economic growth to be combined with environmental and social sustainability and will be realized via collaboration between a multidisciplinary community including chemists, biologists, engineers, environmental scientists, economists, experts in management, and policy makers. Hence, employees with new skills, knowledge, and experience are essential. To realize this approach, the design and development of a series of workshops encompassing systems thinking are presented here. After close consultation with industry, an annual program of interactive workshops has been designed for graduate students to go beyond examining the "greening" of chemical reactions, processes, and products, and instead embed a systems thinking approach to learning. The workshops provide a valuable insight into the issues surrounding sustainable manufacturing covering change management, commercialization, environmental impact, circular economy, legislation, and bioresources incorporating the conversion of waste into valuable products. The multidisciplinary course content incorporates industrial case studies, providing access to real business issues, and is delivered by experts from academic departments across campus and industry

Dementia: 14 Essentials of management

Dementia places a great burden on patients and their families and the challenges vary considerably over the course of the illness. We describe 14 practical points to guide management. Key Points: When a patient is diagnosed with dementia, implement a detailed care plan as soon as possible and follow up regularly. Encourage patients and their families to address issues relating to work, driving, finances and legal responsibilities. Ensure the patient’s environment is dementia-friendly. For patients with Alzheimer’s disease, consider prescribing specific medication when appropriate. Manage neuropsychiatric symptoms and comorbidities with nonpharmacological approaches whenever possible. When psychotropic treatments are considered necessary, minimise dose and duration and evaluate regularly for benefits and side effects. Ensure patients and carers have appropriate assistance and support, including community, respite and residential care. Monitor carers’ ability to cope and level of distress; refer if indicated

Dementia 14 essentials of assessment and care planning

Many GPs report a lack of time and confidence in diagnosing dementia. Fourteen practical points are described to guide the assessment and care of patients with cognitive decline. Key Points: Signs of possible dementia should be taken seriously; timely diagnosis is important to allow patients to be treated and patients and families to prepare for the future. Take a detailed history and perform a standardised test of cognition and a mental and physical examination. Diagnose the dementia cause; investigate for reversible causes and rule out other diagnoses, such as delirium, depression and drug adverse effects. For patients with dementia, discuss key issues including daily living, legal and financial affairs, the transition from work and driving, and the stress on supporting carers and family. Assessment should culminate in a care plan, with strategies to manage specific symptoms, support for the patient and family, regular monitoring and referrals to support groups and organisations. As symptoms and challenges change over the course of dementia, the care plan needs regular review

Characteristics of Social Support in a Community-living Sample of Older People: The Sydney Older Persons Study

As people advance in age there is a marked increase in the development of health-related problems, in both the chronic and acute illnesses and diseases. In fact disease is the major factor that prevents old people from remaining independent. As a result old-old people may rely on assistance from both informal and formal suppodrt sources in order to maintain independence. In the Australian Bureau of Statistics Survey of Diasbility, Ageing and Carers, researchers found that 67% of people aged 75 or over need some form of assistance with housework, home maintenance, meals preparation, personal affairs or transport. The majority of this assistance is provided by informal carers (ie., family , friends and neighbours) in the older person's home. Analysing the characteristics and level of social support received by older people is an important research agenda because lower levels of social support have been associated with mortality, poor health and lower levels of well-being. Describing the characteristics of social support in this age group is also particularly important because there is a dearth of information on the nature of social support which focuses on people over the age of 75 years in Australia. Previous research on older adults has found that lower levels of social support are associated with male gender, greater age and single marital status. The aim of this study is to firstly describe the characteristics of social support in a sample of community-living people over the age of 75 years and secondly to identify sociodemographic variables associated with social support

Alcohol consumption in a community sample of older people

Objective: To examine the prevalence and pattern of alcohol use among community-living elderly Australians. Methods: A survey was conducted of randomly selected non-institutionalised people aged 75 years and older living in the inner western suburbs of Sydney. Personal interviews by trained interviewers covered background demographic information and self-reported alcohol use. Results: 72% of men and 54% of women drank alcohol. The median usual daily volume of ethanol consumed by drinkers was 10 grams for men and 1.3 grams for women. However 11% of male drinkers and 6% of female drinkers consumed at defined hazardous or harmful levels. Conclusions and implications: Although a sizeable majority of these older people were either non-drinkers or very light drinkers, a small but important proportion drank in the hazardous to harmful range. Despite increasing evidence of the health benefits of alcohol consumption it remains important to be alert for potentially harmful alcohol use among older people

Satisfaction With Medical and Allied Health Services Among Aged People In Sydney

Objectives: To assess satisfaction with medical and allied health services among communityliving aged persons and to determine whether satisfaction had changed over a three-year period. Method: An interview survey of a random sample of 320 people aged 7

Transportation Needs of Community-living Older People in Sydney

Objectives: To assess difficulty of access to both private and public transport experienced by older people living in the community in Sydney, to identify demographic and disability-related risk factors for poor access to transport, and to gauge the extent to which transport needs were met by assistance from relatives and friends. Method: An interview survey of a random sample of 620 people aged 75 years and older living in the community was conducted in the inner western suburbs of Sydney between August 1991 and September 1993. Questions covered demographic background, self-perceived disability, difficulty of access to transport, and assistance given by relatives and friends. Results: Slightly over half of the respondents said that access to private transport was difficult or impossible for them; one-third said that using public transport was difficult; 29% had difficulty with both forms of transport; yet only a quarter received help from relatives or friends. Fifteen per cent of all respondents were transport deprived in that they found access to both forms of transport difficult but did not receive any assistance. In general, the severely disabled were not significantly at risk of transport deprivation. Conclusions: There was a sizeable group of older people living in the community for whom access to transport posed considerable difficulties and who received no transport assistance from relatives or friends. Further research is needed on the impact of transport deprivation and the extent to which this is ameliorated by formal services