Subjective social support in older male Italian-born immigrants in Australia

This paper describes differences in subjective social support between older male Italian-born immigrants in Australia and their Australian-born counterparts. Data came from 335 Italian-born and 849 Australian-born men aged 70 years and over who participated in the baseline phase of the Concord Health and Ageing in Men Project (CHAMP) in inner suburban Sydney, Australia. Social support was measured using the shortened (11 item) version of the Duke Social Support Index (DSSI). This index measures both social interactions and expressive social support. Logistic regression was used to examine differences in subjective social support between the two groups of men after controlling for other related factors. Italian-born men were about twice as likely to report low subjective social support compared to Australian-born men (unadjusted odds ratio (OR) = 1. 8, p = 0. 0002). This difference remained after adjustment for sociodemographic, socioeconomic, social network and health factors (adjusted OR = 2. 1, p = 0. 0007). Italian-born men were more likely to report that they had no non-family members in the local area to rely on. However, lack of non-family supports did not remain significantly associated with perceived social support after adjustment for social interactions and depressive symptoms. Italian-born men were more likely to report low subjective support despite the presence of several protective factors such as a greater number of local family supports and a high rate of home ownership

Prescribing in Older People

BACKGROUND: Prescribing medications to older people is difficult due to comorbidity, limited evidence for efficacy, increased risk of adverse drug reactions, polypharmacy, and altered pharmacokinetics. OBJECTIVE: This article describes the principles underlying clinical geriatric pharmacology including approaches to evaluating the evidence for risk and benefit, and adjusting dose for age related pharmacokinetic changes. DISCUSSION: The challenge for the general practitioner is to balance an incomplete evidence base for efficacy in frail, older people against the problems related to adverse drug reactions without denying older people potentially valuable pharmacotherapeutic interventions

Perceptions of preparation for further training: How our medical schools prepare graduates and the perceived factors influencing access to training

Objective: To investigate the specific factors that graduates perceive to influence their success in obtaining primary training in a chosen field. Design, setting and participants: The New South Wales Medical Registration Board provided data on doctors who were registered to practise between 1995 and 2006. A brief, paper-based survey was sent to a random selection of 2000 doctors. Main outcome measures: Doctors' self-reported perceptions on the impact of demographic details, specialty training applied for, university training and other factors on opportunities for further training after medical school. Results: Of the 375/1915 doctors (19.6%) who responded, most had completed a 6-year undergraduate degree from the University of Sydney, University of NSW or University of Newcastle, and most were at registrar level. Of 242/321 doctors (76%) who had applied for a training position, 240 (99%) had been accepted. The support of a mentor was considered the most positive influence on meeting long-term career goals (255/318 [80%]). Learning how to communicate with patients was valued as the most helpful aspect of medical school (270/318 [85%]). Conclusion: The personal attributes of graduates were considered more influential in achieving career goals and accessing further training than perceived features of a medical program. This suggests that more emphasis and research should be devoted to selecting the most appropriate candidates, rather than restructuring medical curricula to meet a presumed need for more content knowledge before graduation

High-risk prescribing and incidence of frailty among older community-dwelling men

Evidence about the association between treatment with high-risk medicines and frailty in older individuals is limited. We investigated the relationship between high-risk prescribing and frailty at baseline, as well as 2-year incident frailty, in 1,662 men 70 years of age. High-risk prescribing was defined as polypharmacy (5 medicines), hyperpolypharmacy (10 medicines), and by the Drug Burden Index (DBI), a dose-normalized measure of anticholinergic and sedative medicines. At baseline, frail participants had adjusted odds ratios (ORs) of 2.55 (95% confidence interval, CI: 1.69-3.84) for polypharmacy, 5.80 (95% CI: 2.90-11.61) for hyperpolypharmacy, and 2.33 (95% CI: 1.58-3.45) for DBI exposure, as compared with robust participants. Of the 1,242 men who were robust at baseline, 6.2% developed frailty over two years. Adjusted ORs of incident frailty were 2.45 (95% CI: 1.42-4.23) for polypharmacy, 2.50 (95% CI: 0.76-8.26) for hyperpolypharmacy, and 2.14 (95% CI: 1.25-3.64) for DBI exposure. High-risk prescribing may contribute to frailty in community-dwelling older men

Diet quality and its implications on the cardio-metabolic, physical and general health of older men: The Concord Health and Ageing in Men Project (CHAMP)

The revised Dietary Guideline Index (DGI-2013) scores individuals’ diets according to their compliance with the Australian Dietary Guideline (ADG). This cross-sectional study assesses the diet quality of 794 community-dwelling men aged 74 years and older, living in Sydney, Australia participating in the Concord Health and Ageing in Men Project; it also examines sociodemographic and lifestyle factors associated with DGI-2013 scores; it studies associations between DGI-2103 scores and the following measures: homoeostasis model assessment – insulin resistance, LDLcholesterol, HDL-cholesterol, TAG, blood pressure, waist:hip ratio, BMI, number of co-morbidities and medications and frailty status while also accounting for the effect of ethnicity in these relationships. Median DGI-2013 score was 93·7 (54·4, 121·2); most individuals failed to meet recommendations for vegetables, dairy products and alternatives, added sugar, unsaturated fat and SFA, fluid and discretionary foods. Lower education, income, physical activity levels and smoking were associated with low scores. After adjustments for confounders, high DGI-2013 scores were associated with lower HDL-cholesterol, lower waist:hip ratios and lower probability of being frail. Proxies of good health (fewer comorbidities and medications) were not associated with better compliance to the ADG. However, in participants with a Mediterranean background, low DGI-2013 scores were not generally associated with poorer health. Older men demonstrated poor diet quality as assessed by the DGI-2013, and the association between dietary guidelines and health measures and indices may be influenced by ethnic background