End of life hospitalisations differ for older Australian women according to death trajectory: a longitudinal data linkage study

BACKGROUND: Hospitalisations are the prime contributor to healthcare expenditure, with older adults often identified as high hospital users. Despite the apparent high use of hospitals at the end of life, limited evidence currently exists regarding reasons for hospitalisation. Understanding complex end of life care needs is required for future health care planning as the global population ages. This study aimed to investigate patterns of hospitalisation in the last year of life by cause of death (COD) as well as reasons for admission and short-term predictors of hospital use. METHODS: Survey data from 1,205 decedents from the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health were matched with the state-based hospital records and the National Death Index. Hospital patterns based on COD were graphically summarised and multivariate logistic regression models examined the impact of short-term predictors of length of stay (LOS). RESULTS: 85 % of women had at least one admission in the last year of life; and 8 % had their first observed admission during this time. Reasons for hospitalisation, timing of admissions and LOS differed by COD. Women who died of cancer, diabetes and 'other' causes were admitted earlier than women who died of organ failure, dementia and influenza. Women who died of organ failure overall spent the longest time in hospital, and women with cancer had the highest median LOS. Longer LOS was associated with previous short- and medium-term- hospitalisations and type of hospital separation. CONCLUSIONS: Reducing acute care admissions and LOS at the end of life is complex and requires a shift in perceptions and treatment regarding end of life care and chronic disease management

Accuracy of self-reported medicines use compared to pharmaceutical claims data amongst a national sample of older Australian women

This study assessed agreement between two measures of medicine use, self-report by mail and pharmaceutical claims data, for a national sample (N = 4687) of older women aged 79 to84 in2005, from the Australian Longitudinal Study on Women’s Health. Medicines used for common chronic diseases in older people were selected, with pharmaceutical claims data retrieval periods of three and six months. For six month retrieval, Kappa’s ranged between 0.44 (nervous system medicines) and 0.94 (glucose lowering medicines). For three month retrieval, aspirin (Kappa: 0.35) and folic acid (Kappa = 0.48) had lowest agreement. Women were least able to accurately report use of nervous system medicines (sensitivity < 50%), and most accurately report glucose lowering medicines use (sensitivity > 80%). Specificity was consistently high across all classes, suggesting women could accurately report using a medicine. Pharmaceutical claims data can assist evaluation of judicious medicines use, changes to availability and uptake of medicines, and track medicine expenditure for chronic conditions. Over-the-counter medicines, medicines not covered by pharmaceutical subsidies and those used on an as needed basis may be best measured by self-report, as use may be underestimated using pharmaceutical claims data

Use, access to, and impact of Medicare services for Australian women: findings from the Australian Longitudinal Study on Women’s Health

This major report from the Australian Longitudinal Study on Women’s Health (also known as Women’s Health Australia) adopts a life course approach to investigate changes in women’s health and health service use change across life stages. Women’s survey data were linked to Medicare Benefits Scheme (MBS) data, enabling analysis of women’s health, health behaviours and social circumstances over time, and how these relate to health care use at different life stages. Using these data, the report provides detailed information on how and when women use health services, and their costs, throughout the women’s life course

Validation of Frail Scale and comparison with hospital frailty risk score to predict hospital use in a cohort of older Australian women

Introduction: With no standard frailty tool for clinical care, research and policymaking, identifying frail older people is a challenge. Aims: This study aimed to compare two validated scales, which are the Frail Scale and Hospital Frailty Risk Score (HFRS) for their ability in identifying frailty in older Australian women and predicting hospital use. Methods: This study included older Australian women aged 75–95 years, who had unplanned overnight hospital admission as an index admission between 2001 and 2016. Data from the Australian Longitudinal Study on Women\u27s Health (ALSWH) were linked with administrative hospital data to calculate HFRS (using the International Statistical Classification of Diseases, Australia Modification (ICD-10-AM) diagnostic codes) and the Frail Scale (using the ALSWH self-reported survey). Results: The Frail Scale identified a higher proportion of older frail women (30.54%) compared to the HFRS (23.0%). Frail older women, classified by Frail Scale, were at higher risk of long hospital stay (adjusted odds ratio = 1.28, 95% CI = 1.02–1.60), repeated admission (adjusted hazard ratio [AHR] = 1.30, 95% CI = 1.03–1.41) and death (AHR = 1.70, 95% CI = 1.45–2.01). HFRS was associated with longer hospital stay and mortality. Conclusions: The proportion of older women classified as frail by the Frail Scale tool was higher than women classified as frail by HFRS. The Frail Scale and HFRS were not significantly associated with each other. While both tools were associated with the risk of long hospital stay and mortality, only the Frail Scale predicted the risk of repeated admission

Unplanned Readmission within 28 Days of Hospital Discharge in a Longitudinal Population-Based Cohort of Older Australian Women

This study aimed to estimate the incidence of 28-day unplanned readmission among older women, and associated factors. Data were used from the 1921&ndash;1926 birth cohort of the Australian Longitudinal Study on Women&rsquo;s Health. Linkage of self-reported survey data with the Admitted Patient Data Collection allowed the identification of hospital admissions for each woman and the corresponding baseline characteristics. The Cox proportional-hazards model was used to identify factors associated with time to unplanned readmission, using SAS software V 9.4. (SAS Institute, Cary, NC, USA). Of 2056 women with index unplanned admission, 363 (17.5%) were readmitted within 28 days of discharge, and of these 229 (11.14%) had unplanned readmission. Among women with unplanned readmission, 24% were for the same condition as for the index hospitalisation. Cardiovascular diseases were the main diagnoses for the index admission and readmission. Unplanned readmission risk was higher if not partnered (hazard ratio (HR) = 1.43, 95% confidence interval (CI): 1.05&ndash;1.95), of non-English speaking background (HR = 1.62%, 95% CI: 1.07&ndash;2.47), more than three days length of stay on index admission (HR = 1.41%, 95% CI: 1.04&ndash;1.90) and one or two of the assessed chronic diseases (HR = 1.68, 95% CI: 1.19&ndash;2.36). At least one in ten women had unplanned readmission at some time between ages 75&ndash;95 years. Women who are not partnered, not of English-speaking background, with longer hospital stay and those with multi-morbidity, may need further efforts during their stay and on discharge to mitigate unplanned readmission

Patterns of Hospitalization Risk for Women Surviving Into Very Old Age: Findings From the Australian Longitudinal Study on Women's Health

Background: By 2050, adults aged 80 years and over will represent around 20% of the global population. Little is known about how adults surviving into very old age use hospital services over time. Objective: The objective of the study was to examine patterns of hospital usage over a 10-year period for women who were aged 84 to 89 in 2010 and examine factors associated with increased use. Methods: Survey data from 1936 women from the 1921 to 1926 cohort of the Australian Longitudinal Study on Women's Health were matched with the state-based Admitted Patients Data Collection. Hospital use profiles were determined using repeated measures latent class analysis. Results: Four latent class trajectories were identified. One-quarter of the sample were at low risk of hospitalization, while 20.6% demonstrated increased risk of hospitalization and a further 38.1% had moderate hospitalization risk over time. Only 16.8% of the sample was classified as having high hospitalization risk. Correlates of hospital use for very old women differed according to hospital use class and were contingent on the timing of exposure (ie, short-term or long-term). Conclusions: Despite the perception that older adults place a significant burden on health care systems, the majority of women demonstrated relatively low hospital use over an extended period, even in the presence of chronic health conditions. High hospitalization risk was found to be concentrated among a small minority of these long-term survivors. The findings suggest the importance of service planning and treatment regimes that take account of the diverse trajectories of hospital use into and through advanced old age.The Australian Longitudinal Study on Women’s Health is funded by the Australian Government Department of Health. Analysis costs were supplemented by the New South Wales Science Leveraging Fund. There was no involvement from the financial partners in the preparation of this article, the analysis and interpretation of the data, and the writing of the report or the decision to submit this article for publication

Intimate partner violence adversely impacts health over 16 years and across generations: A longitudinal cohort study.

OBJECTIVES:To determine the impact of intimate partner violence on women's mental and physical health over a 16 year period and across three generations. PARTICIPANTS:Participants were from the Australian Longitudinal study on Women's Health, a broadly representative national sample of women comprised of three birth cohorts 1973-78, 1946-51 and 1921-26 who were randomly selected from the Australian Medicare (i.e. national health insurer) database in 1996 to participate in the longitudinal health and wellbeing survey. Since baseline, six waves of survey data have been collected. Women from each cohort who had returned all six surveys and had a baseline measure (Survey 1) for intimate partner violence were eligible for the current study. MAIN OUTCOME MEASURES:The main outcome of interest was women's physical and mental health, measured using the Medical Outcome Study Short-Form (SF-36). The experience of intimate partner violence was measured using the survey item 'Have you ever been in a violent relationship with a partner/spouse?' Sociodemographic information was also collected. RESULTS:For all cohorts, women who had lived with intimate partner violence were more likely to report poorer mental health, physical function and general health, and higher levels of bodily pain. Some generational differences existed. Younger women showed a reduction in health associated with the onset of intimate partner violence, which was not apparent for women in the older two groups. In addition, the physical health differences between women born 1921-26 who had and had not experienced intimate partner violence tapered off overtime, whereas these differences remained constant for women born 1973-78 and 1946-51. CONCLUSIONS:Despite generational differences, intimate partner violence adversely impacted on mental and physical health over the 16 year study period and across generations