Development of benchmarks for determining infrastructure needs for the aged

This project developed benchmarks and benchmarking procedures to indicate the current and future infrastructure requirements of the aged in regional centres. The benchmarks correlate the infrastructure requirements of the aged with demographic trends. The research also modelled aged infrastructure requirements within the broader context of the sustainability of cities.

Nutrition screening of older people in a community general practice, using the MNA-SF

Background: Objective The study aimed to determine the prevalence of malnutrition risk in a population of older people (aged 75 years and over) attending a community general practice and identify characteristics of those classified as malnourished or at risk of malnutrition.

Design Cross-sectional study of nutritional risk screen conducted over a six month period.

Participants and setting Patients attending a general practice clinic in Victoria, Australia, who attended for the “75 plus” health assessment check.

Measurements The Mini Nutritional Assessment Short Form (MNA®-SF) was included as part of the health assessment. Information was collected on living situation, co-morbidities, independence with meal preparation and eating, number of medications. Height and weight was measured and MNA®-SF score recorded.

Results Two hundred and twenty five patients attending a general practice for a health assessment with a mean age of 81.3(4.3)(SD) years, 52% female and 34% living alone. Only one patient was categorised by the MNA®-SF as malnourished, with an additional 16% classified as at risk of malnutrition. The mean Body Mass Index (BMI) of the at-risk group was significantly lower than the well-nourished group (23.6 ± 0.8 (SEM) vs 27.4 ± 0.3; p=0.0001). However, 34% of the at-risk group had a BMI of 25 or more with only 13% in the underweight category.

Conclusion In this population of older adults attending their general practitioner for an annual health assessment, one in six were identified as being at nutritional risk which is an additional risk factor for a severe health issue. Importantly, one third of the at-risk group had a BMI in the overweight or obese category, highlighting that older people can be at nutritional risk although they may be overweight or obese.

Out of the shadows: a discussion on law reform for the prevention of financial abuse of older people

Financial abuse of older people too often lives ‘in the shadows, hidden by fear and shame’. This and the protective love between family members can screen changes that are critical to an older person’s financial and living arrangements. Rather than a single event, it is usually a series of well-intentioned but ill-considered financial acts, which at some point tips over into abuse interwoven with an intricate web of family relationships. Was a transfer of title or a loan to an adult child really misappropriation? Has thoughtlessness become undue influence or even theft? 

Using complemenatry therapies wisely in older people.

Key points
• Over 30%, of older people use complementary therapies.
• Nurses need to be able to use complementary therapies safely if indicated and provide objective. accurate information about them.
• Complementary therapies can be used with conventional medical treatment to improve diabetes balance and quality of life.
• Herb-drug and herb-herb interactions and other adverse events can occur when conventional and complementary therapies are combined inappropriately.
• Complementary therapy use and the reasons for their use should be ascertained when taking a routine history and assessment.

Subjective quality of life, perceived control and dispositional optimism among older people

Objectives: To examine whether the subjective quality of life (QOL) of elderly people is held under homeostatic control, and to investigate the role of perceived control and dispositional optimism in the maintenance of subjective QOL.
Method: 100 older people (M=75.6 years) and a control group of 107 younger people (M=20.1 years) completed a self-report survey.
Results: Both groups had a level of subjective QOL within the normal range. The older group reported higher levels of secondary control and optimism, but similar levels of primary control, as the younger group. Primary control and optimism predicted subjective QOL for both groups. Secondary control was a significant predictor (or the younger group, however it was only marginally significant for the older group. Optimism accounted for the most subjective QOL variance for both groups.
Conclusions: The finding that the subjective QOL of the older group lay within the normative range supports the proposal that their subjective QOL is being successfully maintained under bomeostatic control. However, they appear to have an increased reliance on secondary control. The fact that dispositional optimism captures the predictive variance of perceived control, is an important finding adding to the understanding of subjective QOL maintenance.

Should older people in residential care receive vitamin D to prevent falls? Results of a randomized trial

Objectives: To determine whether vitamin D supplementation can reduce the incidence of falls and fractures in older people in residential care who are not classically vitamin D deficient.

Design: Randomized, placebo-controlled double-blind, trial of 2 years' duration.

Setting: Multicenter study in 60 hostels (assisted living facilities) and 89 nursing homes across Australia.

Participants: Six hundred twenty-five residents (mean age 83.4) with serum 25-hydroxyvitamin D levels between 25 and 90 nmol/L.

Intervention: Vitamin D supplementation (ergocalciferol, initially 10,000 IU given once weekly and then 1,000 IU daily) or placebo for 2 years. All subjects received 600 mg of elemental calcium daily as calcium carbonate.

Measurements: Falls and fractures recorded prospectively in study diaries by care staff.

Results: The vitamin D and placebo groups had similar baseline characteristics. In intention-to-treat analysis, the incident rate ratio for falling was 0.73 (95% confidence interval (CI)=0.57–0.95). The odds ratio for ever falling was 0.82 (95% CI=0.59–1.12) and for ever fracturing was 0.69 (95% CI=0.40–1.18). An a priori subgroup analysis of subjects who took at least half the prescribed capsules (n=540), demonstrated an incident rate ratio for falls of 0.63 (95% CI=0.48–0.82), an odds ratio (OR) for ever falling of 0.70 (95% CI=0.50–0.99), and an OR for ever fracturing of 0.68 (95% CI=0.38–1.22).

Conclusion: Older people in residential care can reduce their incidence of falls if they take a vitamin D supplement for 2 years even if they are not initially classically vitamin D deficient.

A comparison of four functional test in discriminating fallers from non-fallers in older people

Purpose : Which functional tests on mobility and balance can better screen older people at risk of falls is unclear. This study aims to compare the Berg Balance Scale (BBS), Tinetti Mobility Score (TMS), Elderly Mobility Scale (EMS) and Timed Up and Go test (TUG) in discriminating fallers from non-fallers in older people.
Method : This was a case-control study involving one rater who conducted a mobility and balance assessment on subjects using the four functional tests in random sequence. Subjects recruited included 17 and 22 older people with a history of single and multiple falls respectively from a public Falls Clinic, and 39 community-dwellers without fall history and whose age, sex and BMI matched those of the fallers. All subjects underwent the mobility and balance assessment within one day.
Results : Single fallers performed better than multiple fallers in all four functional tests but were worse than non-fallers in the BBS, TMS and TUG. The BBS demonstrated the best discriminating ability, with high sensitivity and specificity. The BBS item 'pick up an object from the floor' was the best at screening fallers.
Conclusion : BBS was the most powerful functional test of the four in discriminating fallers from non-faller.

Effectiveness of staff training programs for behavioral problems among older people with dementia

This paper reviewed studies on staff training programs to address the behavioral problems associated with dementia among older people in residential care. The papers were classified according to whether or not the studies included a control group in the research design. The results of the review demonstrate that there has been a wide range of psychosocial and educational interventions to reduce behavioral problems among older people with dementia, with inconsistent results being obtained. However, many of these studies suffer from problems in their research design that make it difficult to evaluate their effectiveness. Problems in conducting research in the nursing home setting are highlighted, and suggestions for future research in this area are discussed.