Managing constipation in older people

The study consists of two parts: a systematic review that critically analysed existing Chinese medicine clinical trials in managing constipation and, a cluster randomised controlled trial investigating the effects of education and acupressure on constipation in older people. Participants in the experimental group reported significant improvements in their constipation symptoms.

Environmental mastery and depression in older adults in residential care

This study investigated the association between environmental mastery and depression in a sample of 96 older adults (aged 64–98 years) in residential care. The participants completed a scale that assessed depression along with measures for risk factors for depression such as functional capacity, self-evaluated physical health, bereavement experiences and environmental mastery. The results showed that 49 per cent of the variance in participants’ scores in depression could be attributed to their self-reported level of environmental mastery. Given the complexity of depression and the likelihood of reduced environmental mastery among older adults in residential care, the construct was further assessed as a mediating variable between the risk factors and depression. With environmental mastery taken as such, the explained variance in depression increased to 56 per cent. It was concluded that environmental mastery may be one of the more important factors affecting the mental health of older adults living in residential care and that strategies for increasing the residents’ environmental mastery are important to their psychological wellbeing. The discussion notes that among the questions needing further investigation are whether older adults who experience high environmental mastery make the transition from community living to residential nursing home care more successfully than others, and whether perceived mastery diminishes over time or occurs at the point of transition from community independent living to dependent supported living.

Effects of resistance exercise and fortified milk on skeletal muscle mass, muscle size, and functional performance in middle-aged and older men: an 18-mo randomized controlled trial

Limited data have suggested that the consumption of fluid milk after resistance training (RT) may promote skeletal muscle hypertrophy. The aim of this study was to assess whether a milk-based nutritional supplement could enhance the effects of RT on muscle mass, size, strength, and function in middle-aged and older men. This was an 18-mo factorial design (randomized control trial) in which 180 healthy men aged 50–79 yr were allocated to the following groups: 1) exercise + fortified milk, 2) exercise, 3) fortified milk, or 4) control. Exercise consisted of progressive RT with weight-bearing impact exercise. Men assigned to the fortified milk consumed 400 ml/day of low-fat milk, providing an additional 836 kJ, 1000 mg calcium, 800 IU vitamin D3, and 13.2 g protein per day. Total body lean mass (LM) and fat mass (FM) (dual-energy X-ray absorptiometry), midfemur muscle cross-sectional area (CSA) (quantitative computed tomography), muscle strength, and physical function were assessed. After 18 mo, there was no significant exercise by fortified milk interaction for total body LM, muscle CSA, or any functional measure. However, main effect analyses revealed that exercise significantly improved muscle strength (∼20–52%, P < 0.001), LM (0.6 kg, P < 0.05), FM (−1.1 kg, P < 0.001), muscle CSA (1.8%, P < 0.001), and gait speed (11%, P < 0.05) relative to no exercise. There were no effects of the fortified milk on muscle size, strength, or function. In conclusion, the daily consumption of low-fat fortified milk does not enhance the effects of RT on skeletal muscle size, strength, or function in healthy middle-aged and older men with adequate energy and nutrient intakes.

Association between hyperglycaemia and fracture risk in non-diabetic middle-aged and older Australians : a national, population-based prospective study (AusDiab)

Summary : The association between pre-diabetes and fracture risk remains unclear. In this large cohort of middle-aged and older Australian men and women without diabetes, elevated 2-h plasma glucose and pre-diabetes were associated with a reduced 5-year risk of low trauma and all fractures in women, independently of BMI, fasting insulin and other lifestyle factors.

Introduction : We aimed to (1) examine associations between fasting and 2-h plasma glucose (FPG and 2-h PG), fasting insulin and risk of low trauma and all fractures in non-diabetic adults and (2) compare fracture risk between adults with pre-diabetes (impaired glucose tolerance or impaired fasting glucose) and those with normal glucose tolerance (NGT).

Methods : Six thousand two hundred fifty-five non-diabetic men and women aged ≥40 years with NGT (n = 4,855) and pre-diabetes (n = 1,400) were followed for 5 years in the AusDiab Study. Fractures were self-reported.

Results : Five hundred thirty-nine participants suffered at least one fracture (368 women, 171 men), of which the majority (318) occurred after a low-energy trauma (258 women, 60 men). In women, a 2-h PG ≥7.2 mmol/L (highest quartile) was associated with a decreased risk of low trauma and all fractures independent of age and BMI [OR (95% CI) for low trauma fractures, 0.59 (0.40–0.88)], but also fasting insulin, smoking, physical activity, history of fracture, dietary calcium and alcohol intake or menopausal status. There was no effect of 2-h PG on fracture risk in men [OR (95% CI), 1.39 (0.60–3.26)] or any relationship between fracture risk and quartiles of FPG or insulin in either sex. Compared to women with NGT, those with pre-diabetes had a reduced risk of fracture [OR (95% CI) for all fractures, 0.70 (0.52–0.95); for low trauma fractures, 0.75 (0.53–1.05)].

Conclusion : Elevated 2-h PG levels and pre-diabetes were inversely associated with low trauma and/or all fractures in non-diabetic women, independent of BMI and fasting insulin levels.

Prescription medication hoarding and borrowing or sharing behaviours in older residents in the Illawarra, New South Wales, Australia

Aim: To examine prescription medication hoarding and borrowing or sharing (PMHBS) behaviours in older people, particularly which medications are subject to these behaviours and the circumstances that enable these behaviours.

Methods: A mixed methods triangulation design, using consecutive qualitative (focus groups) and quantitative (survey) methodologies in a convenience sample of people older than 65 years, living independently in the Illawarra region (New South Wales).

Results: Focus group participants (n= 28) acknowledged PMHBS behaviours were widespread; however, very few survey respondents (n= 226) admitted to engaging in these behaviours. Main findings in the study were enablers for these behaviours: the prescription medication is considered the same as that prescribed previously; and self-medicating for pain relief.

Conclusions: The prevalence of PMHBS behaviours in this study was low, although it was acknowledged such behaviours occurred in the wider community. Sharing strong pain medication and the same prescription medication appeared to be acceptable in this population.

Effects of lifetime loading history on cortical bone density and its distribution in middle-aged and older men

We have reported previously that long-term participation of weight-bearing exercise is associated with increased QCT-derived cortical bone size and strength in middle-aged and older men, but not whole bone cortical volumetric BMD. However, since bone remodeling and the distribution of loading-induced strains within cortical bone are non-uniform, the aim of this study was to examine the effects of lifetime loading history on cortical bone mass distribution and bone shape in healthy community dwelling middle-aged and older men. We used QCT to assess mid-femur and mid-tibia angular bone mass distribution around its center (polar distribution), the bone density distribution through the cortex (radial distribution), and the ratio between the maximum and minimum moments of inertia (I_max/I_min ratio) in 281 men aged 50 to 79 years. Current (> 50 years) and past (13–50 years) sport and leisure time activity was assessed by questionnaire to calculate an osteogenic index (OI) during adolescence and adulthood. All men were then categorized into a high (H) or low/non impact (L) group according to their OI scores in each period. Three contrasting groups were then formed to reflect weight-bearing impact categories during adolescence and then adulthood: H–H, H–L and L–L. For polar bone mass distribution, bone deposition in the anterolateral, medial and posterior cortices were 6–10% greater at the mid-femur and 9–24% greater at mid-tibia in men in the highest compared to lowest tertile of lifetime loading (p < 0.01– < 0.001). When comparing the influence of contrasting loading history during adolescence and adulthood, there was a graded response between the groups in the distribution of bone mass at the anterior-lateral and posterior regions of the mid-tibia (H–H > H–L > L–L). For radial bone density distribution, there were no statistically significant effects of loading at the mid-femur, but a greater lifetime OI was associated with a non-significant 10–15% greater bone density near the endocortical region of the mid-tibia. In conclusion, a greater lifetime loading history was associated with region-specific adaptations in cortical bone density.

Where will we live when we get older?

Ageing populations, although exhibiting marked differences across countries and cultures, are a global phenomenon. Old-age dependency ratios in most developed countries are projected to double by the year 2050. In Australia there will be a strain on economic growth as a large part of the population moves from pre-retirement to post-retirement age over the next 25 years. A disproportionate amount of this strain will be concentrated in aged-care housing or retirement accommodation. Current evidence suggests that existing housing stock for older people is inadequate. As the Australian population ages, the maintenance and long-term performance of retirement housing is a key concern of government and housing providers. This study looked at four aged-care or retirement providers across Australia and examined the performance of the current housing stock managed by these providers. The interviews revealed that housing design decisions in retirement stock, although critically important to the changing needs of occupants and the adequate supply of suitable housing, are often ill-considered. The findings critically question the idea of simply building ‘more of the same’ to relieve demand. This study has major implications for the future of Australian retirement housing, especially as the population ages dramatically.

Care needs and functional status of older acute care patients

A growing number of older adults are admitted to hospitals, and information is needed on how age-related functional decline affects nursing care needs of this population. This study compared the functional status at admission and total nursing care needs of three age groups of older inpatients. A 12-month retrospective audit was performed on the records of 225 patients in a private metropolitan hospital. The three groups of patients were matched on diagnosis. Findings revealed that older patients were significantly more dependent, had greater total nursing care needs, and were less likely to be discharged to home, indicating that in addition to medical diagnoses, age-related differences of older patients’ functional status at admission and inpatient nursing care needs should be factored into staff workloads and funding of nursing care. The finding that significantly fewer of the older patients returned home must be considered when reviewing health care policy and services.

Ways in which 'community' benefits frail older women's well-being : '... we are much happier when we feel we belong'

Aim: This paper aims to explore frail older women’s lived experiences of ‘community’ and which aspects of ‘community’ they perceive as beneficial to their well-being.

Method: This qualitative project used a mixed methodological approach which integrated aspects of descriptive phenomenology and grounded theory. Ten frail, older women residing in South East Melbourne, Australia participated in in-depth interviews.

Results: This research obtained a rich and detailed account of the aspects of ‘community’ identified by participants as enhancing their well-being. These included: social contact, community dynamics, feelings of support and positive orientation.

Conclusion: This paper has increased our understanding of the factors supporting well-being of frail older women. Service providers should actively consider how they can strengthen these factors to improve social connectedness for frail older women by the use of volunteers, developing social networks and increasing availability and quality of community-based activities.