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Objective: This study sought to determine the feasibility and acceptability of a facilitated advance care planning (ACP) intervention implemented in outpatient clinics, as perceived by health-care professionals (HCPs)., Methods: Data from seven focus groups (n = 27) and nine semi-structured interviews with HCPs recruited as part of a pragmatic, randomised controlled trial (RCT) were analysed using qualitative descriptive methodology. Components of the intervention included HCP education and training, tools to assist HCPs with patient selection, hardcopy information, and ACP documentation, and specialised nurse-facilitators to support HCPs to complete ACP conversations and documentation with patients and caregivers., Results: Health-care professionals working in tertiary outpatient clinics perceived the facilitated ACP intervention as feasible and acceptable. Health-care professionals reported a high level of satisfaction with key elements of the intervention, including the specialised education and training, screening and assessment procedures and ongoing support from the nurse-facilitators. Health-care professionals reported this training and support increased their confidence and ACP knowledge, leading to more frequent ACP discussions with patients and their families. Health-care professionals noted their ability to conduct ACP screening and assessment in clinic was impeded by large clinical caseloads and patient-related factors (e.g., dementia diagnoses, and emotional distress). Additional barriers to ACP implementation identified by HCPs included poor collaboration, constrained time and clinical space, undefined roles and standardised recording procedures for HCPs., Conclusions: Facilitated ACP intervention in outpatient clinics is perceived by HCPs as feasible and acceptable. Addressing barriers and tailoring implementation strategies may improve the delivery of ACP as part of tertiary outpatient care., (© 2024 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)

Objectives: This study aimed to investigate the relationship between sarcopenia and frailty and examine factors associated with frailty among older patients with and without sarcopenia., Methods: This cross-sectional study was conducted on older inpatients and outpatients in Vietnam. Participants aged 60 years or older were consecutively enrolled in the study. Sarcopenia was defined using the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Fried's frailty phenotype was applied to define frailty. Logistic regression models with frailty as the dependent variable were applied., Results: A total of 835 patients (mean age: 71.3 years, SD 8.4) were recruited. The overall prevalence of frailty was 17%. Among participants with and without frailty, 92% and 47% had sarcopenia, respectively. In unadjusted analysis, sarcopenia was significantly associated with increased frailty (OR 12.3, 95% CI 6.7-22.6) and remained significant after adjustment for sociodemographic factors (OR 6.3, 95% CI: 3.0-12.6) and for both sociodemographic and clinical factors (OR 5.4, 95% CI: 2.4-12.2). Among participants with sarcopenia, older age, inpatient status, having a high risk for falls, malnutrition and a history of hospitalisation in the last year were significantly associated with frailty. Among participants without sarcopenia, the factors associated with frailty were older age, inpatient status, low educational level, high risk of falls and malnutrition., Conclusions: Our study results highlighted that sarcopenia and frailty are two related but distinct geriatric syndromes., (© 2023 AJA Inc’.)

Objectives: The aim of this study was to describe the characteristics of clients receiving home-based dietetic intervention and to evaluate the effectiveness of these interventions in improving nutritional status, functional status, and quality of life in a culturally and socioeconomically diverse client group., Methods: Participants referred to a home-based dietetic service were recruited to this prospective cohort study. Dietetic interventions were recommended at baseline and reviewed at 3-month follow-up. Assessment of nutritional, functional and quality of life markers was measured using the Mini Nutritional Assessment (MNA), Timed Up and Go (TUG) and EQ-5D-5L, respectively, at baseline and after home-based dietetic intervention., Results: Participants (n = 99) were recruited from consecutive referrals. Participant's weight, body mass index (BMI), total daily energy and protein intake, MNA total score, and TUG significantly improved after a 3-month nutrition intervention (effect sizes 0.257, 0.257, 0.580, 0.533, 0.577 and 0.281, respectively). The most common interventions dietitians utilised were nutrition education, use of oral nutritional supplements (ONS) and meal fortification. In total, 339 dietetic interventions were recommended to participants at baseline with 197 (58.11%) implemented at 3 months, with meal planning and referral to other relevant allied health or Commonwealth Home Support Program (CHSP) services the most implemented interventions., Conclusions: Home-based dietetic intervention improves nutritional status, functional status and quality of life in community-dwelling older adults referred for dietetic input. Improvements observed in nutritional and functional status were consistent with benchmarks of change from published literature., (© 2024 AJA Inc’.)

Objective: To describe the types of hospital and out-of-hospital services provided by public geriatric medicine departments in Australia and New Zealand, and to explore head of department (HOD) views on issues in current and future service provision., Methods: An electronic survey was sent to HODs of public geriatric medicine departments., Results: Seventy-six (89%) of 85 identified HODs completed the survey. Seventy-one (93%) departments admit inpatients and 51 (67%) admit acute inpatients, with variable admission criteria. Sixty-four (84%) have hospitals with an inpatient general medicine service, and 58 (91%) of these admit older patients with acute geriatric issues. Sixty (79%) departments provide inpatient rehabilitation. Forty (53%) have beds for behavioural symptoms of dementia and/or delirium. Seventy (92%) provide a proactive orthogeriatric service. In terms of out-of-hospital services, 74 (97%) departments have outpatient clinics, 59 (78%) have telehealth and 68 (89%) perform home visits. Forty-five (59%) provide an inreach/outreach service to nursing homes. The most frequent gaps in service provision identified by HODs were acute geriatrics, surgical liaison, a designated dementia/delirium behavioural management unit, geriatricians in Emergency, outreach/inreach to residential care and shared care with some medical specialities. Increasing staff numbers and government policy change were the most frequently identified ways to address these gaps., Conclusions: Geriatric medicine service provision is variable across Australia and New Zealand, with key gaps identified. These findings will inform future directions in implementation of geriatric medicine models of care and discussions with various levels of government about the ongoing development of geriatric medicine services., (© 2024 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)

Objective: A growing proportion of older adults are undergoing surgery, but there is a paucity of patient and carer experience research in this group. This study investigated the experience of hospital care in an older vascular surgery population for patients and their carers., Methods: This was a mixed-methods convergent design, including simultaneous collection of quantitative and qualitative research strands by combining open-ended questions with rating scales in a questionnaire. Recently hospitalised vascular surgery patients aged ≥65 years at a major teaching hospital were recruited. Carers were also approached to participate., Results: Forty-seven patients (mean age 77 years, 77% male, 20% with a Clinical Frailty Scale score >4) and nine carers participated. The majority of patients reported that their views were listened to (n = 42, 89%), they were kept informed (n = 39, 83%), and were asked about their pain (n = 37, 79%). Among carers, seven reported their views were listened to and that they were kept informed. Thematic analysis of patients' and carers' responses to open-ended questions about their experience of hospital care revealed four themes in terms of what mattered to them: fundamental care including hygiene and nutrition, comfort of the hospital environment such as sleep and meals, being informed and involved in health-care decision-making, and treating pain and deconditioning to help recovery., Conclusions: Older adults admitted to hospital for vascular surgery and their carers, valued highly the care that met both their fundamental needs and facilitated shared decisions for care and recovery. These priorities can be addressed through Age-Friendly Health System initiatives., (© 2023 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)

Objective: To investigate geriatricians' views about issues facing geriatric medicine, and the preparedness of the health-care system during the COVID-19 pandemic., Methods: An online survey of heads of geriatric medicine departments in hospitals in Australia and New Zealand undertaken in May 2020., Results: The majority of hospitals had admitted one or more patients with suspected COVID-19. Most geriatricians believed their hospital was 'adequately' or 'well prepared' for the pandemic. Inpatient capacity increased to manage acute, post-acute and rehabilitative care of older patients with COVID-19. Non-inpatient services for older people were reduced and telehealth-instituted widely. Increases in work hours, on-call and staffing levels were reported. Geriatricians voiced major concerns about the preparedness of residential aged care facilities to manage the pandemic., Conclusions: The COVID-19 pandemic impacted on geriatricians and the provision of geriatric medicine services. Many issues that subsequently affected older people were predicted in advance., (© 2021 AJA Inc’.)

Objective: To investigate the association between home ownership and health in older men., Methods: Cross-sectional analysis of 909 community-dwelling Australian men (mean age: 81.3 ± 4.6) from the Concord Health and Ageing in Men Project (CHAMP, 2012-2013). We considered self-rated health, frailty status, multimorbidity, and anxiety and depressive symptoms which identify different dimensions of health., Results: Most participants were owner-occupiers (89.7%). In age- and country of birth-adjusted analyses, not being an owner-occupier was associated with an increased likelihood of depressive symptoms [prevalence ratio: 1.82, 95% confidence intervals 1.17 to 2.84]. There were no associations between home ownership and other health conditions., Conclusion: Lack of home ownership was associated with a higher prevalence of depressive symptoms, largely explained by poorer social support. Thus, targeting mental health programs at older divorced or separated men who do not own their own home could be an appropriate community-based intervention., (© 2021 AJA Inc.)

Objective: To investigate whether poorer oral health, tooth loss and lower usage of dental services are associated with depressive symptoms in older Australian men., Methods: Cross-sectional study of data collected from participants of the Concord Health and Ageing in Men Project. Depressive symptoms were evaluated by the Geriatric Depression Scale. Chewing capacity was estimated by ability to chew 11 food items., Results: The prevalence of depressive symptoms was 17.5%. Self-evaluated oral health, chewing capacity and the number of natural and decayed teeth were associated with depressive symptoms. After adjusting for multiple confounders, chewing capacity (PR 1.93; 95% CI 1.34-2.79) and decayed teeth (PR 1.68; 95% CI 1.03-2.75) maintained a significant association with depressive symptoms., Conclusion: The direction of causality between oral health and depression is unclear; however, oral health may contribute to depression in older Australian men and depressive symptoms may limit chewing capacity and be aggravated by untreated dental decay., (© 2019 AJA Inc.)

Objective: To gain insights into the experience and challenges faced by Australasian geriatricians who have recently made the transition from advanced trainee to consultant., Methods: An interpretative exploratory qualitative study. Geriatricians with five or less years of experience as consultants were recruited by email. Data were collected through semi-structured interviews, with themes identified through open axial coding., Results: Respondents (n = 20) experienced a transition period in which they adjusted to the roles of final decision-maker and manager. Respondents felt relatively confident with their clinical skills, but under-prepared for non-clinical roles associated with becoming a consultant. Most respondents described challenges with career planning. Support networks were considered critical., Conclusions: This is the first study in Australasia exploring the transition from trainee to consultant geriatrician. Training programs should endeavour to create "consultant-like roles" during advanced training and address non-clinical competencies. Participants perceived that there should be more emphasis on career planning and mentorship., (© 2019 AJA Inc.)

Objective: To describe perioperative geriatric medicine services in Australia and New Zealand, and to explore geriatricians' views on the need for and challenges in providing perioperative care., Method: An electronic questionnaire was sent to heads of geriatric medicine departments., Results: Sixty-seven (83%) of 81 identified geriatric medicine departments responded. Twelve (18%) departments provide a proactive surgical-geriatric medicine service. Their most common features were regular geriatric medicine ward rounds (100%), medication review (92%) and attendance at multidisciplinary meetings (83%). All respondents thought there was a need for geriatric medicine to provide greater input into the care of older surgical patients. Lack of funding (88%) and not enough geriatricians (58%) were the major perceived barriers., Conclusions: Although geriatricians believe they should provide proactive collaborative care for older surgical patients, only a few hospitals currently provide these services. Funding streams for these services and further research to determine the best models of care are needed., (© 2019 AJA Inc.)

Objective: To determine whether an oral health therapist daily oral hygiene intervention, compared with the same routine performed by nurses with some dental support, can improve the oral health of older inpatients., Methods: A prospective study was conducted at two tertiary referral hospitals with three phases: (i) pre-intervention (PI) usual oral care; (ii) oral health therapist intervention (OHTI); and (iii) nurse-led intervention (NI). Oral health was assessed with the Oral Health Assessment Tool., Results: Three hundred and fifty nine patients participated across three phases (PI (n = 206); OHTI (n = 77); NI (n = 76)). In the intervention groups, there was a significant decrease in 'unhealthy' oral cleanliness at day 7, OHTI; 86 to 53% (P < 0.001), NI; 80 to 50% (P < 0.001) compared to PI; 78 to 72% (P > 0.14). Movement from 'unhealthy' oral cleanliness at day 1 to 'healthy' at day 7 was significantly higher in the OHTI (35%) and NI (37%) compared to PI (17%) (P < 0.001)., Conclusion: With support, nurses can improve the oral health of older patients similarly to an oral health therapist., (© 2018 AJA Inc.)

Objective: To characterise older inpatients in a haematology unit., Methods: Hospital case-mix data of haematology separations of all ages (n = 7419) and more extensive data restricted to older patients (age ≥75 years, n = 1025) were evaluated., Results: From 2000 to 2014, there was a 200% increase in those aged ≥85 years who were more likely to have a geriatric syndrome as the principal diagnosis (P < 0.05), have delirium (P < 0.05), receive less intensive treatment (P < 0.001) and be discharged to a nursing home (P < 0.001). Compared to younger inpatients, those aged ≥75 years were more likely to be emergency admissions (48% vs 37%, P < 0.001) and die during the admission (8% vs 4%, P < 0.001)., Conclusion: Haematologists care for older inpatients who are complex with multidisciplinary health service needs. There may be value in conducting comprehensive geriatric assessments in this setting., (© 2018 AJA Inc.)

Falls in hospital are common and up to 70% result in injury, leading to increased length of stay and accounting for 10% of patient safety-related deaths. Yet, high-quality evidence guiding best practice is lacking. Fall prevention strategies have worked in some trials but not in others. Differences in study setting (acute, subacute, rehabilitation) and sampling of patients (cognitively intact or impaired) may explain the difference in results. This article discusses these important issues and describes the strategies to prevent falls in the acute hospital setting we have studied, which engage the cognitively impaired who are more likely to fall. We have used video clips rather than verbal instruction to educate patients, and are optimistic that this approach may work. We have also explored the option of co-locating high fall risk patients in a close observation room for supervision, with promising results. Further studies, using larger sample sizes are required to confirm our findings., (© 2018 AJA Inc.)

Objective: To explore differences between older male caregivers and non-caregivers on health status, health behaviours and well-being, including symptoms of anxiety., Methods: Data were collected through self-completed questionnaires and face-to-face interviews with 1705 community living men aged ≥70 in the Concord Health and Ageing in Men Project., Results: Eleven per cent of older men were caregivers, of whom 81.7% were looking after their wives or partners. Older male caregivers did not have worse physical health or more depressive symptoms than non-caregivers, but being a caregiver was associated with increased likelihood of reporting anxiety symptoms (OR: 2.32, 95% CI: 1.39-3.87). Caregivers had similar levels and frequencies of leisure activities but did more housework activities than non-caregivers., Conclusion: Higher anxiety levels were the main adverse health condition in older male caregivers. Strategies to assist minimising anxiety for caregivers should be a target of interventions., (© 2017 AJA Inc.)

Aim: To describe the age at which the geriatric syndromes and frailty become common in community-dwelling men., Methods: The Concord Health and Ageing in Men Project involves a population-based sample of 1705 community-dwelling men aged 70 and over from a defined geographic region in Sydney. Data were obtained by physical performance tests, clinical examinations, and questionnaire to determine the prevalence of the following conditions by five-year age group., Results: Poor mobility, recurrent falls, urinary incontinence, dementia and frailty phenotype were all uncommon (less than 10%) in men in their 70s, but the prevalence of each of these conditions exceeded 10% in men aged 85-89. The prevalence of Frailty Index-defined frailty, multimorbidity, polypharmacy and instrumental activities of daily living dependence was constantly high in all age groups., Conclusions: The different health-care needs of the 'old old' aged 85 years and older should be accounted for in health service planning., (© 2016 AJA Inc.)

Aim: To describe the prevalence and correlates of alcohol consumption and tobacco smoking among older Australian men., Method: Self-reported alcohol and tobacco use was assessed among a random sample of community-dwelling men aged ≥70 years living in Sydney (n = 1705) from 2005 to 2007. Logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with alcohol and tobacco use., Results: The prevalence of heavy/excessive drinking was 19.2%, daily drinking 33.7%, and binge drinking 14.1%. Daily drinking was associated with chronic pain (OR = 1.38, 95% CI: 1.07-1.78). Binge drinking was associated with anxiety (OR = 1.93, 95% CI: 1.05-3.54) and being widowed (OR = 1.74, 95% CI: 1.11-2.73). Six per cent of men were current smokers and 56.7% were former smokers. Former smoking was associated with polypharmacy (OR = 1.47, 95% CI: 1.14-1.91) and each additional comorbid condition (OR = 1.11, 95% CI: 1.03-1.19)., Conclusions: Nearly one-fifth of older men drank heavily or excessively. This highlights the need for public health initiatives to reduce alcohol consumption in older people., (© 2013 The Authors. Australasian Journal on Ageing © 2013 ACOTA.)

Aims: The aim of this study was to identify seminal Australasian Journal on Ageing papers published over 30 years through a Delphi consensus process., Method: The main data collection was a three-round Delphi consensus study with 38 past and current members of the Australasian Journal on Ageing Editorial Board, Editorial Team and Management Committee., Results: Three papers were agreed as top-ranking. One of the top-ranking articles was also highly cited. One article was published in the 1990 s, two in 2001., Conclusions: While it is difficult to judge how well the top-ranking papers represent seminal papers arising over 30 years, these papers do represent three different research strengths in Australasia, they do span three different disciplines, and they do reflect some of the diversity that characterises ageing research in Australasia over 30 years., (© 2013 ACOTA.)