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Introduction: This study aimed to assess the extent to which a single item of self-reported hearing difficulties is associated with future risk of falling among community-dwelling older adults. Methods: We used data from two Australian population-based cohorts: three waves from the PATH Through Life study (PATH; n = 2,048, 51% men, age 66.5 ± 1.5 SD years) and three waves from the Concord Health and Ageing in Men Project (CHAMP; n = 1,448, 100% men with mean age 77.3 ± 5.3 SD years). Hearing difficulties were recorded on a four-point ordinal scale in PATH and on a dichotomous scale in CHAMP. The number of falls in the past 12 months was reported at each wave in both studies. In CHAMP, incident falls were also ascertained by triannual telephone call cycles for up to four years. Multivariable-adjusted random intercept negative binomial regression models were used to estimate the association between self-reported hearing difficulties and number of falls reported at the following wave or 4-monthly follow-ups. Results: In PATH, self-reported hearing difficulties were associated with a higher rate of falls at follow-up (incidence rate ratio = 1.15, 95% CI = 1.03–1.27 per a one-level increase in self-reported hearing difficulties), after adjusting for sociodemographic characteristics, health behaviours, physical functioning, balance, mental health, medical conditions, and medications. There were no significant associations between hearing difficulties and the rate of falls based on either repeated survey or 4-monthly follow-ups in CHAMP. Conclusion: Though we find mixed results, findings from PATH data indicate an ordinal measure of self-reported hearing loss may be predictive of falls incidence in young-old adults. However, the null findings in the male-only CHAMP preclude firm conclusions of a link between hearing loss and falls risk.

There is a need to know how changes in health expectancy differ for population subgroups globally. The aim of this study was to estimate 10-year trends in health expectancies by individual markers of socioeconomic position from three points over the lifecourse, evaluating how compression and expansion of morbidity have varied within a national population.We analysed data from two cohorts of the Household Income and Labour Dynamics in Australia survey. The cohorts were followed annually from 2001 to 2007 (n=4720; baseline age range 50-100 years) and 2011 to 2017 (n=6632; baseline age range 50-99 years). Health expectancies were estimated at age 65 years for four outcomes reflecting activity limitations, disability, perceived health, and mental health. Cohort differences were compared by gender, age left school, occupational prestige, and housing tenure.Women with low socioeconomic position were the only group with no improvements in life expectancy across the two cohorts. Among men with low education and all women gains in life expectancy comprised entirely of years lived with global activity limitations. Compression of years lived with severe-disability, poor self-rated health, and poor mental health was most consistently observed for men and women with high education and home ownership. Occupational prestige did not greatly differentiate cohort differences in health expectancies.Over the past two decades in Australia, social disparities in health expectancies have at least been maintained, and have increased for some outcomes. Equitable gains in health expectancies should be a major public health goal, and will help support sustainable health and social care systems.Australian Research Council.

Research must be well designed, properly conducted and clearly and transparently reported. Our independent medical research institute wanted a simple, generic tool to assess the quality of the research conducted by its researchers, with the goal of identifying areas that could be improved through targeted educational activities. Unfortunately, none was available, thus we devised our own. Here, we report development of the Quality Output Checklist and Content Assessment (QuOCCA), and its application to publications from our institute’s scientists. Following consensus meetings and external review by statistical and methodological experts, 11 items were selected for the final version of the QuOCCA: research transparency (items 1–3), research design and analysis (items 4–6) and research reporting practices (items 7–11). Five pairs of raters assessed all 231 articles published in 2017 and 221 in 2018 by researchers at our institute. Overall, the results were similar between years and revealed limited engagement with several recommended practices highlighted in the QuOCCA. These results will be useful to guide educational initiatives and their effectiveness. The QuOCCA is brief and focuses on broadly applicable and relevant concepts to open, high-quality, reproducible and well-reported science. Thus, the QuOCCA could be used by other biomedical institutions and individual researchers to evaluate research publications, assess changes in research practice over time and guide the discussion about high-quality, open science. Given its generic nature, the QuOCCA may also be useful in other research disciplines.

Understanding gender differences in human cognitive development may contribute to understanding the gender differences in outcomes in cognitive ageing. However, evaluation of this topic has been hindered by a lack of representative, longitudinal data from different aged cohorts measured on the same cognitive tests. Gender differences in cognitive abilities were evaluated in three population-based cohorts (baseline age-span 20 to 76, 52% female, 94% Caucasian, 5% Asian and 1% other ethnic background, baseline N = 7,485), initially drawn from the electoral role in Australia where voting is compulsory, that were assessed four times over 12 years on measures of verbal memory, processing speed, working memory, verbal ability, and reaction time. Linear mixed models showed that within each cohort, women had better verbal memory and men had better working memory and faster reaction times. Verbal ability and processing speed showed variable gender differences in the young and middle-aged cohorts but no difference in the oldest cohort. In young and middle age, there were no gender differences in rates of change in verbal memory, processing speed, reaction time, verbal ability, or working memory. In old age, the gender differences were only observed in rates of change in verbal memory. Women showed more verbal memory decline between the 8-year and 12-year follow-ups than men, despite retaining higher average memory performance than men. We conclude that from ages 20-76, gender differences in cognitive abilities are stable except for faster memory ageing among women in the eighth decade. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

ObjectivesThis study investigates whether the within-person associations between a recent major financial crisis and deficits in cognitive performance vary across the life course.MethodsFour waves of data from 7,442 participants (49% men) spanning 12 years and comprising 3 narrow age birth cohorts (baseline age: 20–25, 40–45, and 60–65) were drawn from a representative prospective survey from Canberra, Australia (1999–2014). Cognitive performance was assessed by the California Verbal Learning Test (CVLT) immediate recall trails, Symbol Digit Modalities Test (SDMT), Digit Span Backward (DSB), and Trail Making Test B (TMT-B). A single item from the Threatening Life Experiences Questionnaire assessed self-reported major financial crisis in the past 6 months. Multivariable-adjusted fixed-effect regression models tested the time-dependent association between financial crisis and cognition.ResultsA recent financial crisis coincided with contemporaneous declines in CVLT (mean change = −0.14, 95% confidence interval [CI] = −0.262 to −0.025), SDMT (mean change = −0.08, 95% CI = −0.147 to −0.004), and TMT-B (mean change = −0.17, 95% CI = −0.293 to −0.039) for adults in the oldest age group, and these associations were larger than in the younger age groups. In contrast, there was an overall association between financial crisis and deficits in DSB (mean change = −0.06, 95% CI = −0.105 to −0.007), with weak evidence of stronger associations in midlife relative to other age groups. These associations were independent of changes in health and socioeconomic circumstances.DiscussionThis study provides important new evidence that financial difficulties in later life are potent stressors associated with occasion-specific deficits in cognitive performance.

To examine (i) reciprocal longitudinal associations between social connectedness and mental health, and (ii) how these associations vary by age and gender. Three waves of nationally representative data were drawn from the HILDA survey (n = 11,523; 46% men). The five-item Mental Health Inventory (MHI-5) assessed symptoms of depression and anxiety. The Australian Community Participation Questionnaire provided measures of informal social connectedness, civic engagement and political participation. Multivariable adjusted cross-lagged panel regression models with random intercepts estimated bidirectional within-person associations between mental health and each of the three types of social connectedness. Multi-group analyses were used to quantify differences between men and women, and between three broad age groups (ages: 15–30; 31–50; 51+). Reliable cross-lagged associations between prior informal social connections and future mental health were only evident among adults aged 50 years and older (B = 0.101, 95% CI 0.04, 0.16). Overall, there was no significant association between prior civic engagement and improvements in mental health (p = 0.213) though there was weak evidence of an association for men (B = 0.051, 95% CI 0.01, 0.09). Similarly, there was no significant association in the overall sample between political participation and improvements for mental health (p = 0.337), though there was weak evidence that political participation was associated with a decline in mental health for women (B = − 0.045, CI − 0.09, 0.00) and those aged 31–50 (B = − 0.057, CI − 0.10, − 0.01). Conversely, prior mental health was associated with future informal social connectedness, civic engagement, and political participation. Interventions promoting social connectedness to improve community mental health need to account for age- and gender-specific patterns, and recognise that poor mental health is a barrier to social participation.

Hearing loss is one of the most common long-term health conditions associated with ageing, and a considerable contributor to Australia’s late-life disability burden. Acquired hearing loss in adulthood presents significant challenges for the social, physical, mental and cognitive health of many Australians. These wide-ranging individual and societal impacts have been highlighted by a number of high-profile national inquiries into Australia’s hearing health during the past decade. Yet hearing loss remains poorly recognised and is undertreated in many communities. In this perspective article we argue that effective public health measures such as limiting occupational and recreational exposure to hazardous noise and ototoxic chemicals, promoting hearing health behaviours, early detection, improved access to hearing health services, and urban design, are all critical to mitigating these adverse outcomes. We also make the case for updated epidemiological data about hearing loss among older Australians.

Background There is a need to understand how early adversity is linked with mental health in older adults. The aim of this study was to 1) explore the optimal way to operationalise a scale of adverse childhood experiences (ACEs) and 2) examine the association between ACEs with depression and anxiety in older adulthood. Methods Data were from Wave 1 of the Personality and Total Health (PATH) Through Life Project (N = 7485, 51% women). Older adults aged 60-65 reported their childhood experiences of domestic adversity on a 17-item scale (e.g., physical abuse, neglect, poverty). Depression and anxiety were assessed using four validated screening instruments (GDS, GAS, MCS-12, PHQ-9). Three approaches to scoring the ACE scale were compared: i) cumulative risk, ii) factor analysis, and iii) latent class analysis (LCA). Linear regression models estimated associations between ACEs and mental health, adjusting for age, race, education, and gender. Results Childhood adversity was associated with late life depression and anxiety using the cumulative risk approach. Factor analysis produced latent factors of threat and deprivation, which were highly correlated, leading to problems with multicollinearity when estimating associations. Finally, LCA revealed three classes of ACEs: high adversity, low adversity, and parental maladjustment. High adversity and parental maladjustment were associated with higher levels of depression and anxiety symptoms compared to low adversity. Conclusion Different approaches to operationalising childhood adversity reveal that ACE exposure is associated with depression and anxiety in older adults. Future studies will utilise these methods to investigate links with cognitive decline and dementia.

Background: Vision loss and hearing loss are common in later life and are associated with cognitive impairment and neuropsychiatric symptoms. There is a need to better understand how individual characteristics, such as poor sensory functioning, are linked with familial well-being. Objectives: The aim of this study was to investigate whether, among persons with neuropsychiatric symptoms, age-related sensory loss is related to increased emotional distress reported by their family and friends. Methods: The sample comprised 537 participant-informant dyads from the Personality and Total Health through Life (PATH) study, a community-based cohort. Participants were aged between 72 and 79 years (56% men), and all were reported to exhibit at least 1 neuropsychiatric symptom. Informants were participants’ spouse (50%), child (35%), friend (7%), or other relatives (7%). Neuropsychiatric symptom-related distress of friends and family was assessed with the distress subscale of the Neuropsychiatric Inventory (NPI). Sensory functioning in participants was assessed by visual acuity and self-reported hearing difficulties. Ordinal logistic regression analyses estimated the association between sensory problems and NPI distress. Results: In models adjusted for informant dyadic relationship and socio-demographics, both lower visual acuity (B = 0.23, SE = 0.10) and self-reported hearing difficulty (B = 0.15, SE = 0.06) were associated with increased levels of distress. The increased informant distress associated with poor visual acuity was attenuated after adjusting for neurocognitive disorder and health conditions (p = 0.069). A significant interaction between vision and hearing remained after multivariable adjustment (χ2(1) = 6.73, p = 0.010). Conclusions: Friends and family of persons with poor visual acuity and perceived hearing difficulties report elevated levels of neuropsychiatric symptom-related distress relative to friends and family of persons with poor sensory functioning in only 1 sensory domain or unimpaired levels of vision and hearing. These findings provide evidence of the third-party effects of sensory loss in the context of neuropsychiatric symptoms, and in particular show how dual sensory loss can confer additional challenges over and above the effects of a single sensory loss.

This article presents a broad narrative review of the epidemiological evidence on how and why the mental health of older adults varies by gender. We draw upon international research literatures spanning gerontology and population mental health, as well as major reports from global health agencies. Compared with older men, older women are more likely to experience common mental disorders such as depression and anxiety, although the gender gap is smaller than it is at younger ages. In contrast, the mortality-related impacts of poor mental health, including suicide, are more severe for older men. These gendered patterns vary by country and other social contexts. Factors proposed to account for these findings include cultural and social norms, differentiation of gender roles, disadvantage and (dis)empowerment across the life course, and the coping styles of older men. However, little research has explicitly tested these explanations. Research to date has overwhelmingly focused on identifying differences in the mental health of older men and women. Notably, most studies have been restricted to binary comparisons, lacking the data to disentangle sex and gender dynamics, and few studies have examined the mental health of minority gendered adults in later life. Finally, there remains a need for high-quality population-based research into the mental health of those aged over 80 that includes coverage of people living in residential aged care settings.

BackgroundThe aims of this study were (1) to estimate 10-year trends in disability-free life expectancy (DFLE) by area-level social disadvantage and (2) to examine how incidence, recovery and mortality transitions contributed to these trends.MethodsData were drawn from the nationally representative Household Income and Labour Dynamics in Australia survey. Two cohorts (baseline age 50+ years) were followed up for 7 years, from 2001 to 2007 and from 2011 to 2017, respectively. Social disadvantage was indicated by the Socio-Economic Indexes for Areas (SEIFA). Two DFLEs based on a Global Activity Limitation Indicator (GALI) and difficulties with activities of daily living (ADLs) measured by the 36-Item Short Form Survey physical function subscale were estimated by cohort, sex and SEIFA tertile using multistate models.ResultsPersons residing in the low-advantage tertile had more years lived with GALI and ADL disability than those in high-advantage tertiles. Across the two cohorts, dynamic equilibrium for GALI disability was observed among men in mid-advantage and high-advantage tertiles, but expansion of GALI disability occurred in the low-advantage tertile. There was expansion of GALI disability for all women irrespective of their SEIFA tertile. Compression of ADL disability was observed for all men and for women in the high-advantage tertile. Compared to the 2001 cohort, disability incidence was lower for the 2011 cohort of men within mid-advantage and high-advantage tertiles, whereas recovery and disability-related mortality were lower for the 2011 cohort of women within the mid-advantage tertile.ConclusionOverall, compression of morbidity was more common in high-advantage areas, whereas expansion of morbidity was characteristic of low-advantage areas. Trends also varied by sex and disability severity.

Background Smoking and obesity are 2 modifiable risk factors for disability. We examine the impact of smoking and obesity on disability-free life expectancy (DFLE) at older ages, using 2 levels of disability. Method We used the DYNOPTA dataset, derived by harmonizing and pooling risk factors and disability outcomes from 5 Australian longitudinal aging studies. We defined mobility disability as inability to walk 1 km, and more severe (activities of daily living [ADL]) disability by the inability to dress or bathe. Mortality data for the analytic sample (N = 20 401; 81.2% women) were obtained from Government Records via data linkage. We estimated sex-specific total life expectancy, DFLE, and years spent with disability by Interpolated Markov Chain (IMaCh) software for each combination of smoking (never vs ever), obesity (body mass index ≥30 vs 18.5 to Results Compared to those without either risk factor, high educated nonobese smokers at age 65 lived shorter lives (men and women: 2.5 years) and fewer years free of mobility disability (men: 2.1 years; women: 2.0 years), with similar results for ADL disability. Obesity had the largest effect on mobility disability in women; high educated obese nonsmoking women lived 1.3 years less than nonsmoking, not obese women but had 5.1 years fewer free of mobility disability and 3.2 fewer free of ADL disability. Differences between risk factor groups were similar for the low educated. Conclusions Our findings suggest eliminating obesity would lead to an absolute reduction of disability, particularly in women.

To examine (i) reciprocal longitudinal associations between social connectedness and mental health, and (ii) how these associations vary by age and gender.Three waves of nationally representative data were drawn from the HILDA survey (n = 11,523; 46% men). The five-item Mental Health Inventory (MHI-5) assessed symptoms of depression and anxiety. The Australian Community Participation Questionnaire provided measures of informal social connectedness, civic engagement and political participation. Multivariable adjusted cross-lagged panel regression models with random intercepts estimated bidirectional within-person associations between mental health and each of the three types of social connectedness. Multi-group analyses were used to quantify differences between men and women, and between three broad age groups (ages: 15-30; 31-50; 51+).Reliable cross-lagged associations between prior informal social connections and future mental health were only evident among adults aged 50 years and older (B = 0.101, 95% CI 0.04, 0.16). Overall, there was no significant association between prior civic engagement and improvements in mental health (p = 0.213) though there was weak evidence of an association for men (B = 0.051, 95% CI 0.01, 0.09). Similarly, there was no significant association in the overall sample between political participation and improvements for mental health (p = 0.337), though there was weak evidence that political participation was associated with a decline in mental health for women (B = - 0.045, CI - 0.09, 0.00) and those aged 31-50 (B = - 0.057, CI - 0.10, - 0.01). Conversely, prior mental health was associated with future informal social connectedness, civic engagement, and political participation.Interventions promoting social connectedness to improve community mental health need to account for age- and gender-specific patterns, and recognise that poor mental health is a barrier to social participation.

Childhood adversity is a multifaceted construct that is in need of comprehensive operationalisation.The aim of this study was to explore the optimal method to operationalise a scale of adverse childhood experiences (ACEs).Data were from Wave 1 of the Personality and Total Health (PATH) Through Life Project (N = 7485, 51% women). Participants from three age groups (20-25, 40-45, 60-65) retrospectively reported their childhood experiences of domestic adversity on a 17-item scale (e.g., physical abuse, verbal abuse, neglect, poverty).We compared three approaches to operationalising the 17-item scale: a cumulative risk approach, factor analysis, and latent class analysis (LCA). The cumulative risk and dimensional models were represented by a unidimensional and two-dimensional model respectively using confirmatory factor analysis (CFA).The cumulative risk approach and LCA were viable approaches to operationalising ACE data in PATH. CFA of the dimensional model produced latent factors of threat and deprivation that were highly correlated, potentially leading to problems with multicollinearity when estimating associations. LCA revealed six classes of ACEs: high adversity, low adversity, low affection, authoritarian upbringing, high parental dysfunction, and moderate parental dysfunction.Our study found multiple latent classes within a 17-item questionnaire assessing domestic adversity. Using both the cumulative method and latent class approach may be a more informative approach when examining the relationship between ACEs and later health outcomes. Future ACE studies may benefit by considering multi-dimensional approaches to operationalising adversity.

Objective This study examined the association between mental ill-health and subsequent receipt of a disability pension in Australia, and assessed how the strength of the association varied in relation to the duration between mental health measurement and reported disability pension receipt. Methods Eight thousand four hundred seventy-four working-age adults not receiving a disability pension at baseline were followed for up to 11 years; 349 transitioned onto a disability pension. Discrete-time survival analysis considered baseline and time-varying (12-month lagged) measures of mental ill-health. Results Proximal measures of mental ill-health were more strongly associated with subsequent pension receipt than baseline measures (odds ratio: 6.6 vs 3.9) and accounted for a significantly greater proportion of pension transitions (35% vs 21%). Conclusion Mental ill-health is an independent risk factor for disability pension receipt, and proximal circumstances better capture this association than mental health measured earlier.

Background:To investigate the differential associations between sensory loss and neuropsychiatric symptoms among older adults with and without diagnosed neurocognitive disorder.Methods:The sample comprised 1,393 adults (52.3% men) aged between 72 and 79 years from a community-based cohort study. There were 213 cases of mild and 64 cases of major neurocognitive disorders. The main outcome was number of informant reported symptoms on the Neuropsychiatric Inventory (NPI). Sensory loss was defined by visual acuity worse the 0.3 logMAR (6/12 or 20/40) and self-reported hearing problems.Results:Clinically relevant NPI symptoms were reported in 182 (13.1%) participants, but no individual symptom occurred in more than 5% of the total sample. Among participants diagnosed with a major neurocognitive disorder, those with any sensory loss had over three times (95%CI: 1.72–11.78) greater rates of NPI symptoms than those with unimpaired levels of sensory functioning. There were no differences in the number of neuropsychiatric symptoms by type of sensory loss, and no additional risk associated with a dual sensory loss compared to a single sensory loss. There was no evidence of an association between sensory loss and number of neuropsychiatric symptoms among cognitively healthy adults.Conclusions:The extent to which this association is the result of underlying neuropathology, unmet need, or interpersonal factors is unclear. These findings have significant implications for dementia care settings, including hospitals and respite care, as patients with sensory loss are at increased risk of neuropsychiatric symptoms and may require additional psychosocial support. Interventions to manage sensory loss and reduce the impact of sensory limitations on neuropsychiatric symptoms are needed.

We report the first analysis of inequalities in Disability-Free Life Expectancy (DFLE) trends for Australia, based on two cohorts of the nationally representative Household Income and Labour Dynamics in Australia survey. Each cohort was aged 45+ at baseline with 7-years of annual follow-up (Older cohort: 2001-2007, n=6363; Younger cohort: 2011-2017, n=8197). Disability was defined by a Global Activity Limitation Indicator, and socioeconomic position (SEP) by an area-level index of disadvantage. Compared to men in high advantage areas, men residing in low advantage areas experienced smaller gains in life expectancy (3.0 vs 4.6 years at age 65), DFLE (0.6 vs 1.8 years) and years with disability (2.4 vs 2.8 years). In contrast, for women in low advantage areas all years gained in life expectancy (2.6 years) were years with disability, whereas women in high advantage areas experienced gains in DFLE (1.7 years) and even more years with disability (2.7 years).

BackgroundItem 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.MethodsWe conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.Results16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).ConclusionsPHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.

Research on cognitive and mental health expectancies has slowly accumulated over the past decade, with wider geographic coverage and evaluation of results within sub-population characterised by demographic or health factors. Most studies show that women spend more years with dementia and cognitive impairment than men, despite longer life expectancies. While cognitive health expectancies are particularly important for describing outcomes for older adults, mental health expectancies are particularly important for outcomes in younger adults. Methodological challenges in this field relate to the consistency in measurement of outcomes, particularly given language and cultural differences, as well as the interpretation of findings over time. Significant knowledge gaps remain with a lack of data from particular regions and countries, and for several mental disorders.

BACKGROUND: Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9. METHODS: We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy. RESULTS: 16,742 participants (2,097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0·996 (95% confidence interval 0·996 to 0·996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0·02 (−0·06 to 0·00) and more specific by 0·01 (0·00 to 0·01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0·00 to 0·05 (0·03 at cutoff 10), and specificity was within 0·01 for all cutoffs (0·00 to 0·01). CONCLUSIONS: PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.

Objective: There is limited Australian information on the prevalence and mental health consequences of bullying and ill-treatment at work. The aims of this study were to use data from an ongoing Australian longitudinal cohort study to (1) compare different measures of workplace bullying, (2) estimate the prevalence of bullying and ill-treatment at work, (3) evaluate whether workplace bullying is distinct from other adverse work characteristics and (4) examine the unique contribution of workplace bullying to common mental disorders in mid-life. Method: The sample comprised 1466 participants (52% women) aged 52–58 from wave four of the Personality and Total Health (PATH) through Life study. Workplace bullying was assessed by a single item of self-labelling measure of bullying and a 15-item scale of bullying-related behaviours experienced in the past 6 months. Factor analysis the identified underlying factor structure of the behavioural bullying scale. Results: Current bullying was reported by 7.0% of respondents, while 46.4% of respondents reported that they had been bullied at some point in their working life. Person-related and work-related bullying behaviours were more common than violence and intimidation. The multi-dimensional scale of bullying behaviours had greater concordance with a single item of self-labelled bullying (Area Under the Curve = 0.88) than other adverse work characteristics (all Area Under the Curves Conclusion: This study provides unique information on the prevalence and mental health impacts of workplace bullying and ill-treatment in Australia. Workplace bullying is a relatively common experience, and is associated with increased risk of depression and anxiety. Greater attention to identifying and preventing bullying and ill-treatment in the workplace is warranted.

There has been little investigation of how life-course social mobility is linked to Disability-Free Life Expectancy (DFLE). We report novel analysis of the HILDA survey examining how DFLE trends differs by three markers of socio-economic position (SEP): early-life (educational attainment), midlife (occupational level), and late-life (area-disadvantage). All women, irrespective of their educational level, gained years with disability (Age 65: Low education=1.5 and High education=2.5 years). Similar results were obtained by level of occupation, but women with low occupation showed small declines in LE (-0.8 years), all being losses in DFLE. Only women in the most advantaged areas gained DFLE. For men, higher levels of any marker of SEP were associated with DFLE gains that were larger than, or comparable to, gains in years lived with disability, although lower education was associated only with gains in years lived with disability. DFLE trends differ by SEP marker more in women than men.

Key Points Question Are brief off-road screening measures sufficiently sensitive and specific to identify older drivers who will not pass an on-road driving test in Australia? Findings This prognostic study including 560 drivers aged 63 years and older found that off-road screening tests could identify older drivers who would not pass an on-road driving test with 77% sensitivity and 82% specificity. A combination of measures drawing from multiple skill domains provided the best prediction. Meaning These findings suggest that brief off-road screening tests could be a cost-effective, objective tool to screen older drivers to determine who might be an unsafe driver and to indicate referral for an on-road driving test., This prognostic study examines participants’ scores on 8 screening tools to identify drivers who are potentially unsafe compared with on-road driving test scores., Importance There is an urgent need to develop evidence-based assessments to identify older individuals who may be unsafe drivers. Objective To validate 8 off-road brief screening tests to predict on-road driving ability and to identify which combination of these provides the best prediction of older adults who will not pass an on-road driving test. Design, Setting, and Participants This prognostic study was conducted between October 31, 2013, and May 10, 2017, using the criterion standard for screening tests, an on-road driving test, with analysis conducted from August 1, 2019, to April 2, 2020. A volunteer sample of older drivers was recruited from community advertisements, rehabilitation and driver assessment clinics, and an optometry clinic in Canberra and Brisbane, Australia. Exposures Off-road driver screening measures, including the Useful Field of View, DriveSafe/DriveAware, Multi-D battery, Trails B, Maze test, Hazard Perception Test, DriveSafe Intersection test, and 14-item Road Law test. Main Outcomes and Measures Classification as unsafe on a standardized 50-minute on-road driving assessment administered by a driving instructor and an occupational therapist masked to the participant’s clinical diagnosis and off-road test performance. Results A total of 560 drivers aged 63 to 94 years (mean [SD] age, 74.7 [6.2] years]; 350 [62.5%] men) were assessed. Logistic regression and receiver operating characteristic analyses indicated the area under the curve was largest for a multivariate model comprising the Multi-D, Useful Field of View, and Hazard Perception Test, with an area under the curve of 0.89 (95% CI, 0.85-0.94), sensitivity of 80.4%, and specificity of 84.1% for predicting unsafe drivers. The Multi-D battery was the most accurate individual assessment and had an area under the curve of 0.85 (95% CI, 0.79-0.90), sensitivity of 77.1%, and specificity of 82.1%. The multivariate model had sensitivity of 83.3% and specificity of 91.8% in the cognitively impaired group and sensitivity of 87.5% and specificity of 70.8% in the visually impaired group. Conclusions and Relevance These findings suggest that off-road screening tests can reliably identify older drivers with a strong probability of failing an on-road driving test. Implementation of these measures could enable better targeting of resources for managing older driver licensing and support injury prevention strategies in this group.

Background The aim of this study was to estimate the expected years lived with hearing impairment, vision impairment, and dual sensory impairment among older adults. Methods A total of 4,160 adults (45.1% men) from two Australian community based studies were followed for up to 16 years (average 8.9 years). Hearing impairment was defined by a pure-tone average (500-4000 Hz) greater than 25 dB in the better ear. Vision impairment was defined by presenting distance visual acuity worse than 6/12 (20/40). Postliminary analyses were also conducted for moderate levels of sensory impairment. Dual sensory impairment was defined by concurrent hearing and vision impairment. Multistate Markov models were used to calculate sensory life expectancies based on transition probabilities between health states (no sensory impairment, sensory impairment, and death). Results Based on thresholds for mild impairment, men aged 65 had a total life expectancy of 19.4 years, and were estimated to live for 10.4 years (95% confidence interval [CI]: 9.1, 11.7) with hearing impairment, 2.8 years (95% CI: 2.4, 3.2) with vision impairment, and 2.2 years (95% CI: 1.8, 2.6) with dual sensory impairment. Women aged 65 had a total life expectancy of 23.2 years, and were estimated to live for 12.9 years (95% CI: 11.9, 13.9) with hearing impairment, 3.9 years (95% CI: 3.4, 4.4) with vision impairment, and 3.2 years (95% CI: 2.7, 3.7) with dual sensory impairment. Conclusions In addition to being highly prevalent, hearing and vision impairment affect older adults for substantial periods of their remaining life. Given their broad ranging impacts on health and well-being, sensory impairments are ideal targets for strategies to compress morbidity in late life.

The CLPsych 2018 Shared Task B explores how childhood essays can predict psychological distress throughout the author’s life. Our main aim was to build tools to help our psychologists understand the data, propose features and interpret predictions. We submitted two linear regression models: ModelA uses simple demographic and word-count features, while ModelB uses linguistic, entity, typographic, expert-gazetteer, and readability features. Our models perform best at younger prediction ages, with our best unofficial score at 23 of 0.426 disattenuated Pearson correlation. This task is challenging and although predictive performance is limited, we propose that tight integration of expertise across computational linguistics and clinical psychology is a productive direction.

Objective: Computerized training for cognitive enhancement is of great public interest, however, there is inconsistent evidence for the transfer of training gains to every day activity. Several large trials have focused on speed of processing (SOP) training with some promising findings for long-term effects on daily activity, but no immediate transfer to other cognitive tests. Here, we examine the transfer of SOP training gains to cognitive measures that are known predictors of driving safety in older adults. Methods: Fifty-three adults aged 65–87 years who were current drivers participated in a two group non-randomized design with repeated measures and a no-contact matched control group. The Intervention group completed an average of 7.9 (SD = 3.0) hours of self-administered online SOP training at home. Control group was matched on age, gender and test-re-test interval. Measures included the Useful Field of View (UFOV) test, a Hazard Perception test, choice reaction time (Cars RT), Trail Making Test B, a Maze test, visual motion threshold, as well as road craft and road knowledge tests. Results: Speed of processing training resulted in significant improvement in processing speed on the UFOV test relative to controls, with an average change of -45.8 ms (SE = 14.5), and effect size of ω2 = 0.21. Performance on the Maze test also improved, but significant slowing on the Hazard Perception test was observed after SOP training. Training effects on the UFOV task was associated with similar effects on the Cars RT, but not the Hazard Perception and Maze tests, suggesting transfer to some but not all driving related measures. There were no effects of training on any of the other measures examined. Conclusion: Speed of processing training effects on the UFOV task can be achieved with self-administered, online training at home, with some transfer to other cognitive tests. However, differential effects of training may be observed for tasks requiring goal-directed search strategies rather than diffuse attention.

Aim We evaluated the effectiveness of individually tailored driving lessons compared with a road rules refresher course for improving older driver safety. Methods Two arm parallel randomised controlled trial, involving current drivers aged 65 and older (Mean age 72.0, 47.4% male) residing in Canberra, Australia. The intervention group (n = 28) received a two-hour class-based road rules refresher course, and two one-hour driving lessons tailored to improve poor driving skills and habits identified in a baseline on-road assessment. The control group (n = 29) received the road rules refresher course only. Tests of cognitive performance, and on-road driving were conducted at baseline and at 12-weeks. Main outcome measure was the Driver safety rating (DSR) on the on-road driving test. The number of Critical Errors made during the on-road was also recorded. Results 55 drivers completed the trial (intervention group: 27, control group: 28). Both groups showed reduction in dangerous/hazardous driver errors that required instructor intervention. From baseline to follow-up there was a greater reduction in the number of critical errors made by the intervention group relative to the control group (IRR = 0.53, SE = 0.1, p = .008). The intervention group improved on the DSR more than the control group (intervention mean change = 1.07 SD = 2.00, control group mean change = 0.32 SD = 1.61). The intervention group had 64% remediation of unsafe driving, where drivers who achieved a score of ‘fail’ at baseline, ‘passed’ at follow-up. The control group had 25% remediation. Conclusion Tailored driving lessons reduced the critical driving errors made by older adults. Longer term follow-up and larger trials are required.

Objective: To examine longitudinal associations between mental health and welfare receipt among working-age Australians. Method: We analysed 9 years of data from 11,701 respondents (49% men) from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Mental health was assessed by the mental health subscale from the Short Form 36 questionnaire. Linear mixed models were used to examine the longitudinal associations between mental health and income support adjusting for the effects of demographic and socio-economic factors, physical health, lifestyle behaviours and financial stress. Within-person variation in welfare receipt over time was differentiated from between-person propensity to receive welfare payments. Random effect models tested the effects of income support transitions. Results: Socio-demographic and financial variables explained the association between mental health and income support for those receiving student and parenting payments. Overall, recipients of disability, unemployment and mature age payments had poorer mental health regardless of their personal, social and financial circumstances. In addition, those receiving unemployment and disability payments had even poorer mental health at the times that they were receiving income support relative to the times when they were not. The greatest reductions in mental health were associated with transitions to disability payments and parenting payments for single parents. Conclusions: The poor mental health of welfare recipients may limit their opportunities to gain work and participate in community life. In part, this seems to reflect their adverse social and personal circumstances. However, there remains evidence of a direct link between welfare receipt and poor mental health that could be due to factors such as welfare stigma or other adverse life events coinciding with welfare receipt for those receiving unemployment or disability payments. Understanding these factors is critical to inform the next stage of welfare reform.

Purpose: to describe the methodology and present the retinal grading findings of an older sample of australians with well-defined indices of neurocognitive function in the Personality and total Health (PatH) through life project. Design: a cross-sectional study. Methods: three hundred twenty-six individuals from the PatH through life project were invited to participate. Participants completed a general questionnaire and 2-field, 45-degree nonmydriatic color digital retinal photography. Photographs were graded for retinal pathology according to established protocols. Results: two hundred fifty-four (77.9%) subjects, aged 72 to 78 years, agreed to participate in the eye substudy. gradable images of at least 1 eye were acquired in 211 of 254 subjects (83.1%). retinal photographic screening identified 1 or more signs of pathology in 130 of the 174 subjects (74.7%) with gradable images of both eyes. a total of 45 participants (17.7%) had self-reported diabetes and diabetic retinopathy was observed in 22 (48.9%) of these participants. Conclusions: this well-defined sample of older australians provides a unique opportunity to interrogate associations between retinal findings, including retinal vascular geometric parameters, and indices of neurocognitive function.

We aimed to investigate predictors of change in pure-tone hearing thresholds in older adults.Data were drawn from a pooled sample from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project (N = 4,221, mean age = 73.6, range: 50-103 years). Pure-tone hearing thresholds were tested for frequencies between 0.5 and 8 kHz, on up to four occasions over a period of 11 years. Linear mixed models tested for predictors of change in hearing.Hearing loss for high-range frequencies preceded decline in low-range frequencies. Men had higher baseline hearing thresholds, but women experienced faster rates of decline in hearing for mid- to high-range frequencies. The estimated rate of change for a 75-year-old adult was 0.91 decibel hearing level (dB HL) per year for pure-tone thresholds averaged over frequencies ranging between 0.5 and 4 kHz in the better ear. Baseline age (β = 0.03, p.01), hypertension (β = 0.15, p.01), and probable cognitive impairment (β = 0.40, p = .01) were independent predictors of annual rate of change in hearing thresholds. Incidence of probable cognitive impairment was also associated with higher hearing thresholds. Other known correlates for prevalence of hearing impairment, including low education, noise damage, diabetes, and history of stroke were independently associated with baseline levels of hearing but were not predictive of change in hearing thresholds.Faster rates of decline in hearing are predicted by probable cognitive impairment and hypertension.

The coexistence of depressive symptoms and cognitive decline in older adulthood is well established, whereby greater depressive symptoms are associated with poorer cognitive functioning and cognitive decline (Dotson, Resnick, & Zonderman, 2008). However, the causal and temporal relations between depressive symptoms and cognition remain ill-defined. There are suggestions that depressive symptoms may increase an individual's risk for subsequent cognitive decline. For example, there are reports that those with more baseline depressive symptoms had greater cognitive decline over time than those without depressive symptoms (Kohler et al., 2010; Yaffe et al., 1999). Another study found no increase in depressive symptoms during the prodromal phase of Alzheimer's disease (AD; Wilson, Arnold, Beck, Bienias, & Bennett, 2008), and concluded that depression acts to change cognition, and not the other way around. In contrast, lower cognitive functioning may increase the risk for depressive symptoms. Studies that have found depressive symptoms were unrelated to the rate of cognitive decline (Ganguli, Yangchun, Dodge, Ratcliff, & Chang, 2006; Vinkers, Gussekloo, Stek, Westendorp, & van der Mast, 2004) have consequently concluded that the alternative directional explanation (i.e., cognitive decline leads to depressive symptamotology) is more probable. Thus the connection between aspects of depression and cognition remains equivocal. Further, it may not be best expressed by a simple unidirectional temporal pathway. Han and colleagues (2006) attributed the link between depressive symptoms and general cognitive functioning to short-term situational factors, in that the relation is concurrent or temporary, rather than leading to increased risk. Alternatively, Jorm (2000) noted various hypotheses concerning the common coexistence of depressive symptoms and dementia including other conceptualizations such that depression and dementia share common risk factors (e.g., vascular disease). Nonetheless, we restrict our focus to the time-ordered relation between depressive symptoms and cognitive decline. Insight into the directionality of this association will aid in understanding whether and how their interrelation develops over time, and possibly provide key information into the disease process of dementia and major depression. Although longitudinal analysis has informed our understanding of covariation between depressive symptoms and cognitive decline (Chen, Ganguli, Mulsant, & DeKosky, 1999; Ganguli et al., 2006; Han et al., 2006; Vinkers et al., 2004; Yaffe et al., 1999), there has been no direct test of the directionality of the relation whereby a dynamic association is allowed to occur across time, or where one variable is modeled as being related to change in the other variable over time. With recent advances in statistical modeling, the bivariate dual change score model (BDCSM, McArdle & Hamagami, 2001) indeed allows for such temporal comparisons. This model is based in a structural equation modeling framework, and builds upon the latent growth curve model which estimates latent intercept and slope factors at the population level. The BDCSM allows for examining time-ordered associations between two constructs, thereby testing whether one variable at a given point in time predicts subsequent change in the other variable (see Figure 1). This model has been successfully applied to empirically test associations among other psychological domains, including competing hypotheses about the nature of lead-lag associations between cognition and leisure activities (Lovden, Ghisletta, & Lindenberger, 2005), cognition and well-being (Gerstorf, Lovden, Rocke, Smith, & Lindenberger, 2007), and the dynamic associations of cognitive functioning between spouses (Gerstorf, Hoppmann, Anstey, & Luszcz, 2009). 1 Graphical representation of a two-variable Dual Change Score Model (DCSM(McArdle & Hamagami, 2001)) for a system of two variables X and Y. Observed (manifest) variables are represented by squares, unobserved (latent) variables by circles, regression ... In this study, we applied the BDCSM to 15-year longitudinal data of depressive symptoms and perceptual speed. Perceptual speed was selected as the marker of cognitive functioning, as it constitutes the limiting factor for other cognitive processes (Luszcz & Bryan, 1999) and is a highly reliable and sensitive marker of cognitive change throughout adulthood (Anstey, Hofer, & Luszcz, 2003; Salthouse, 2004). By simultaneously modeling longitudinal changes in depressive symptoms and cognition, we tested various hypotheses about their dynamic relation over time. First, we investigated both unidirectional hypotheses: whether the level of depressive symptoms at time [t] predicts subsequent change in perceptual speed between [t] and [t + 1], or whether the level of perceptual speed predicts changes in depressive symptomatology. Next, we analyzed bidirectional associations, including where both leading pathways exist and are of different magnitude, and where neither variable is associated with changes in the other. Finally, we covaried the effects of baseline age, education, general cognitive status, and number of medical conditions to ensure our findings do not simply reflect the influence of these variables on cognitive functioning and depressive symptoms (Bassuk, Berkman, & Wypij, 1998; Geerlings et al., 2000).

OBJECTIVES: To investigate self-reported driving status within three Australian states; associations between demographic, health, and functional factors and driving status; and the extent to which remaining a driver in spite of cognitive and visual impairments varies as a function of sex. DESIGN: Secondary data analysis of a pooled data set. SETTING: Australian communities. PARTICIPANTS: Adults aged 65 to 103 (N=5,206) from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project. DYNOPTA is a unique data set created through the harmonization and pooling of data across nine separate Australian longitudinal studies of aging conducted between 1990 and 2007 (N=50,652). MEASUREMENTS: Driving status, demographic characteristics, Mini-Mental State Examination score, visual acuity, physical activity, and occupation. RESULTS: Men and participants with higher-level occupations had greater odds of driving. Older age, more medical conditions, and poorer vision increased the odds of not driving. Persons who were divorced, widowed, or never married were at a greater risk than married adults of not driving. Descriptive analyses revealed a large proportion of men with probable visual or cognitive impairments who reported driving. Subsequent comparative analyses between the DYNOPTA sample and other published U.S. and Canadian data revealed lower proportions of current drivers among Australian women and those at older ages, although there were consistently lower proportions of drivers within Australia and Canada than in the United States. CONCLUSION: The rate of men with probable dementia or visual impairments who reported driving is of particular concern. Research and policy need to focus on evidence-based assessment of older drivers and development of appropriate interventions and programs to maintain the mobility and independence of older adults. Language: en

Current social policy and public discourse strongly encourages older adults to remain in the workforce. While there are health benefits associated with employment and productive ageing, poor health may also limit labour-force participation, particularly in low skill and labor intensive occupations. This study investigates ‘healthy-working life expectancies’ in Australia using the nationally representative HILDA survey. The sample comprised 6,164 respondents aged 45–100 at baseline (2001). One-fifth of respondents deceased over the 14-years of annual follow-up. Poor health was defined by long-term health conditions that restrict everyday activities. Multistate models estimated health transitions, employment transitions, and mortality rates. Life expectancies were partitioned into years: working in good health, working in poor health, retired in good health, and retired in poor health. At age 50 healthy-working life expectancies were 8.9 years (95%CL=8.6,9.2) for men, and 7.0 years (95%CL=6.7,7.2) for women; unhealthy-working life expectancies were 3.4 years (95%CL=3.2,3.6) for men, and 2.6 years (95%CL=2.4,2.7) for women; healthy-retirement expectancies were 6.1 years (95%CL=5.8,6.5) for men, and 9.4 years (95%CL=8.9,9.8) for women; unhealthy-retirement expectancies were 10.5 years (95%CL=10.1,11.0) for men, and 13.8 years (95%CL=13.2,14.3) for women. Lower education levels were associated with shorter healthy-working life, shorter healthy-retirement (but only among men), and longer retirement in poor health. Findings will be discussed in relation to the rising pension age in Australia, challenges faced by those who wish to remain in the workforce, as well as the moral imperative and social pressure felt by those who are unable to work or fulfil their ‘active ageing’ obligations.

Data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey were used to calculate weighted norms for the written version of the Symbol Digits Modalities Test (SDMT) by gender, 5-year age groups and four levels of educational attainment. The sample comprised 14,456 Australians (47% male; age range 15-100), of whom 25% reported a tertiary qualification, 30% reported a technical qualification (diploma or trade certificate), 16% reported completing Year 12 (final year of high school), and 29% reported their highest level of educational attainment to be Year 11 or below. Participants were excluded if they reported physical or neurological conditions that limited performance. Age, gender, and education were all significantly associated with SDMT performance, as was poor health, and cultural background. The reported norms are of greater scope and precision than previously available and have utility in a range of clinical and research settings. Indeed, normative data for the SDMT that are representative of a national population have not previously been published.

Poor mental health has been consistently linked with the experience of financial hardship and poverty. However, the temporal association between these factors must be clarified before hardship alleviation can be considered as an effective mental health promotion and prevention strategy. We examined whether the longitudinal associations between financial hardship and mental health problems are best explained by an individual's current or prior experience of hardship, or their underlying vulnerability.We analysed nine waves (years: 2001-2010) of nationally representative panel data from the Household, Income, and Labour Dynamics in Australia survey (n = 11,134). Two components of financial hardship (deprivation and cash-flow problems) and income poverty were coded into time-varying and time-invariant variables reflecting the contemporaneous experience of hardship (i.e., current), the prior experience of hardship (lagged/12 months), and any experience of hardship during the study period (vulnerability). Multilevel, mixed-effect logistic regression models tested the associations between these measures and mental health.Respondents who reported deprivation and cash-flow problems had greater risk of mental health problems than those who did not. Individuals vulnerable to hardship had greater risk of mental health problems, even at the times they did not report hardship. However, their risk of mental health problems was greater on occasions when they did experience hardship.The results are consistent with the argument that economic and social programmes that address and prevent hardship may promote community mental health.

There is a need to validate screening measures of affective and generalized anxiety disorders for use in epidemiological surveys of mental health in the general population. This study examined the diagnostic accuracy of the Patient Health Questionnaire (PHQ-9), Goldberg Anxiety and Depression Scales (GAS, GDS) and the 12-item Short Form Health Survey (SF-12) Mental Health Component Summary Scale (MCS-12) in a population based longitudinal study in Australia. We report analyses of two narrow age birth cohorts in the Personality and Total Health (PATH) through life study (ages 32-36 and 52-58). Depressive episodes (severe, moderate, and mild), dysthymia and generalized anxiety disorder were diagnosed according to International Classification of Diseases (ICD-10) criteria using the World Health Organisation (WHO) Composite International Diagnostic Interview (CIDI) as a criterion. All scales had high concordance with their target 30-day diagnoses, with area under the Receiver Operating Characteristic (ROC) curve (AUC) ranging between 0.85 and 0.90. The PHQ-9, GDS, GAS and MCS-12 were all valid instruments for identifying possible cases of depression and anxiety, and assessing the severity of these common mental disorders in the general population. We report recommended cut-points for each scale, though note that the optimal cut-point on mental health screening instruments may vary depending on the context of test administration.

The higher occurrence of common psychiatric disorders among welfare recipients has been attributed to health selection, social causation and underlying vulnerability. The aims of this study were to test for the selection effects of mental health problems on entry and re-entry to working-age welfare payments in respect to single parenthood, unemployment and disability.Nationally representative longitudinal data were drawn from the Household Income and Labour Dynamics in Australia survey. Multiple spell discrete-time survival analyses were conducted using multinomial logistic regression models to test if pre-existing mental health problems predicted transitions to welfare. Analyses were stratified by sex and multivariate adjusted for mental health problems, father's occupation, socioeconomic position, marital status, employment history, smoking status and alcohol consumption, physical function and financial hardship. All covariates were modelled as either lagged effects or when a respondent was first observed to be at risk of income support.Mental health problems were associated with increased risk of entry and re-entry to disability, unemployment and single parenting payments for women, and disability and unemployment payments for men. These associations were attenuated but remained significant after adjusting for contemporaneous risk factors.Although we do not control for reciprocal causation, our findings are consistent with a health selection hypothesis and indicate that mental illness may be a contributing factor to later receipt of different types of welfare payments. We argue that mental health warrants consideration in the design and targeting of social and economic policies.

This Document is Protected by copyright and was first published by Frontiers. All rights reserved. it is reproduced with permission. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, dis- tribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms., Background: The association between dual sensory loss (DSL) and mental health has been well established. However, most studies have relied on self-report data and lacked measures that would enable researchers to examine causal pathways between DSL and depression. This study seeks to extend this research by examining the effects of DSL on mental health, and identify factors that explain the longitudinal associations between sensory loss and depressive symptoms. Methods: Piecewise linear-mixed models were used to analyze 16-years of longitudinal data collected on up to five occasions from 1611 adults (51% men) aged between 65 and 103 years. Depressive symptoms were assessed by the Centre for Epidemiological Studies Depression (CES-D). Vision loss (VL) was defined by corrected visual acuity >0.3 logMAR in the better eye, blindness, or glaucoma. Hearing loss (HL) was defined by pure-tone average (PTA) >25 dB in the better hearing ear. Analyses were adjusted for socio-demographics, medical conditions, lifestyle behaviors, activities of daily living (ADLs), cognitive function, and social engagement. Results: Unadjusted models indicated that higher levels of depressive symptoms were associated with HL (B = 1.16, SE = 0.33) and DSL (B = 2.15, SE = 0.39) but not VL. Greater rates of change in depressive symptoms were also evident after the onset of HL (B = 0.16, SE = 0.06, p < 0.01) and DSL (B = 0.30, SE = 0.09, p < 0.01). The associations between depressive symptoms and sensory loss were explained by difficulties with ADLs, and social engagement. Conclusion: Vision and HL are highly prevalent among older adults and their co-occurrence may compound their respective impacts on health, functioning, and activity engagement, thereby exerting strong effects on the mental health and wellbeing of those affected. There is therefore a need for rehabilitation programs to be sensitive to the combined effects of sensory loss on individuals.

Objectives: To evaluate a harmonized binary measure of self-reported hearing loss against gold standard audiometry in an older adult population. Method: Seven nationally representative population-based studies were harmonized and pooled ( n = 23,001). Self-report items were recoded into a dichotomous format. Audiometric hearing loss was defined by averaged pure-tone thresholds greater than 25-decibel hearing level in the better ear. We compared age and sex stratified prevalence rates of hearing loss estimated by self-report and audiometric measures. Results: Overall, 56% of men and 43% of women had audiometric hearing loss. There were moderate associations between self-reported and audiometric hearing loss. However, prevalence based on self-report was overestimated for adults aged below 70 years and underestimated for adults aged above 75. Discussion: Self-report of hearing loss is insensitive to age effects and does not provide a reliable basis for estimating prevalence of age-related hearing loss, although may indicate perceived hearing disability.

Objective: Evidence-based policy depends on the availability of high-quality research that is relevant to the population. This study aimed to identify the available data on the health of older Indigenous Australians in population-based longitudinal studies of ageing. Approach: Evaluation of the Dynamic Analyses to Optimise Ageing Project (DYNOPTA) dataset that has pooled nine Australian longitudinal ageing studies, six of which were analysed here. Main outcome measures: Proportions of the DYNOPTA sample identified as Indigenous. Results: Indigenous participants made up 0.7% of males and 0.5% of females in the weighted sample, compared with 0.8% of both sexes in the Australian population. Indigenous under-representation is greater at ages 45–54 than at older ages, despite overall greater participation in this age range. Conclusions and implications: Within the existing Australian longitudinal ageing studies, Indigenous Australians are under-represented. This means there is a significant gap in the evidence base relating to the health of older Indigenous Australians. Research approaches specifically designed to address the health and wellbeing of older Indigenous Australians are urgently required.

Objective The Mini-Mental State Examination (MMSE) is used to estimate current cognitive status and as a screen for possible dementia. Missing item-level data are commonly reported. Attention to missing data is particularly important. However, there are concerns that common procedures for dealing with missing data, for example, listwise deletion and mean item substitution, are inadequate. Study Design and Setting We used multiple imputation (MI) to estimate missing MMSE data in 17,303 participants who were drawn from the Dynamic Analyses to Optimize Aging project, a harmonization project of nine Australian longitudinal studies of aging. Results Our results indicated differences in mean MMSE scores between those participants with and without missing data, a pattern consistent over age and gender levels. MI inflated MMSE scores, but differences between those imputed and those without missing data still existed. A simulation model supported the efficacy of MI to estimate missing item level, although serious decrements in estimation occurred when 50% or more of item-level data were missing, particularly for the oldest participants. Conclusions Our adaptation of MI to obtain a probable estimate for missing MMSE item level data provides a suitable method when the proportion of missing item-level data is not excessive.

To investigate self-reported driving status within three Australian states; associations between demographic, health, and functional factors and driving status; and the extent to which remaining a driver in spite of cognitive and visual impairments varies as a function of sex.Secondary data analysis of a pooled data set.Australian communities.Adults aged 65 to 103 (N=5,206) from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project. DYNOPTA is a unique data set created through the harmonization and pooling of data across nine separate Australian longitudinal studies of aging conducted between 1990 and 2007 (N=50,652).Driving status, demographic characteristics, Mini-Mental State Examination score, visual acuity, physical activity, and occupation.Men and participants with higher-level occupations had greater odds of driving. Older age, more medical conditions, and poorer vision increased the odds of not driving. Persons who were divorced, widowed, or never married were at a greater risk than married adults of not driving. Descriptive analyses revealed a large proportion of men with probable visual or cognitive impairments who reported driving. Subsequent comparative analyses between the DYNOPTA sample and other published U.S. and Canadian data revealed lower proportions of current drivers among Australian women and those at older ages, although there were consistently lower proportions of drivers within Australia and Canada than in the United States.The rate of men with probable dementia or visual impairments who reported driving is of particular concern. Research and policy need to focus on evidence-based assessment of older drivers and development of appropriate interventions and programs to maintain the mobility and independence of older adults.