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Background Adaptive models of healthcare delivery, such as telehealth consultations, have rapidly been adopted to ensure ongoing delivery of essential healthcare services during the COVID-19 pandemic. However, there remain gaps in our understanding of how clinicians have adapted to telehealth. This study aims to explore the telehealth experiences of specialists, based at a tertiary hospital in the Hunter Region, and general practitioners (GP), including barriers, enablers and opportunities. Methods An interpretative qualitative study involving in-depth interviews explored the telehealth experiences of specialists, based at a tertiary hospital in the Hunter Region of Australia, and GPs, including barriers, enablers and opportunities. Data were analysed using an inductive thematic approach with constant comparison. Results Individual interviews were conducted with 10 specialists and five GPs. Key themes were identified: (1) transition to telehealth has been valuable but challenging; (2) persisting telehealth process barriers need to be addressed; (3) establishing when face-to-face consults are essential; (4) changes in workload pressures and potential for double-up; (5) essential modification of work practices; and (6) exploring what is needed going forward. Conclusions While there is a need to rationalize and optimize health access during a pandemic, we suggest that more needs to be done to improve telehealth going forward. Our results have important policy implications. Specifically, there is a need to effectively train clinicians to competently utilize and be confident using this telehealth and to educate patients on necessary skills and etiquette.

Objective: To assess the use of Medicare‐subsidised health services by women with and without dementia. Methods: Data from women of the 1921–26 birth cohort of the Australian Longitudinal Study on Women's Health were linked to various administrative datasets to ascertain dementia diagnosis. The use of subsidised general practitioner (GP) services (75+ health assessments [HAs], chronic disease management meetings [CDMs], multidisciplinary case conferences [MCCs]) and specialist and allied health services between 2000 and 2013 for these women was analysed using longitudinal GEE models. Results: A total of 9,683 women were included with 1,444 (15%) women identified as having dementia. Compared to women with no dementia indication, women with dementia had more yearly non‐emergency GP attendances (short [30 minutes] IRR=1.11 [1.04, 1.19]) and fewer specialist attendances (IRR=0.91 [0.85, 0.97]) and were more likely to have an emergency GP attendance (OR=2.29 [2.05, 2.57]). There were no significant differences in the odds of having either a HA or CDM or using allied health services for women with and without dementia indicators. Conclusions: The overall use of services designed to improve the prevention and coordination of the care of older people with chronic conditions was low. Women with dementia were no more likely to access these services. Implications for public health: There is underuse of some primary and allied healthcare services designed for people with complex chronic conditions. These could be better used by women with dementia to improve the management of complex comorbidities (e.g. CDMs), to prevent the onset of disability (e.g. physiotherapy), and enhance needs assessment and service access (e.g. HAs).

Objectives Home Medicines Reviews (HMRs) can optimize medications for frail older adults. This study aimed to determine the use of HMRs according to frailty status and the association between frailty and use of HMRs. Methods The study included 9139 female participants enrolled in the Australian Longitudinal Study on Women’s Health from 2003 (aged 77–82 years) to 2017 (aged 91–96 years). Generalized estimating equations (GEEs) using log-binomial regressions were used to determine associations using repeated measures on individuals over time. Key findings The majority of participants in the study remained non-frail and did not receive HMRs from 2003 [7116 (77.86%)] to 2017 [1240 (71.31%)]. The use of HMRs was low in both groups with 33 (1.68%; 95% CI, 1.16 to 2.36) frail and 64 (0.89%; 95% CI, 0.69 to 1.14) non-frail participants receiving HMRs in 2003; by 2017, 19 (4.19%; 95% CI, 2.54 to 6.46) frail and 45 (3.50%; 95% CI, 2.57 to 4.66) non-frail participants received HMRs. Frailty was not associated with receiving a HMR (RR 1.06; 95% CI, 0.95 to 1.20), although for every 1-year increase, participants were 10% more likely to receive a HMR (RR 1.10; 95% CI, 1.09 to 1.11). Participants with continuous polypharmacy, ≥4 chronic diseases, >4 general practitioner visits and Department of Veterans Affairs coverage were more likely to receive a HMR. Conclusions Despite the proven value of HMRs for frail older people, HMRs were not used for most frail and non-frail community-dwelling women in this study. Reasons for low use of the service should be explored, with interventions to raise awareness of the benefits of the service.

This study examined predictors of driving among oldest-old Australian women in their late 80s in accordance with the World Health Organization's healthy aging framework. The study used data from the 1921-26 cohort of the Australian Longitudinal Study on Women's Health, wave-6 (n = 4025). The result of the multivariable logistic regression showed providing care, living alone, volunteering, living in rural/outer regional Australia, having higher educational attainment, and social interactions were associated with driving. The findings indicate driving should not be dismissed based on age alone. Policymakers need to also consider social roles, driving environment and context with the goals of healthy aging.

Background: Estimates of future burden of cancer attributable to current modifiable causal exposures can guide cancer prevention. We quantified future head and neck cancer burden in Australia attributable to individual and joint causal exposures, and assessed whether these burdens differ between population subgroups. Methods: We estimated the strength of the associations between exposures and head and neck cancer using adjusted proportional hazards models from pooled data from seven Australian cohorts (N = 367,058) linked to national cancer and death registries and estimated exposure prevalence from the 2017 to 2018 Australian National Health Survey. We calculated population attributable fractions (PAF) with 95% confidence intervals (CI), accounting for competing risk of death, and compared PAFs for population subgroups. Results: Contemporary levels of current and former smoking contribute 30.6% (95% CI, 22.7%–37.8%), alcohol consumption exceeding two standard drinks per day 12.9% (95% CI, 7.6%–17.9%), and these exposures jointly 38.5% (95% CI, 31.1%–45.0%) to the future head and neck cancer burden. Alcohol-attributable burden is triple and smoking-attributable burden is double for men compared with women. Smoking-attributable burden is also at least double for those consuming more than two alcoholic drinks daily or doing less than 150 minutes of moderate or 75 minutes of vigorous activity weekly, and for those aged under 65 years, unmarried, with low or intermediate educational attainment or lower socioeconomic status, compared with their counterparts. Conclusions: Two-fifths of head and neck cancers in Australia are preventable by investment in tobacco and alcohol control. Impact: Targeting men and other identified high-burden subgroups can help to reduce head and neck cancer burden disparities.

Background and aims Little is known about how weight trajectories among women during menopausal transition and beyond may be related to risk of type 2 diabetes mellitus (T2DM). The aim of this study was to examine associations between body mass index (BMI) trajectories over 20 years, age of obesity onset, cumulative obese-years and incidence of T2DM among middle-aged women. Methods and results 12,302 women enrolled in the Australian Longitudinal Study on Women's Health (ALSWH) were surveyed in 1996 (Survey 1, age 45–50), 1998 and then every three years to 2016. Self-reported weight and height were collected for up to eight time points. Incident diabetes was assessed via validated self-report of physician-diagnosed diabetes. Growth mixture models were used to identify distinct BMI trajectories. A total of 1380 (11.2%) women newly developed T2DM over an average 16 years of follow-up. Seven distinct BMI trajectories were identified with differential risk of developing T2DM. Initial BMI was positively associated with T2DM risk. We also observed that risk of T2DM was positively associated with rapid weight increase, early age of obesity onset and greater obese-years. Conclusion Slowing down weight increases, delaying the onset of obesity, or reducing cumulative exposure to obesity may substantially lower the risk of developing T2DM.

Background Over recent decades an increasing number of adults will retain their driver’s licenses well into their later years. The aim of this study was to understand and explore the experience of driving and driving cessation in very old Australian women with self-reported eye disease. Methods An interpretative qualitative study. Participants were from the Australian Longitudinal Study on Women’s Health (cohort born in 1921–26), a sample broadly representative of similarly aged Australian women. Responses to open-ended questions were analysed using an inductive thematic approach, employing a process of constant comparison. Results Qualitative data were from 216 older women with eye disease who made 2199 comments about driving, aged between 70 and 90 years depending on the timing of their comments. Themes included: (1) Access to treatment for eye disease promotes driving independence and quality of life; (2) Driving with restrictions for eye disease enables community engagement and (3) Driving cessation due to poor vision leads to significant lifestyle changes. Conclusions Key findings highlighted driving cessation, or reduction, is often attributed to deterioration in vision. The consequence is dependence on others for transport, typically children and friends. Access to successful treatment for eye disease allowed older women to continue driving. We posit that occupational therapists can play an essential role in promote driving confidence and ability as women age. Trial registration: Not applicable.

Objective: To cross‐sectionally examine heavy episodic drinking (HED) and pre‐loading with alcohol among young Australian women in relation to the alcohol‐induced adverse outcomes of memory loss, vomiting and injury. Methods: A total of 7,800 participants, aged 20–25 years, from the 1989–95 cohort of the Australian Longitudinal Study on Women's Health answered all questions on alcohol use, reported drinking alcohol in the previous year and were not pregnant at the third survey in 2015. Log‐binomial models were used to estimate prevalence ratios for adverse outcomes associated with increased frequency of HED and pre‐loading. Results: The majority of participants reported HED (83.4%) and/or pre‐loading (65.6%), which had a moderate correlation (r=0.646). Just over half (55.2%) of participants experienced at least one adverse event, with vomiting being most common. As the frequency of HED or pre‐loading increased, so did the risk of an adverse outcome. Conclusions: Both HED and pre‐loading pose a risk to young Australian women, and that risk rises with increased frequency. Implications for public health: Although HED has been a target of public health policy and interventions, pre‐loading has received limited attention. In addition to addressing HED, there is a need to consider the risk posed by pre‐loading, a related, yet unique risky drinking behaviour.

Purpose: Examine patterns of medication use, changes in medication patterns over time, and investigate factors associated with medication patterns among older Australian women with Atrial Fibrillation (AF). Methods: It is a retrospective analysis of the 1921-26 birth cohort of the Australian Longitudinal Study on Women’s Health (ALSWH), diagnosed with AF between 2000-2015 (N = 1206). Survey data of these women was linked with national registries for medications and death. Latent Transition Analysis (LTA) identified distinct patterns of medication use and transitions among these patterns for 3 consecutive years following AF diagnosis. LTA with co-variates determined the factors associated with latent status membership. Results: One-tenth (9.6%, 11.7%, 11.4%) of the study population did not receive any medication for AF in all 3 years following AF diagnosis and about 60% did not receive any medication for the prevention of thromboembolism. Among those who received medications, almost three-quarters (76.6%, 68.4%, 68.5%) received some kind of combination of medications. LTA indicated at least 6 different patterns of AF medications. These patterns had transition probabilities >85% for most of the latent statuses. All factors but diabetes mellitus among the CHA2DS2-VA scoring scheme were independently associated with latent status membership at the time of AF diagnosis. Conclusions: Evaluation of pharmacological treatment indicates that prevention of thromboembolism is inadequate among women with AF. There exists wide variations in medication patterns. However, once in a particular pattern, women are likely to continue the same medications long-term. This underscores the importance of initial assessment of patient profile and stroke risk score in determining the treatment for AF. Failure to assess risk makes women susceptible to devastating AF complications.

The aim of this study was to assess the long-term risk for mortality and incident dementia associated with exposure to intimate partner violence (IPV) at any time over the life course. Data were taken from the Australian Longitudinal Study of Women’s Health, a population-based cohort study initiated in 1996. Analysis is based on 12,085 community-dwelling women aged 70 to 75 years at baseline from all states and territories. Self-reported exposure to violence was separated into historical (any time before baseline), current (past 12 months), or both. Date of death was obtained from the National Death Index, and dementia status was self-reported or obtained from administrative data. We modeled mortality risk using Cox regression, and risk for incident dementia using Fine-Gray proportional hazards modeling with death as a competing risk. Follow up continued to December 2017. At baseline, 728 women (6.0%) reported historical IPV, 121 (1.0%) reported current violence, and 38 reported both (0.3%). Historical IPV increased 20-year mortality risk after controlling for demographic, socioeconomic, and lifestyle variables (hazard ratio 1.10, 95% confidence interval = [1.00, 1.20]). There was no relationship between current violence and mortality (hazard ratio 1.04, 95% confidence interval = [0.85, 1.29]). There was also no association between IPV and risk for incident dementia (hazard ratio 1.02, 95% confidence interval = [0.89, 1.17]). Older women who self-report exposure to IPV over the lifespan die significantly earlier than women who do not. Further research that considers the mediating role of psychological trauma is needed to examine the relationship between IPV and dementia.

Objectives: Low education and unhealthy lifestyle factors such as obesity, smoking, and no exercise are modifiable risk factors for disability and premature mortality. We aimed to estimate the individual and joint impact of these factors on disability-free life expectancy (DFLE) and total life expectancy (TLE).Methods: Data (n = 22,304) were from two birth cohorts (1921–26 and 1946–51) of the Australian Longitudinal Study on Women’s Health and linked National Death Index between 1996 and 2016. Discrete-time multi-state Markov models were used to assess the impact on DFLE and TLE.Results: Compared to the most favourable combination of education and lifestyle factors, the least favourable combination (low education, obesity, current/past smoker, and no exercise) was associated with a loss of 5.0 years TLE, 95% confidence interval (95%CI): 3.2–6.8 and 6.4 years DFLE (95%CI: 4.8–7.8) at age 70 in the 1921–26 cohort. Corresponding losses in the 1946–51 cohort almost doubled (TLE: 11.0 years and DFLE: 13.0 years).Conclusion: Individual or co-ocurrance of lifestyle risk factors were associated with a significant loss of DFLE, with a greater loss in low-educated women and those in the 1946–51 cohort.

Introduction Although Cataract Surgery Rate is increasing, the availability of surgery is outstripped by the increasing number of cataract cases as populations age. Aim The study aimed to identify factors associated with cataract surgery uptake in terms of predisposing, enabling, and need factors in very old Australian women. Method This study used ALSWH data included 6229 women aged 79–84 to 85–90 years. Women were asked whether they had undergone eye surgery (including cataracts) three years prior to each survey. Generalised estimating equation modelling was used to determine factors associated with these surgeries. Result At baseline (2005), more than half of the participants either had undergone surgery (43.5%) or had unoperated cataracts (7.6%). Increasing age (AOR = 1.11, 95% CI = 1.07, 1.15) and being current or ex-smokers (AOR = 1.15, 95% CI = 1.03, 1.29) were associated with higher odds of cataract surgery (predisposing factors). Women who had private health insurance had 27% higher odds of having surgery (AOR = 1.27, 95% CI = 1.16, 1.39) (enabling factor). Need factors of more General Practitioner visits (AOR = 1.16, 95% CI = 1.09, 1.25) and skin cancer (AOR = 1.09, 95% CI = 1.01, 1.17) also increased the odds of cataract surgery. Women who had no difficulty seeing newspaper print were more likely to have had cataract surgery (AOR = 1.35, 95% CI = 1.23, 1.48). Conclusion Need factors are the major drivers of cataract surgery; however, predisposing and enabling factors also play a role, including access to private health insurance. This finding indicates some inequity regarding access to cataract surgery in the Australian setting.

Thyroid cancer incidence and the prevalence of overweight and obesity are increasing, but the future thyroid cancer burden attributable to contemporary levels of overweight and obesity has not been evaluated before. We quantified this burden in Australia, and assessed whether the overweight/obesity-attributable burden differed by sex or other population subgroupings. We estimated the strength of the associations of overweight and obesity with thyroid cancer with adjusted proportional hazards models using pooled data from seven Australian cohorts (N=367,058) with 431 thyroid cancer cases ascertained from linked national cancer registry data during a maximum 22-year follow-up. We combined these estimates with nationally representative 2017-2018 estimates of overweight and obesity prevalence to estimate Population Attributable Fractions (PAFs) of future thyroid cancers attributable to overweight and obesity, accounting for competing risk of death, and compared PAFs for population subgroups. Contemporary levels of overweight and obesity explain 18.6% (95%CI=5.2%-30.2%), and obesity alone 13.7% (95%CI=5.2%-21.4%), of the future thyroid cancer burden. The obesity-attributable thyroid cancer burden is 21.4% (95%CI=2.8%-36.5%) for men and 10.1% (95%CI=0.8%-18.6%) for women. Were the currently obese overweight instead, 9.9% (95%CI=1.0%-18.1%) of thyroid cancers could be avoided. The relative overweight/obesity-attributable burden is higher for those consuming on average more than two alcoholic drinks per day (63.4%) and for those who are not married/co-habiting (33.2%). In conclusion, avoiding excess weight, especially obesity, should be a priority for thyroid cancer prevention. Further studies, with findings stratified by tumour size, may reveal the potential role of overdiagnosis in our results. This article is protected by copyright. All rights reserved.

To examine whether patterns of home and community care (HACC) use and person-based characteristics were associated with time to enter permanent residential aged care (RAC).A prospective cohort study. The sample consisted of 8062 participants of the Australian Longitudinal Study on Women's Health who used HACC services between 2001 and 2014.Time from first HACC use to enter permanent RAC. The median follow-up time was 63 months. Factors associated with time to enter RAC were identified using competing risk regression models.Of the 8062 participants, 60% belonged to the 'basic HACC' group, who used few services minimally; 16% belonged to the 'moderate HACC' group, who predominantly used domestic assistance with moderate use of other services; and 24% belonged to the 'complex HACC' group, who used many services frequently. Being a member of the complex HACC group was associated with a lower cumulative incidence of RAC than basic or moderate HACC (chances 15% versus 30% by the median observation period, p 0.01). Living in a remote/outer region (sub-distributional hazard ratio (sdHR) = 0.83, 95%CI: 0.74 - 0.93) was associated with delayed admission to RAC. Meanwhile, earlier admission was associated with living in an apartment (sdHR = 1.29, 95%CI: 1.20-1.40) or a retirement village (sdHR = 1.54, 95%CI = 1.38-1.72), having a physical functioning score40 (sdHR = 1.16, 95%CI = 1.05-1.25), and falls with injury (sdHR = 1.15, 95%CI = 1.05-1.25).Our findings highlight the importance of providing more community care services, age-friendly housing, falls prevention and physical activity programs to reduce inappropriate admission to RAC.

Background Over two-thirds of older Australians use different types/levels of aged care at some point in later life. Our aims were to estimate transitional probabilities and to identify risk factors influencing the movement between different levels of long-term care. Methods The sample consisted of 9007 women from the 1921-26 birth cohort of the Australian Longitudinal Study on Women’s Health. Transitional probabilities between different levels of long-term care were estimated using a continuous-time Markov model. Results An 11-fold transition rates ratio was observed for the movement from non-user to home and community care (HACC) versus non-user to residential aged care (RAC). The predicted probabilities of remaining in the non-user state, HACC, and RAC after 10 years from the baseline were .28, .24, and .11, respectively. While the corresponding probabilities of dying from these states were .36, .65, and .90. The risk of transitioning from the non-user state to either HACC or RAC was greater for participants who were older at baseline, widowed, living outside of major cities, having difficulties in managing income, or having chronic condition, poor/fair self-rated health, or lower SF-36 scores (p < .05). Conclusion Women spend a substantial period of their later life using long-term care. Typically, this will be in the community setting with a low level of care. The transition to either HACC or RAC was associated with several demographic and health-related factors. Our findings are important for the planning and improvement of long-term care among future generations of older people. Trial registration Not applicable.

Heavy metal exposures may contribute to diabetes risk but prospective studies are uncommon. We analyzed the Australian Longitudinal Study on Women's Health (three cohorts aged 18-23, 45-50, or 70-75 at baseline in 1996, N = 34,191) merged with emissions data for 10 heavy metals (As, Be, Co, Cr, Cu, Hg, Mn, Ni, Pb, Zn) from the National Pollutant Inventory. Over 20-year follow-up, 2,584 women (7.6%) reported incident diabetes. Cox proportional hazards regression models showed that women aged 45-50 at baseline had higher diabetes risk in association with exposure to total air emissions, total water emissions, all individual metals air emissions, and six individual water emissions. After correction for false discovery rate, nine of 11 air emissions and five water emissions remained significant. Associations were not observed for land-based emissions, or for younger or older cohorts. Emissions were dominated by mining, electricity generation and other metals-related industrial processes.

Delayed health care access is a potential collateral effect of pandemic conditions, health rationing strategies and social distancing responses. We investigated experiences of delayed health care access in Australian women during COVID‐19. A mixed methods study used quantitative and free‐text data from the Australian Longitudinal Study on Women's Health COVID‐19 survey 4 (health care access or delay). Logistic regression models were used to estimate factors associated with delaying access to general practitioners (GPs), specialists and allied health services. Free‐text comments were analysed thematically, employing a process of constant comparison. COVID‐19 survey 4 was completed by 8,200 women and 2,727 provided free‐text comments. Of the women who needed the health service, 25% (1,268/5,071) delayed seeing their GP, 23.6% (570/1,695) delayed seeing a specialist and 45% (791/1,757) delayed use of an allied health service. Younger age was most significantly associated with delaying attendance. Women born 1989–95 were significantly more likely to delay compared to women born 1946–51 (OR (95% CI): GP = 0.28 (0.22, 0.35)); Specialist = 0.65 (0.45, 0.92; Allied Health = 0.59 (0.42, 0.82)). Women born 1973–78 were also likely to delay GP visits (0.69, (0.58, 0.83)). Four qualitative themes emerged including: (1) Challenges negotiating care during a pandemic; (2) Ongoing uncertainty towards accessing health care when a specialist delays an appointment; (3) Accessing health care (or not) using Telehealth and (4) Managing complex care needs. COVID‐19 has had a significant effect on access to health care. Women delayed seeking help for cancer screening, mental health, and other health conditions involving chronic and complex needs for health and social care. While there is a need to rationalise and optimise health access during a pandemic, our outcomes suggest a need for public health campaigns that clarify how to access care, engage with telehealth and respond to missed appointments.

To estimate the probability of onset and progression of disease and disability, length of life with or without disease and/or disability, and incidence of mortality, and to identify factors associated with transitioning to disease and/or disability over time.A prospective cohort study. Data were provided by 12,432 participants (born 1921-26) of the Australian Longitudinal Study of Women's Health linked with National Death Index data from 1996 (age: 70-75) to 2016 (age: 90-95).A five-state Markov model was fitted to estimate the transition probability, length of life with or without disease and/or disability, and the association between baseline characteristics and disease/disability/mortality risk.Over two-thirds of women had died by age 90-95, and only 3.8% of these had died with no chronic disease and disability. Those reporting chronic disease were more likely to have experienced disability (Transition Rate Ratio: 2•72, 95%CI= 2•52-2•93) than those who died without disability. At age 70-75, the expected life without chronic disease and disability was 7•68 (95%CI: 7•52-7•80) years, life with chronic disease but no disability was 4•39 (95%CI=4•23-4•49) years, and life with disability was 3.76 (95%CI=3•66-3•92) years. The factors difficulties managing on available income (HR=1•18, 95%CI=1•02-1•38), did not complete secondary school (HR=1•19, 95%CI=1•03-1•37), and overweight/obese (HR=1•36, 95%CI=1•20-1•55) were associated with an increased risk of disability.Our findings provide important insights on the onset and progression of disease and disability in older women, underscoring the importance of addressing mid-/early old-life risk factors, managing chronic conditions, and delaying disability onset and progression through targeted intervention programs.

Background Polypharmacy is an important consideration for the provision of Residential Medication Management Reviews (RMMRs) among older women given their enhanced risk of medication-related problems and admission to residential aged care (RAC). Objectives To determine the prevalence of the use of RMMRs among older women in RAC, and the association between RMMRs and polypharmacy, medications, and costs. Setting Older Australian women aged 79-84 years in 2005 who had at least one Medicare Benefits Schedule and Pharmaceutical Benefits Scheme record, received a service in aged care, and consented to data linkage. Methods Generalised estimating equations were used to determine the association between polypharmacy and RMMRs, while adjusting for confounding variables. Main outcome measures Prevalence of the use of RMMRs among older women in RAC, association between RMMRs and polypharmacy, medications, and costs. Results Most participants did not have continuous polypharmacy and did not receive RMMRs from 2005 [451 (67.4%)] until 2017 [666 (66.6%)]. Participants with continuous polypharmacy were 17% more likely to receive a RMMR (risk ratio 1.17; 95% confidence interval 1.11, 1.25). Participants in their final year of life and residing in outer regional/remote/very remote Australia were less likely to receive RMMRs. Out-of-pocket medication costs increased over time, and alendronate and aspirin were common contributors to polypharmacy among participants who received RMMRs. Conclusion Polypharmacy was associated with receiving RMMRs and around two-thirds of women who are entitled to a RMMR never received one. There is potential to improve the use of medicines by increasing awareness of the service among eligible individuals, their carers and health care professionals.

It is unknown whether a healthy diet or unhealthy diet combined with specific supplements may jointly contribute to incidence of obesity and cardiovascular disease (CVD). We included 69,990 participants from the 45 and Up Study who completed both baseline (2006–2009) and follow-up (2012–2015) surveys. We found that compared to participants with a long-term healthy diet and no supplement consumption, those with a long-term healthy diet combined with multivitamins and minerals (MVM) or fish oil consumption were associated with a lower incidence of CVD (p &lt, 0.001), whilst those with an unhealthy diet and no MVM or fish oil consumption were associated with a higher risk of obesity (p &lt, 0.05). Compared to participants with a long-term healthy diet and no calcium consumption, the combination of a long-term healthy diet and calcium consumption was linked to a lower risk of CVD (IRR = 0.87, 95% CI: 0.78, 0.96). In conclusion, a long-term healthy diet combined with MVM or fish oil was associated with a lower incidence of CVD. Participants who maintained a healthy diet and used calcium supplements were associated with a lower incidence of obesity. However, these associations were not found among those with an unhealthy diet, despite taking similar supplements.

Frailty is an essential consideration with potentially inappropriate medications (PIMs), especially among older women.This study determined the use of potentially inappropriate medications according to frailty status using the Beers Criteria 2019, identified medications that should be flagged as potentially inappropriate and harmful depending on individual health factors, and determined the association between frailty and PIMs, adjusted for characteristics associated with PIMs.This prospective longitudinal study included 9355 participants aged 77-82 years at baseline (2003). Frailty was measured using the FRAIL (fatigue, resistance, ambulation, illness and loss of weight) scale. Generalised estimating equations using log-binomial regressions determined the association between frailty and risk of using PIMs.Among participants who were frail and non-frail at baseline, the majority used ≥ 3 PIMs (74.2% and 58.5%, respectively). At 2017, the proportion using ≥ 3 PIMs remained constant in the frail group (72.0%) but increased in the non-frail group (66.0%). Commonly prescribed medications that may be potentially inappropriate in both groups included benzodiazepines, proton-pump inhibitors and non-steroidal anti-inflammatory drugs, and risperidone was an additional contributor in the non-frail group. When adjusted for other characteristics, frail women had a 2% higher risk of using PIMs (RR 1.02; 95% CI 1.01, 1.03).Given that the majority of frail women were using medications that may have been potentially inappropriate, it is important to consider both frailty and PIMs as indicators of health outcomes, and to review the need for PIMs for women aged 77-96 years who are frail.

Comorbidity can complicate cardiovascular diseases (CVDs), increasing the risk of adverse events including hospitalisation and death. This study aimed to assess the Charlson Comorbidity Index (CCI) as a predictor of repeated hospital admission and mortality in older CVD patients. This study linked data from the Australian longitudinal study on women’s health (ALSWH) with hospital and National Death Index datasets to identify dates for hospital admission, discharge, and death for women born 1921–26. CCI was calculated using the International Statistical Classification of Diseases, Australia Modification (ICD-10-AM) diagnostic codes. Women with a higher CCI on index admission had increased risk of repeated hospital admission (AHR = 1.29, 95% CI 1.06, 1.58) and mortality (AHR = 3.05, 95% CI 2.15, 4.31). Older age and hypertension were also significantly associated with a higher risk of repeated hospital admission and mortality. Living in a remote area was associated with a higher risk of mortality. The Charlson Comorbidity Index predicts repeated hospital admission and mortality incidences among older women with CVD. Improving management of comorbidities for older CVD patients should be considered as part of a strategy to mitigate subsequent repeated hospitalisation and delay mortality.

Over one-third of diabetes-related encounters with healthcare providers in Australia fail to meet clinical guidelines. Evidence is mounting that care provision within an integrated framework may facilitate greater adherence to clinical guidelines and improved outcomes for patients. The Diabetes Alliance Program was implemented across a large healthcare district to enhance diabetes care capacity at the primary care level through intensive case-conferencing involving the primary care team, patients and visiting specialist team, whole practice performance review and regular diabetes education for practitioners. Here, we provide an in-depth patient assessment of the case-conferencing process and impact on diabetes management. Two practices with high pre-intervention HbA1c monitoring and three practices with low HbA1c monitoring provided the sampling frame. Patients were selected according to their score on the Patient Activation MeasureTM to achieve maximum variation, with up to two patients with high scores and three with low scores, selected from each practice. Patients were sampled until data saturation was achieved and then subjected to thematic content analysis (n = 19). Patients mostly described the model of care as a positive experience, reporting a boost in confidence in diabetes self-management (particularly around nutrition). The program was also seen to be helpful in providing an opportunity to refocus when "life gets in the way". Other valued aspects of the program included the holistic approach to healthcare, reduced travel time, familiarity in environment and clinical care, top-down knowledge transfer as well as mutual learning by the patient and their primary care team. Despite this, difficulties in coping with diabetes and adherence to treatment recommendations remained for a minority of patients. Integrating specialist teams within primary care has the ability to provide efficient healthcare delivery, better patient experience and health outcomes. Investment in such approaches will be critical to navigating healthcare provision in order to meet the demands of an ageing population.

OBJECTIVE To identify factors associated with incidence of medication reviews (MRs), particularly in women with dementia and in residential aged care (RAC). METHODS Data from 10 359 women in the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health were linked to Medicare Benefits Schedule data to identify MRs for each year from 2003 to 2015. RESULTS Incidence of MR increased from 2003 to 2013 (age 87-92 years) when 37.1% of women with dementia had a MR compared to 19.8% of women without dementia. Adjusting for time and other factors, the odds of having a MR were higher for women with dementia (AOR = 1.18, 95% CI: 1.06-1.32) and women in RAC (AOR = 3.61, 95% CI: 3.28-3.98). CONCLUSIONS Although higher in women with dementia and those in RAC, utilisation of MR was modest. System-level interventions may be required to ensure the use and benefits of MRs.

Older people use many medications, but combinations of medications used among the oldest old (≥ 80 years) are not commonly reported.This study aimed to determine common combinations of medications used among women aged 77-96 years and to describe characteristics associated with these combinations.A cohort study of older women enroled in the Australian Longitudinal Study on Women's Health over a 15-year period was used to determine combinations of medications using latent class analysis. Multinomial logistic regression was used to determine characteristics associated with these combinations.The highest medication users during the study were for the cardiovascular (2003: 80.28%; 2017: 85.63%) and nervous (2003: 66.03%; 2017: 75.41%) systems. A 3-class latent model described medication use combinations: class 1: 'Cardiovascularneurology anatomical group' (27.25%) included participants using medications of the cardiovascular and nervous systems in their later years; class 2: 'Multiple anatomical group' (16.49%) and class 3: 'Antiinfectivesmultiple anatomical group' (56.27%). When compared to the reference class (class 1), the risk of participants being in class 3 was slightly higher than being in class 2 if they had 4 general practitioner visits (RRR 2.37; 95% CI 2.08, 2.71), Department of Veterans Affairs' coverage (RRR 1.59; 95% CI 1.36, 1.86), ≥ 4 chronic diseases (RRR 3.16; 95% CI 2.56, 3.90) and were frail (RRR 1.47; 95% CI 1.27, 1.69).Identification of combinations of medication use may provide opportunities to develop multimorbidity guidelines and target medication reviews, and may help reduce medication load for older individuals.

Objectives This study aimed to determine the prevalence of continuous polypharmacy and hyperpolypharmacy, determine medications that contribute to continuous polypharmacy, and examine the association between frailty and continuous polypharmacy. Study design A prospective study using data from the Australian Longitudinal Study on Women’s Health. Women aged 77–82 years in 2003, and 91–96 years in 2017 were analysed, linking the Pharmaceutical Benefits Scheme data to participants’ survey data. Main outcome measures The association between frailty and continuous polypharmacy was determined using generalised estimating equations for log binomial regressions, controlling for confounding variables. Descriptive statistics were used to determine the proportion of women with polypharmacy, and medications that contributed to polypharmacy. Results The proportion of women with continuous polypharmacy increased over time as they aged. Among participants who were frail (n = 833) in 2017, 35.9 % had continuous polypharmacy and 1.32 % had hyperpolypharmacy. Among those who were non-frail (n = 1966), 28.2 % had continuous polypharmacy, and 1.42 % had hyperpolypharmacy. Analgesics (e.g. paracetamol) and cardiovascular medications (e.g. furosemide and statins) commonly contributed to continuous polypharmacy among frail and non-frail women. Accounting for time and other characteristics, frail women had an 8% increased risk of continuous polypharmacy (RR 1.08; 95 % CI 1.05, 1.11) compared to non-frail women. Conclusions Combined, polypharmacy and frailty are key clinical and public health challenges. Given that one-third of women had continuous polypharmacy, monitoring and review of medication use among older women are important, and particularly among women who are frail.

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.

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

Background/aim Increased age and cognitive decline have been linked to difficulties with activities of daily living (ADL) and instrumental activities of daily living (IADL). Cognitive decline can often be signalled by complaints about one's cognition, such as memory. With older Australians living longer, there is an increasing proportion of the population at risk of declined performance in daily tasks. The aim of this study was to identify if subjective memory complaints in later life among older women predict changes in independence in performing ADL and IADL. Methods Data were from 3721 women born 1921-1926, who completed Surveys 4-6 of the Australian Longitudinal Study on Women's Health. Memory complaints and difficulties on ADL were measured at each survey, using the Memory Complaint Questionnaire and 16 questions regarding specific ADL. Latent growth modelling examined correlations between initial scores on each measure, changes in measures, and the association between memory complaints and changes in ADL and IADL. Results There was a significant association between baseline scores for subjective memory difficulty and baseline ADL and IADL scores. Initial memory difficulty was also associated with increase in ADL and IADL difficulty. Conclusions Subjective memory complaints may be a risk factor for decline in performance on ADL. Attention to these concerns may be important in identifying functional decline in older age.

Objective To explore qualitative insights into the pain experience of older women with quantitatively derived pain profiles. Methods The sequential mixed methods design involved applying quantitative pain profiles, derived from an earlier latent class analysis, to qualitative comments by a sample of older Australian women with arthritis. Data from a substudy of the Australian Longitudinal Study on Women's Health, mid-aged cohort, born 1946-1951, were used. Inductive content analysis was conducted to explore qualitative insights into the experience of pain. Results The average age of women was 64.6 years (±1.4). Within each derived pain profile, themes generated from the qualitative comments of women were concordant with the profile descriptors: 'I manage my pain' for the uni-dimensional, mild pain profile (comments from 56 women); 'I live with pain every day' and 'I rely on medication regularly' for the moderate multidimensional pain profile (comments from 39 women); and 'multiple pains', 'I suffer with pain' and 'I am unable and adjust' for the severe multidimensional pain profile (comments from 31 women). Conclusion Women with different pain profiles used different language and strategies in managing their pain experience, information which can guide clinicians to provide more tailored support for self-management and care of arthritis pain.

Objective: To provide a direct estimate of the risk of admission to permanent residential aged care among older women while accounting for death, according to housing type and other variables. Methods: A competing risk analysis from 8,867 Australian women born 1921–26, using linked data from the Australian Longitudinal Study on Women's Health (ALSWH), Residential Aged Care (RAC), and the Australian National Death Index. Results: After accounting for deaths, around 35% of women will be admitted to RAC between ages 73 and 90. The conditional cumulative incidence of admission to RAC was 26.9% if living in a house, compared to 36.0% from an apartment, 43.6% within a retirement village, and 37.1% if living in a mobile home. Each one‐year increase in age was associated with a relative 17% increased risk of RAC. Conclusions: Around one‐third of women will enter RAC between age 73 and 90. Living in a house had the lowest risk of entering residential aged care over time. Implications for public health: These findings have important implications for planning for aged care services, including the role of housing in delaying admission to residential aged care, and the need for residential care by a high proportion of women towards the end of life.

Background Falls in older people are a major public health concern. To target falls prevention interventions, screening tools need to be able to identify older people at greater risk of falling. This study aimed to investigate the screening capacity of the Home Falls and Accidents Screening Tool for health professionals (HOME FAST-HP), and to identify the best cut-off score to identify older people at higher risk of falls using the HOME FAST-HP. Methods The study used cross-sectional data from a random sample of 650 women from the 1921 to 1926 cohort of the Australian Longitudinal Study of Women's Health (ALSWH). Selected women were sent a postal survey including the HOME FAST-HP, falls history, and other health factors. Scores on the home fast were calculated and the cut-point for optimal sensitivity and specificity of the HOME FAST-HP in relation to falls was assessed using a Receiver Operating Characteristic curve. Results A total of 567 older women participated (response rate 87%). The mean age of participants was 77.5 yrs (95% CI 77.31-77.70). A total of 153 participants (27%) reported a fall in the previous six months. The mean number of hazards using the HOME FAST-HP was 9.74 (95% CI 9.48-10.01), range 2-22. Non-fallers had a mean of 9.6 hazards (95% CI 9.32-9.91) and fallers had a mean of 10.63 hazards (95% CI 10.08-11.19) which was a significant difference (t = 3.41, P = 0.001). The area under the receiver operator curve (AUC) was 0.58 (95% CI 0.53-0.64). A HOME FAST-HP cut-off score of 9 was associated with the optimal sensitivity for falls (73.9%), with specificity (37.9%), and positive predictive value was 30.6% and negative predictive value was 79.7%. Conclusion The HOME FAST-HP can be used as a screening tool to identify fallers with a cut-off score of nine indicating a higher risk of falling.

Objectives The aims of this study were to (1) report the prevalence and explore the influence of spinal pain on quality of life and (2) assess the relationship between spinal pain and the type and number of comorbidities. Methods This cross-sectional study comprised 579 community-dwelling, older Australian women. Women had “spinal pain” if they marked “yes” to neck pain, upper back pain, mid-back pain, and/or lower back pain. Descriptive statistics and binary logistic regression were performed to report the prevalence and explore the relationship between spinal pain and the type and number of comorbidities. Results A majority of women (55.8%) who returned surveys had spinal pain. Women with spinal pain had significantly lower physical and mental quality of life scores than women without spinal pain (Medical Outcomes Study: 36 Item Short Form Survey [SF-36] physical component summary: 40.1 ± 11.1 vs 49.0 ± 9.0, and SF-36 mental component summary: 50.0 ± 10.5 vs 53.9 ± 8.2, respectively). Having spinal pain was significantly associated with overweight and obesity (odds ratio 1.98 [95% confidence interval 1.3-2.96] and 2.12 [1.37-3.28]), diabetes (1.93 [1.01-3.67]), pulmonary comorbidity (1.66 [1.04-2.65]), and cardiovascular comorbidity (1.57 [1.07-2.28]). More than half of the women with spinal pain reported 2 or more comorbidities, with comorbidities significantly more common among women with spinal pain than among women without spinal pain. The odds of having spinal pain increased with an increasing number of comorbidities (2 comorbidities: 2.44 [1.47-4.04], 3 comorbidities: 3.07 [1.66-5.67], 4 comorbidities: 5.05 [1.64-15.54]). Conclusions Spinal pain is common in community-dwelling, older Australian women and is associated with greater disability and poorer quality of life. Diabetes, cardiovascular disease, pulmonary disease, and obesity appear to have a relationship with spinal pain. There was an incremental increase in the risk of spinal pain associated with increasing comorbidity count.

Parental bonding is cited as a determinant of mental health outcomes in childhood, adolescence and early-mid adulthood. Examination of the long-term impact for older adults is limited. We therefore examine the long-term risk of perceived poor parental bonding on mental health across the lifespan and into early-old age.Participants (N = 1255) were aged 60-64 years of age and drawn from the Australian Life Histories and Health study. Quality of parental bonding was assessed with the Parental Bonding Instrument (PBI). Self-reported history of doctors' mental health diagnoses and current treatment for each participant was recorded. Current depression was assessed with the Centre for Epidemiologic Studies Depression-8 (CESD-8). Due to known gender differences in mental health rates across the lifespan, analyses were stratified by sex.A bi-factor analysis of the PBI in a structural equation framework indicated perceived Poor Parental Quality as a risk for both ever and current depression for both sexes. For males, Over-Protective Fathers were a risk for ever and current depression, whilst overall Poor Parental Quality was a risk for reporting current depression treatment. Whilst a number of the risks associated with current depression and treatment were attenuated when controlling for current mood, parental quality remained a significant risk for having reported a lifetime diagnosis for depression and anxiety for men.Our results extend the existing literature base and demonstrate that mental health risk attributed to poor perceived parental quality continues across the life-course and into early-old age.

Background: By 2050, adults aged 80 years and over will represent around 20% of the global population. Little is known about how adults surviving into very old age use hospital services over time.Objective: The objective of the study was to examine patterns of hospital usage over a 10-year period for women who were aged 84 to 89 in 2010 and examine factors associated with increased use.Methods: Survey data from 1936 women from the 1921 to 1926 cohort of the Australian Longitudinal Study on Women's Health were matched with the state-based Admitted Patients Data Collection. Hospital use profiles were determined using repeated measures latent class analysis.Results: Four latent class trajectories were identified. One-quarter of the sample were at low risk of hospitalization, while 20.6% demonstrated increased risk of hospitalization and a further 38.1% had moderate hospitalization risk over time. Only 16.8% of the sample was classified as having high hospitalization risk. Correlates of hospital use for very old women differed according to hospital use class and were contingent on the timing of exposure (ie, short-term or long-term).Conclusions: Despite the perception that older adults place a significant burden on health care systems, the majority of women demonstrated relatively low hospital use over an extended period, even in the presence of chronic health conditions. High hospitalization risk was found to be concentrated among a small minority of these long-term survivors. The findings suggest the importance of service planning and treatment regimes that take account of the diverse trajectories of hospital use into and through advanced old age.

BackgroundDue to the absence and or costliness of biological measures such as glycated haemoglobin, diabetes case ascertainment and prevalence studies are usually conducted using surveys or routine health service use databases. However, the use of each of these sources is associated with its limitations potentially impacting the quality of the case ascertainment and prevalence estimation. This study aimed at ascertaining diabetes cases and estimating prevalence among mid- and older-age women through simultaneous use of a longitudinal survey and multiple healthcare administrative data sources.MethodsData were available for 12,432 and 13,714 women born in 1921-26 and 1946-51 from the Australian Longitudinal Study on Women's Health (ALSWH). Diabetes was ascertained using the ALSWH survey, health service use, and cause of death data. Parsimonious multiple logistic regression analyses tested associations between sociodemographic and health variables and the presence of diabetes.ResultsIn both cohorts, two or more of the sources captured more than 80% of the women with diabetes. The point prevalence of diabetes increased from 8.4% when the mean age of the women were aged 73, to 22.0% of surviving women at age 90 in the 1921-26 cohort; and from 2.6% at age 48 to 15.8% at age 68 in the 1946-51 cohort. In the 1921-26 cohort, women who were obese (OR: 3.56; 95 CI: 3.04-4.17) and women who were sedentary (OR: 1.18; 95 CI: 1.09-1.40) were more likely to have diabetes compared to those who had a normal weight and engaged in a moderate level of physical activity. In the 1946-51 cohort, the odds of diabetes increased three times (OR: 2.99; 95 CI: 2.54-3.52) for overweight women and nine times (OR: 8.78; 95 CI: 7.46-10.33) for obese women compared to those who had normal weight.ConclusionsThe simultaneous use of multiple data sources improved the validity of diabetes case ascertainment. Application of this methodology in future studies may have important benefits including estimation of disease burden, health service needs, and resource allocation with improved precision. Diabetes prevalence increased with age, was much higher in the 1946-51 cohort than in 1921-26 at similar ages, and was significantly associated with physical inactivity and obesity. Interventions to promote physical activity and a healthy weight are needed to prevent the rising prevalence of diabetes across successive generations.

Background Diabetes is a major chronic condition with ever-increasing health and economic burden. This study aimed to measure the impact of diabetes on total life expectancy (TLE) and healthy life expectancy (HLE) at ages 70 and 80 and to assess how educational level, obesity, and comorbidity affected the expectancies. Methods The study involved 9849 population-representative women born between 1921 and 1926 from the Australian Longitudinal Study on Women’s Health (ALSWH). Self-rated health was obtained from the ALSWH surveys. Diabetes diagnosis was ascertained using survey and health care administrative data. Total life expectancy and HLE were estimated for women with and without diabetes using multistate modeling. Results Diabetes was associated with an increased risk of poor health (adjusted risk ratio: 1.63, 95% confidence interval: 1.49–1.79). Diabetes was also associated with a reduction of 0.9 years in HLE and 2.6 years in TLE at age 70 and 0.4 years in HLE and 1.3 years in TLE at age 80. If a woman had low education, obesity, and more than 2 comorbidities in addition to diabetes, these reductions increased to 3.0 years in TLE and 7.9 years in HLE at age 70 and 1.5 years in TLE and 3.8 years in HLE at age 80. Conclusions Diabetes substantially reduced older women’s quantity and quality of life, with further reductions for those with lower education, obesity, and comorbidities. These findings underscore the importance of optimally managing diabetes by maintaining a healthy weight and delaying the onset of comorbidities, to promote healthy aging for older women with diabetes.

Objective:To explore if better diet quality scores as a measure of adherence to the Australian Dietary Guidelines (ADG) and the Mediterranean diet (MedDiet) are associated with a lower incidence of hypertension and non-fatal CVD.Design:Prospective analysis of the 1946–1951 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH). The Australian Recommended Foods Score (ARFS) was calculated as an indicator of adherence to the ADG; the Mediterranean Diet Score (MDS) measured adherence to the MedDiet. Outcomes included hypertension and non-fatal CVD. Generalised estimating equations estimated OR and 95 % CI across quartiles of diet quality scores.Setting:Australia, 2001–2016.Participants:1946–1951 cohort of the ALSWH (n 5324), without CVD, hypertension and diabetes at baseline (2001), with complete FFQ data.Results:There were 1342 new cases of hypertension and 629 new cases of non-fatal CVD over 15 years of follow-up. Multivariate analysis indicated that women reporting better adherence to the ARFS (≥38/74) had 15 % (95 % CI 1, 28 %; P = 0·05) lower odds of hypertension and 46 % (95 % CI 6, 66 %; P = 0·1) lower odds of non-fatal CVD. Women reporting better adherence to the MDS (≥8/17) had 27 % (95 % CI 15, 47 %; P = 0·0006) lower odds of hypertension and 30 % (95 % CI 2, 50 %; P = 0·03) lower odds of non-fatal CVD.Conclusions:Better adherence to diet quality scores is associated with lower risk of hypertension and non-fatal CVD. These results support the need for updated evidenced based on the ADG as well as public health nutrition policies in Australia.

Obesity is a risk factor for type 2 diabetes, yet little is known about how timing and cumulative exposure of obesity are related to disease risk. The aim of this study was to examine the associations between BMI trajectories, age of onset of obesity and obese-years (a product of degree and duration of obesity) over early adulthood and subsequent risk of type 2 diabetes. Women aged 18–23 years at baseline (n = 11,192) enrolled in the Australian Longitudinal Study on Women’s Health (ALSWH) in 1996 were followed up about every 3 years via surveys for up to 19 years. Self-reported weights were collected up to seven times. Incident type 2 diabetes was self-reported. A growth mixture model was used to identify distinct BMI trajectories over the early adult life course. Cox proportional hazards regression models were used to examine the associations between trajectories and risk of diabetes. One hundred and sixty-two (1.5%) women were newly diagnosed with type 2 diabetes during a mean of 16 years of follow-up. Six distinct BMI trajectories were identified, varying by different initial BMI and different slopes of increase. Initial BMI was positively associated with risk of diabetes. We also observed that age at onset of obesity was negatively associated with risk of diabetes (HR 0.87 [95% CI 0.79, 0.96] per 1 year increment), and number of obese-years was positively associated with diabetes (p for trend

Objectives To estimate the incidence of unplanned and planned hospitalization and identify associated factors among older women aged 75 years and over. Methods This study is a prospective longitudinal cohort study (over the period 2001-2016). Women born between 1921 and 1926 were included from the Australian Longitudinal Study on Women's Health (ALSWH). ALSWH self-reported data were linked with New South Wales's state Admitted Patient Data Collection. A competing risk analysis was performed using SAS v 9.4. Results Overall, during the 15-year observation period, 86.7% of women experienced at least one unplanned admission and 60.3% experienced at least one planned admission. The complement of Kaplan-Meier survival function overestimates hospitalization incidence compared to cumulative incidence function in the presence of a competing risk, that is, "death." Predisposing factors (older age and not partnered) and need factors (hospital doctor visit, GP or family doctor visit, poor perceived general health, and having at least one chronic disease) were associated with increased unplanned admission. First language other than English and not having private health insurance showed a negative association with planned admission; specialist doctor visits had a positive association. Conclusions Hospital admission was influenced by predisposing and enabling factors, as well as need. Intervention aiming to support older people who do not have private health insurance may be required to improve the goal of equal access to healthcare through planned admissions people with equal need.

Objective Prospective studies on obesity incidence specifically among young adults have not been reported. This study examined risks of obesity incidence over 19 years among young women without obesity at baseline. Methods Women aged 18 to 23 years at baseline (N = 8,177) were followed up every 2 to 3 years to ages 37 to 42 using the Australian Longitudinal Study on Women's Health. A latent class analysis identified obesity-risk classes based on time-dependent measures of income, education, physical activity, sleep quality, dietary behavior, depression, stressful events, and social functioning. Cox proportional hazards regression models examined associations between incident obesity and latent classes, controlling for covariates. Results Four latent classes were identified, including a lower-risk referent class and classes characterized by poor exercise and diet, stress and low income, and multiple intermediate-level risks. Compared with the referent, all three risk classes had significantly higher obesity risk, with the highest risk in the stress and low-income group (hazard ratio = 2.22; 95% CI: 1.92-2.56). Individual risks associated with obesity included lower education, stressful life events, and lower vigorous physical activity. Conclusions Young women without baseline obesity were at risk of developing obesity when they experienced co-occurring behavioral, socioeconomic, and psychosocial risks. Both latent classes and individual risk indicators offer insights into prevention strategies.

Substantial changes in the prevalence of the principal kidney and bladder cancer risk factors, smoking (both cancers) and body fatness (kidney cancer), have occurred but the contemporary cancer burden attributable to these factors has not been evaluated. We quantified the kidney and bladder cancer burden attributable to individual and joint exposures and assessed whether these burdens differ between population subgroups. We linked pooled data from seven Australian cohorts (N = 367,058) to national cancer and death registries and estimated the strength of the associations between exposures and cancer using adjusted proportional hazards models. We estimated exposure prevalence from representative contemporaneous health surveys. We combined these estimates to calculate population attributable fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death, and compared PAFs for population subgroups. During the first 10‐year follow‐up, 550 kidney and 530 bladder cancers were diagnosed and over 21,000 people died from any cause. Current levels of overweight and obesity explain 28.8% (CI = 17.3–38.7%), current or past smoking 15.5% (CI = 6.0–24.1%) and these exposures jointly 39.6% (CI = 27.5–49.7%) of the kidney cancer burden. Current or past smoking explains 44.4% (CI = 35.4–52.1%) of the bladder cancer burden, with 24.4% attributable to current smoking. Ever smoking explains more than half (53.4%) of the bladder cancer burden in men, and the burden potentially preventable by quitting smoking is highest in men (30.4%), those aged 2 standard alcoholic drinks/day (41.2%). In conclusion, large fractions of kidney and bladder cancers in Australia are preventable by behavior change. Cancer Institute New South Wales, NHMRC, Ageing and Alzheimer's Institute, Cancer Council Victoria, VicHealth

Objectives We examined the development of disease and disability in a large cohort of older women, the extent to which these conditions exempt them from being classified as successful agers and different trajectories of disease, disability and longevity across women’s later life. Methods We used survey data from 12,432 participants of the 1921–26 birth cohort of the Australian Longitudinal Study of Women’s Health from 1996 (age 70–75) to 2016 (age 90–95). Repeated measures latent class analysis (RMLCA) identified trajectories of the development of disease with or without disability and according to longevity. Bivariate analyses and multivariable multinomial logistic regression models were used to examine the association between participants’ baseline characteristics and membership of the latent classes. Results Over one-third of women could be considered to be successful agers when in their early 70s, few women could still be classified in this category throughout their later life or by the end of the study when they were in their 90s (~1%). RMLCA identified six trajectory groups including managed agers long survivors (9.0%) with disease but little disability, usual agers long survivors (14.9%) with disease and disability, usual agers (26.6%) and early mortality (25.7%). A small group of women having no major disease or disability well into their 80s were identified as successful agers (5.5%). A final group, missing surveys (18.3%), had a high rate of non-death attrition. Groups were differentiated by a number of social and health factors including marital status, education, smoking, body mass index, exercise and social support. Conclusions The study shows different trajectories of disease and disability in a cohort of ageing women, over time and through to very old ages. While some women continue into very old age with no disease or disability, many more women live long with disease but little disability, remaining independent beyond their capacity to be classified as successful agers.

Objective To assess which older Australian women had Medicare subsidized health assessments between 1999 and 2013. Methods This study used prospective, longitudinal survey data from the 1921 to 1926 birth cohort of Australian Longitudinal Study on Women’s Health (ALSWH) linked with Medicare Australia data on health services use. Over 11,000 Australian women were included in the study. Latent class analysis was used to identify assessment patterns over time, accounting for death, and based on three categories (‘no assessment’; ‘assessment; ‘deceased’) for each year between 1999 and 2013. Further analysis explored the impact of health and sociodemographic characteristics on class membership. Results Of the women included in the latent class analysis, 37% never had any assessment and the remainder had had at least one assessment. After a steady uptake from 1999 to 2003, there was decline in uptake from 2003 onwards. A six-class model with sufficient homogeneity and reliable estimation was selected to represent assessment patterns and mortality risk, labelled as: ‘high mortality’ rate with little chance for assessment (12.4%), ‘intermediate mortality, low assessment’ (14.1%), ‘later mortality/low assessment’ (13.1%), ‘later mortality, high assessment’ (7.0%), ‘low mortality, low assessment’ (31.8%), ‘low mortality, high assessment’ (21.6%). Older women with certain conditions (such as diabetes, depression, heart disease) were more likely to be in the low assessment groups, and women with difficulty managing on income were more likely to be in low assessment groups. Conclusion Distinct assessment and mortality patterns were seen, with many women not having assessment, in particular those who had certain health conditions, were taking 3+ medications, had difficulty in managing on income, needed help or were in respite care, and had caring responsibilities. The findings point to a need to promote these assessments among older women, and to reduce financial barriers, even within the context of a heavily subsidized health care system.

Comorbid conditions frequently coexist with asthma in older adults and can alter the natural history of asthma, complicating management and affecting overall prognosis and survival.This study investigates the impact of asthma on mortality among older women, with a specific interest in influence of comorbidities and social factors on survival of older women with asthma.Participants were from the Australian Longitudinal Study on Women's Health and were born between 1921 and 1926. Cox proportional hazards were used to evaluate mortality rates for women with and without asthma, after adjustment for comorbidities and other factors.Of 10,413 women aged 73-78, 829 (8%) reported having been diagnosed by a doctor for asthma. Women with asthma had a higher likelihood of heart disease, hypertension, thrombosis, bronchitis/emphysema, osteoporosis and major illnesses (p 0.0001). Asthma was associated with increased risk of death (HR = 1.31, 95%CI 1.18-1.45, p 0.0001). After adjusting for age, demographic factors, comorbidities, risk factors, residential area and social support, women with asthma retained a 17% increased risk of death compared to women without asthma (HR = 1.17, 95%CI 1.03-1.32, p = 0.016).Older women with asthma have a higher rate of mortality compared with other women of the same age. This increased risk of death remains after age, demographic factors, comorbidities, risk factors, residential area and social support have been taken into account.

Decline in physical function is common in older age, with important consequences for health-related quality of life, health care utilisation, and mortality. This study aimed to identify patterns of change in physical functioning (PF) for women in later life. PF was measured longitudinally using the ten-item subscale of the Medical Outcomes Study 36-item Short Form Health Survey, for 10 515 participants of the Australian Longitudinal Study on Women’s Health, who completed at least two surveys between 1999 (aged 73–78 years) and 2011 (aged 85–90 years). Conditional and unconditional latent profile analysis was conducted separately for deceased and surviving subgroups of women to uncover latent patterns of change in PF scores over time. Four patterns of change were identified for women who were still alive in 2011 (N = 5928), and four similar classes for deceased women (N = 4587): (1) ‘poor PF’ representing women with low PF scores, (2) ‘moderate PF’, (3) ‘high PF’, and (4) ‘very high PF’, where scores remained very high. All patterns exhibited a decrease in PF over time. Factors which predict low PF included sedentary levels of exercise, obese and overweight BMI, difficulty managing on income, and lower education. The results provided evidence for a gradual decrease in PF for all women with age; however, there was no evidence for an increased rate of decline prior to death.

Objective: To explore impact of incident osteoarthritis (OA) on health services use by Australian women born 1946–51. Methods: Secondary analysis of Australian Longitudinal Study on Women's Health survey data linked to Medicare Australia databases (2002 to 2011). Medicare services use was compared for two groups: OA group (n=761) – reported incident OA in 2007; Never group (n=4346) – did not report arthritis in time frame. Interrupted time series regression compared health services use over time. Results: The OA group had higher health services use than the Never group. Rate of services use increased over time for both groups. Rate of increase in quarterly doctor attendances was significantly lower for the OA group after onset of OA, with no corresponding change for the Never group. Conclusions: A pre-existing higher use of health services is associated with reporting incident OA, compared to those who never report arthritis. After onset of OA, rate of doctor use reduced and allied health use increased, consistent with recommended Australian treatment guidelines. Implications: This study provides a rare insight into change in healthcare use for people reporting incident OA, against an appropriate comparison group, highlighting the importance of early diagnosis of OA to optimise effective use of health services. Refereed/Peer-reviewed