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Objective: Improving the quality of life (QoL) of older people is a key priority for governments, clinicians, researchers and service providers worldwide. However, the lack of culturally appropriate QoL tools for First Nations people is a major barrier to such efforts. The purpose of this study was to evaluate the psychometric properties of the Good Spirit, Good Life (GSGL) QoL tool for older Aboriginal Australians. Methods: One hundred and twenty older Aboriginal people living in Perth and Melbourne, Australia, were administered the GSGL tool, along with several other instruments assessing cognition (KICA‐Cog), depression (KICA‐Dep), anxiety (GAI‐SF), health and well‐being (EQ‐5D‐5L and ICECAP‐O) and resilience (ARRQ‐25). Associations between these instruments and the GSGL tool were explored to determine concurrent and known‐groups validity. Internal consistency was assessed with split‐half reliability and Cronbach's alpha. Exploratory factor analysis was performed to investigate construct validity. Results: GSGL scores were positively correlated with ICECAP‐O and ARRQ‐25 scores, and negatively correlated with EQ‐5D‐5L score. GSGL scores differed significantly between participants with a probable anxiety disorder or depression, but not those with cognitive impairment. The Spearman–Brown prophecy estimate was 0.83 and Cronbach's alpha was 0.75. Principal component analysis identified two factors, which were labelled foundation and external. Conclusions: The GSGL tool is a valid tool to assess quality of life in older Aboriginal Australians. The tool demonstrates acceptable convergent, concurrent and known‐groups validity. It was co‐designed at all stages with older Aboriginal people contributing to its strong face and content validity. [ABSTRACT FROM AUTHOR]

Background: Little is known about urinary incontinence in older Aboriginal Australians. Aim: To describe urinary incontinence assessment, prevalence, incidence and associated conditions in older Aboriginal Australians. Methods: Wave 1 consisted of 363 Aboriginal participants aged ≥45 years from Western Australia; 289 participants participated in Wave 2, with 184 included at both time points. Urinary incontinence was assessed by self‐report, family report and the modified International Consultation on Incontinence Questionnaire (ICIQ). We investigated factors associated with incontinence with binary logistic regression. Sensitivity and specificity analyses of incontinence measures were undertaken using the ICIQ score ≥2 as the reference standard. Results: Participant mean age was 61.2 ± 11.2 years. Prevalence of incontinence at Wave 2 (n = 289) using self‐report was 24.6%; using ICIQ ≥2 was 22.5%; and family report 14.2%. Incidence after follow‐up of 6.7 years was 33 (23.6%), higher than estimates of 5–20% in other populations. Cross‐sectional associations with incontinence include female sex (odds ratio (OR) = 6.82; 95% confidence interval (CI) 2.98–15.57), stroke (OR = 3.55; 95% CI 1.43–8.77), head injury (OR = 3.15; 95% CI 1.54–6.45) and depressive symptoms (OR = 1.07; 95% CI 1.01–1.14). Longitudinal associations were age (OR = 1.05; 95% CI 1.01–1.09) and female sex (OR = 2.37; 95% CI 0.99–5.67). Sensitivity (81.5%) and specificity (93.5%) of self‐report were high. Conclusion: The prevalence and incidence of urinary incontinence in Aboriginal Australians is high with risk factors of older age and female sex. The modified ICIQ and self‐report appear to be appropriate incontinence screens. Further research to understand causes and treatments within this population is urgently required. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the prevalence of polypharmacy, under-prescribing and potentially inappropriate medicine use among Aboriginal Australians living in remote Western Australia.Design: Cross-sectional study.Setting: Six remote communities and the town of Derby in the Kimberley, Western Australia.Participants: Aboriginal people aged 45 years or more with complete medication histories.Main Outcome Measures: Proportions of patients with medicine histories indicating polypharmacy, potential under-prescribing of indicated medicines, or potentially inappropriate prescribing (including potential prescribing cascades or drug interactions).Results: Complete medicine histories were available for 273 participants. The mean number of prescribed medicines was 5.1 (SD, 3.6). At least one form of suboptimal prescribing was identified for 166 participants (61%), including polypharmacy for 145 (53%), potential under-prescribing of at least one indicated medicine for 33 (12%), and potentially inappropriate prescribing for 54 participants (20%). Potential prescribing cascades or drug interactions were identified for 12 participants (4%).Conclusions: Potentially suboptimal prescribing affected more than half the participating older Aboriginal Australians from the Kimberley. If generalisable to other remote Indigenous Australians, the prevalence of polypharmacy, potentially inappropriate prescribing, and under-prescribing of indicated medicines is problematic, and suggests that older Indigenous people in remote areas are at risk of medicine-related harm. [ABSTRACT FROM AUTHOR]

Objective: Although the prevalence of dementia in remote living Aboriginal Australians is one of the highest in the world, the factors associated with dementia in this population are yet to be examined. This study was designed to determine the demographic, lifestyle and clinical factors associated with dementia in Aboriginal Australians living in the Kimberley region of Western Australia. Method: A total of 363 Aboriginal Australians aged over 45 years from the Kimberley region were selected by semi-purposeful sampling. The factors analysed for association with dementia were age, sex, education, smoking, chewing tobacco, alcohol, head injury, heart disease, hypertension, diabetes, previous stroke, epilepsy, falls, mobility, incontinence, urinary problems, vision and hearing. This exposure data was collected from participants' and informants' reports using the Kimberley Indigenous Cognitive Assessment and specialist review, and medical records. Results: Factors associated with dementia included older age, male gender (OR 3.1, 95%CI 1.4, 6.8) and no formal education (OR 2.7, 95%CI 1.1, 6.7) and after adjusting for age, sex and education, dementia was associated with current smoking (OR 4.5, 95%CI 1.1, 18.6), previous stroke (OR 17.9, 95%CI 5.9, 49.7), epilepsy (OR 33.5, 95%CI 4.8, 232.3), head injury (OR 4.0, 95%CI 1.7, 9.4), and poor mobility, incontinence and falls. Conclusions: Interventions aimed at better management or prevention of the modifiable factors identified could reduce dementia risk in Aboriginal populations. [ABSTRACT FROM AUTHOR]

Objectives: To describe the processes used to develop an instrument to assess cognition in the older Indigenous community of the Kimberley region of Western Australia, given the diverse history and culture of the region. Methods: Cognition questions were discussed with Indigenous organisations, councils, linguists, interpreters and health professionals. Existing assessment tools were reviewed. The cognition questions and the way in which they were approached were trialled with older Indigenous participants. Results: Questions to assess cognition were developed and incorporated into the Kimberley Indigenous Cognitive Assessment (KICA) instrument, which has since been demonstrated to be a valid and reliable assessment of cognition in older Indigenous Australians in the Kimberley. Conclusion: The KICA-Cog questions in the KICA survey tool provide the first specific instrument for assessing cognitive decline in older Indigenous Australians. This instrument, or a modification of this instrument, is likely to have broader applicability across Indigenous communities in Northern Australia. [ABSTRACT FROM AUTHOR]