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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.

Background National data on dementia prevalence are not always available, yet it may be possible to obtain estimates from large surveys that include dementia screening instruments. In Australia, many of the dementia prevalence estimates are based on European data collected between 15 and 50 years ago. We derived population-based estimates of probable dementia and possible cognitive impairment in Australian studies using the Mini-Mental State Examination (MMSE), and compared these to estimates of dementia prevalence from meta-analyses of European studies. Methods Data sources included a pooled dataset of Australian longitudinal studies (DYNOPTA), and two Australian Bureau of Statistics National Surveys of Mental Health and Wellbeing. National rates of probable dementia (MMSE < 24) and possible cognitive impairment (24-26) were estimated using combined sample weights. Results Estimates of probable dementia were higher in surveys than in meta-analyses for ages 65-84, but were similar at ages 85 and older. Surveys used weights to account for sample bias, but no adjustments were made in meta-analyses. Results from DYNOPTA and meta-analyses had a very similar pattern of increase with age. Contrary to trends from some meta-analyses, rates of probable dementia were not higher among women in the Australian surveys. Lower education was associated with higher prevalence of probable dementia. Data from investigator-led longitudinal studies designed to assess cognitive decline appeared more reliable than government health surveys. Conclusions This study shows that estimates of probable dementia based on MMSE in studies where cognitive decline and dementia are a focus, are a useful adjunct to clinical studies of dementia prevalence. Such information and may be used to inform projections of dementia prevalence and the concomitant burden of disease.

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.

Self-medication among the study respondents ranged from 18% to 36% between 1992 and 2004. The most frequent classes of complementary and alternative medicines were vitamins and minerals, herbal medicines and nutritional supplements, with younger individuals and women more likely to use them. For over-the-counter (OTC) medicines, the most commonly used were analgesics, laxatives and low-dose aspirin. Use of OTC medicines seemed to be done in accord with indications officially approved by the Australian medicine agency. Future work should examine risks associated with the concomitant use of complementary and alternative medicines, prescription and OTC medicines., National Health and Medical Research Council (410215); NHMRC Fellowships (#366756 to K.J.A. and #316970 to P.B.)

We appreciate the important issues detailed by O'Callaghan and O'Neill, although our reading of the evidence is that, despite the majority of safe older drivers, there is a proportion of older drivers who may be unsafe because of cognitive impairment. Given population aging, the size of this subgroup will increase. Persons classified as cognitively impaired (including those with a mean Mini-Mental State Examination (MMSE) score of 26.5 or MMSE scores of ≤26) have demonstrated poorer driving performance in on-road driving assessments, crashes, driving simulators, and other performance measures. Although many older adults may begin to modify their driving behaviors, reducing their exposure to higher-risk situations, such modifications may not be sufficient for drivers who are at greater risk of crashing. Our study identifies a large proportion of older drivers with MMSE scores of 26 or lower. Additionally, the sample is likely to be biased toward higher-functioning older adults because of selection effects at entry to the studies, hence underestimating the numbers with possible cognitive impairment.