Research Interests:
The goal of this study was to describe researchers' experiences in submitting ethical proposals focused on older adult populations, including studies with persons with dementia, to ethical review boards. Ethical approval was granted... more
The goal of this study was to describe researchers' experiences in submitting ethical proposals focused on older adult populations, including studies with persons with dementia, to ethical review boards. Ethical approval was granted for an online survey. Researchers were recruited via listservs and snowballing techniques. Participants included 157 persons (73% female) from Australia and the United States, with a mean age of 46 (±13). Six main issues were encountered by researchers who participated in this survey. In descending order, these included questions regarding: informed consent and information requirements (61.1%), participants' vulnerability, particularly for those with cognitive impairments (58.6%), participant burden (44.6%), data access (29.3%), adverse effects of data collection/intervention (26.8%), and study methodology (25.5%). An inductive content analysis of responses revealed a range of encounters with ethical review panels spanning positive, negative, and...
Research Interests:
Research Interests:
Research Interests:
Pre-operative frailty is an important predictor of poor outcomes but the relationship between frailty and geriatric syndromes is less clear. The aims of this study were to describe the prevalence of frailty and incidence of geriatric... more
Pre-operative frailty is an important predictor of poor outcomes but the relationship between frailty and geriatric syndromes is less clear. The aims of this study were to describe the prevalence of frailty and incidence of geriatric syndromes in a cohort of older vascular surgical patients; and investigate the association of frailty and other key risk factors with the occurrence of one or more geriatric syndromes (delirium, functional decline, falls and/or pressure ulcers) and two hospital outcomes (acute length of stay and discharge destination). This prospective cohort study was conducted in a vascular surgical ward in a tertiary teaching hospital in Brisbane, Australia. Consecutive patients aged ≥ 65 years, admitted for ≥72 hours were eligible for inclusion. Frailty was defined as one or more of functional dependency, cognitive impairment or nutritional impairment at admission. Delirium was identified using the Confusion Assessment Method and a validated chart extraction tool. F...
Research Interests:
Methods: Medical records of patients aged 65 years and over hospitalised with a fall related injury were reviewed. Demographic and injury data were analysed and injury rates calculated using census data as the denominator for the... more
Methods: Medical records of patients aged 65 years and over hospitalised with a fall related injury were reviewed. Demographic and injury data were analysed and injury rates calculated using census data as the denominator for the population at risk. Results: From age 65, hospitalised fall related injury rates increased exponentially for both males and females, with age adjusted incidence rates
Research Interests: Psychology, Injury Prevention, Humans, Older people, Queensland, and 15 moreINTENSIVE CARE, Hospitalization, Female, Male, Population based study, Follow-up studies, Length of Stay, Aged, Head injury, Public health systems and services research, Hip fracture, Bone Loss, Lower limb, Medical Records, and Logistic Models
older people are high users of healthcare resources. The frailty index can predict negative health outcomes; however, the amount of extra resources required has not been quantified. to quantify the impact of frailty on healthcare... more
older people are high users of healthcare resources. The frailty index can predict negative health outcomes; however, the amount of extra resources required has not been quantified. to quantify the impact of frailty on healthcare expenditure and resource utilisation in a patient cohort who entered a community-based post-acute program and compare this to a cohort entering residential care. the interRAI home care assessment was used to construct a frailty index in three frailty levels. Costs and resource use were collected alongside a prospective observational cohort study of patients. A generalized linear model was constructed to estimate the additional cost of frailty and the cost of alternative residential care for those with high frailty. participants (n = 272) had an average age of 79, frailty levels were low in 20%, intermediate in 50% and high in 30% of the cohort. Having an intermediate or high level of frailty increased the likelihood of re-hospitalisation and was associated ...
Research Interests:
Research Interests:
This report describes the case of an 18 year old female who sustained a jellyfish sting on her right wrist. She subsequently developed complete radial, ulnar and median nerve palsies distal to the site of the sting, which recovered fully... more
This report describes the case of an 18 year old female who sustained a jellyfish sting on her right wrist. She subsequently developed complete radial, ulnar and median nerve palsies distal to the site of the sting, which recovered fully over the next 10 months. We believe this to be due to a direct neurotoxic effect of the jellyfish venom.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
With evidence of increasing accident risk due to age-related declines in health and cognition affecting driver performance, there is a need for research promoting safe mobility of older people. The present study aimed to identify... more
With evidence of increasing accident risk due to age-related declines in health and cognition affecting driver performance, there is a need for research promoting safe mobility of older people. The present study aimed to identify transport options and licensing issues for a group of older people in an Australian community. Ninety-five participants aged 75 and over were interviewed about their driving status and accident record and tested for cognitive ability. After stratification on cognitive level and driver status (current, ex-driver or non-driver), 30 were selected for further in-depth interviews concerning demographics, license status and impact of change, travel options available and used, and travel characteristics. Considerable reliance on the motor vehicle as the mode of transport and the decision to cease driving were major quality-of-life issues. There was little evidence of planning and support in making the decision to stop driving. Some differences in transport decisions on the basis of cognitive level were evident; however, people with severely compromised cognitive ability (and, therefore, unable to give informed consent) had been excluded. The study suggested the need for resources to assist older people/carers/health professionals to plan for the transition from driver to non-driver and to manage alternative transport options more effectively.
Research Interests:
To determine whether the frailty status of patients with chronic kidney disease (CKD) can be measured using a Frailty index (FI). One hundred and eleven attending a nephrology clinic were approached to complete a one-page questionnaire... more
To determine whether the frailty status of patients with chronic kidney disease (CKD) can be measured using a Frailty index (FI). One hundred and eleven attending a nephrology clinic were approached to complete a one-page questionnaire evaluating cognitive, psychological and functional status. Data were coded as deficits, summed and divided by the total number of deficits considered, to derive an FI-CKD. One hundred and ten (mean age 65.2 years) agreed to participate and assessments took approximately 10 minutes to complete. Mean FI-CKD was 0.25 (SD 0.12). The FI-CKD increased with age at 3% per year, correlated with a modified Fried phenotype (P < 0.001) and increased significantly across CKD stages (P = 0.04). The FI-CKD is feasible in the outpatient setting and has good construct validity. The greater granularity of a continuous measure has the potential to inform decision-making regarding appropriate interventions for patients at the 'frail' end of the health spectrum.
skip nav. ...
A better understanding of the health status of older inpatients could underpin the delivery of more individualised, appropriate health care. 1418 patients aged ≥ 70 years admitted to 11 hospitals in Australia were evaluated at admission... more
A better understanding of the health status of older inpatients could underpin the delivery of more individualised, appropriate health care. 1418 patients aged ≥ 70 years admitted to 11 hospitals in Australia were evaluated at admission using the interRAI assessment system for Acute Care. This instrument surveys a large number of domains, including cognition, communication, mood and behaviour, activities of daily living, continence, nutrition, skin condition, falls, and medical diagnosis. Variables across multiple domains were selected as health deficits. Dichotomous data were coded as symptom absent (0 deficit) or present (1 deficit). Ordinal scales were recoded as 0, 0.5 or 1 deficit based on face validity and the distribution of data. Individual deficit scores were summed and divided by the total number considered (56) to yield a Frailty index (FI-AC) with theoretical range 0-1. The index was normally distributed, with a mean score of 0.32 (±0.14), interquartile range 0.22 to 0.4...
Research Interests:
Objective The aim of the present study was to describe, from the perspective of the healthcare funder, the cost components of the Australian Transition Care Program (TCP) and the healthcare resource use and costs for a group of transition... more
Objective The aim of the present study was to describe, from the perspective of the healthcare funder, the cost components of the Australian Transition Care Program (TCP) and the healthcare resource use and costs for a group of transition care clients over a 6-month period following admission to the program. Methods A prospective cohort observational study of 351 consenting patients entering community-based transition care at six sites in two states in Australia from November 2009 to September 2010 was performed. Patients were followed up 6 months after admission to the TCP to ascertain current living status and hospital re-admissions over the follow-up period. Cost data were collected by transition care teams and from administrative data (hospital and Medicare records). Results The TCP provides a range of services with most costs attributed to provision of personal care support, case management, physiotherapy and occupational therapy. Most healthcare costs up to 6 months after tran...
Research Interests:
For frail older people, admission to hospital is an opportunity to review the indications for specific medications. This research investigates prescribing for 206 older people discharged into residential aged care facilities from 11 acute... more
For frail older people, admission to hospital is an opportunity to review the indications for specific medications. This research investigates prescribing for 206 older people discharged into residential aged care facilities from 11 acute care hospitals in Australia. Patients had multiple comorbidities (mean 6), high levels of dependency, and were prescribed a mean of 7.2 regular medications at admission to hospital and 8.1 medications on discharge, with hyper-polypharmacy (≥10 drugs) increasing from 24.3% to 32.5%. Many drugs were preventive medications whose time until benefit was likely to exceed the expected lifespan. In summary, frail patients continue to be exposed to extensive polypharmacy and medications with uncertain risk-benefit ratio.
Research Interests:
To examine the effect of wearing an accelerometer (without provision of feedback) on the mobility of older rehabilitation inpatients, using the locomotion component of the FIM at admission and discharge. A retrospective matched cohort... more
To examine the effect of wearing an accelerometer (without provision of feedback) on the mobility of older rehabilitation inpatients, using the locomotion component of the FIM at admission and discharge. A retrospective matched cohort study of patients aged >60 years admitted to a rehabilitation unit between 1 January 2008 and 1 January 2009. The exposed group was 17 patients who had worn an accelerometer daily during their rehabilitation stay. These patients were matched with 17 controls (the unexposed group) identified from the unit database using the following variables: age (within 5 years), sex, admission Functional Independence Measure (locomotion) score and reason for admission to rehabilitation. The median length of stay, median FIM (locomotion) gain and median FIM (locomotion) efficiency for the two groups were compared using the Wilcoxon Signed Ranks Test. There were no statistically significant differences between the two groups at baseline. There was a trend towards a...
Research Interests: Rehabilitation, Nonparametric Statistics, Data Analysis, Physical Activity, Locomotion, and 18 moreGoal Setting, Humans, Female, Male, Statistical Significance, Cohort Study, Length of Stay, Aged, Retrospective Studies, Physical examination, Rehabilitation Centers, Ambulatory BP monitoring, Geriatric Assessment, Inpatients, Case Control Studies, Cohort Studies, Recovery of Function, and Disability Evaluation
The role of physical activity amongst older people in inpatient rehabilitation settings has been little studied. Walking has a number of potential benefits for older people in rehabilitation but it is not known whether increased walking... more
The role of physical activity amongst older people in inpatient rehabilitation settings has been little studied. Walking has a number of potential benefits for older people in rehabilitation but it is not known whether increased walking improves outcomes in this population. Until now mobility monitoring has not been possible in routine practice. Recently tri-axial accelerometers have been validated for ambulatory activity monitoring in older adults. Accelerometry has the potential to explore the role of walking in older patients in rehabilitation. Providing data regarding activity levels may improve patient motivation and assist clinicians with activity prescription. Future research could determine the relationship between activity levels and patient outcomes.
Research Interests:
... people with greater personal resources and better physical and mental health are more likely to seek community service (Thoits and Hewitt 2001). ... Lancet 366(9500):1885–1893 Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK,... more
... people with greater personal resources and better physical and mental health are more likely to seek community service (Thoits and Hewitt 2001). ... Lancet 366(9500):1885–1893 Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL et al (2002) Short screening ...
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Proceedings of ERA 2002 – 1st National Conference for Emerging Researchers in Ageing
Research Interests: Program Evaluation, Human Geography, Epidemiology, Community Health, Risk Management, and 21 morePublic Health, Prevention, Humans, Older people, Environmental Hazards, Female, Community health nursing, Male, Health Science, Incidence, Risk factors, Randomised Controlled Trial, Group Intervention, Intervention Studies, Aged, Risk Factor, Regression Model, Public health systems and services research, Risk Factors, Proportional Hazards Models, and Fall
Research Interests:
With evidence of increasing accident risk due to age-related declines in health and cognition affecting driver performance, there is a need for research promoting safe mobility of older people. The present study aimed to identify... more
With evidence of increasing accident risk due to age-related declines in health and cognition affecting driver performance, there is a need for research promoting safe mobility of older people. The present study aimed to identify transport options and licensing issues for a group of older people in an Australian community. Ninety-five participants aged 75 and over were interviewed about their driving status and accident record and tested for cognitive ability. After stratification on cognitive level and driver status (current, ex-driver or non-driver), 30 were selected for further in-depth interviews concerning demographics, license status and impact of change, travel options available and used, and travel characteristics. Considerable reliance on the motor vehicle as the mode of transport and the decision to cease driving were major quality-of-life issues. There was little evidence of planning and support in making the decision to stop driving. Some differences in transport decisions on the basis of cognitive level were evident; however, people with severely compromised cognitive ability (and, therefore, unable to give informed consent) had been excluded. The study suggested the need for resources to assist older people/carers/health professionals to plan for the transition from driver to non-driver and to manage alternative transport options more effectively.
Research Interests:
Bone mass is the most important determinant of fracture risk. Current bone mass of an individual will be determined by the peak bone mass achieved in early adult life and the subsequent duration and rate of bone loss. In attempting to... more
Bone mass is the most important determinant of fracture risk. Current bone mass of an individual will be determined by the peak bone mass achieved in early adult life and the subsequent duration and rate of bone loss. In attempting to predict an individual&#39;s future risk of fracture it is therefore logical to attempt to assess both of these parameters. Serial measurements of bone mineral density and estimation of the rate of bone turnover may also be used to determine the response to treatment. In this chapter we review the currently available methods of measuring BMD and bone turnover, and discuss their place in the diagnosis and management of osteoporosis.