Australian Journal on Ageing Media releases

AJA Media releases

Australasian Journal On Ageing

The Journal of Aged and Community Services Australia, The Australian Association of Gerontology,
The Australian Society for Geriatric Medicine and Council on the Ageing (Australia)

MEDIA RELEASES

March 2003 issue

December 2002 issue
September 2002 issue
June 2002 issue
March 2002 issue

December 2001 issue
September 2001 issue
June 2001 issue

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NEWS ITEMS FROM RESEARCH ON AGEING
Australasian Journal on Ageing presents research on ageing from Australia, Asia and the Pacific.

The December 2002 issue (Vol 21.4 ) has articles and reports on a number of social and medical issues of concern and interest to those caring for older people and for the community generally. Highlights are summarised below.

They include differences between men and women about treatment choices for life threatening illnesses, differences in the perceptions of staff and residents about residents' quality of care and quality of life, the need to take blood pressure standing up as well as or instead of sitting or lying down, and driving and dementia.

Full copies of any article are available for media from the COTA National Seniors Policy Secretariat by phoning 03-9820 2655 or email aja@cota.org.au or by contacting the author. Please acknowledge AJA as source of information in any article or report.

Fighting On- differences between men and women in treatment choices for life threatening illnesses

A survey of older veterans and war widows about treatment choices for different life threatening illnesses showed an overall preference for palliative rather than invasive treatments. However men, especially older men, were more likely than women to choose invasive treatments. Participants wanted to exercise choice, which was affected by issues such as the impact on family and care needs, and the desire to continue to live, but they wish this to be an informed choice.

Sara Graham, Social Policy Research Centre, University of NSW, Felicity Barr, Dept Veterans Affairs

Differences in staff and residents perceptions of quality of life and quality of care

A South Australian study of what staff think residents feel about their lives, and their actual feelings shows widespread ignorance. Aged care staff 's assessments of resident life satisfaction differed from those reported by residents. Male residents wanted more comfort and less conflict, while female residents wanted more independence and less organisation than had been assessed.

Differences in the perceptions of staff and residents concerning resident life satisfaction and real and ideal residential conditions could make it difficult to agree on and implement any changes that residents might want This would be a particular problem where staff believed that conditions were already close to ideal.

The researchers speculate that staff might be reluctant to report dissatisfaction as it could reflect on the care they provide. They conclude that further studies and government evaluations should utilise male and female residents' ratings of their own life satisfaction and evaluations of their residential environments rather than relying on staff or management perceptions.

Dr Neil Kirby, Leah Wilson

Social Policy and Older People in England

After years of underfunding, the UK Labor Government has directed extra NHS and local authority resources to services for older people. However these resources might not mean improved services and support. The UK is also experiencing difficulties in retaining and attracting front line health and social care stuff due to lower pay and working conditions. This article by a leading UK researcher, also shows that country grappling with funding, including user pays for aged care including residential care, similar to the Australian experience.

Caroline Glendenning, National Primary Care Research and Development Centre, University of Manchester Ph. UK

Myths, false beliefs and strong negative attitudes towards dentistry among Greek and Italian older Australians pose public health challenge

A Melbourne study has shown myths, false beliefs, past experiences and negative attitudes towards dentistry could affect treatment sought and quality of oral health among elderly Greek and Italian born Australians. Although they generally knew about major oral diseases and treatments, there were many barriers which interfered with seeking check-ups and treatment including costs, waiting lists and lack of confidence in the public system. The authors recommend removal of structural problems such as costs and waiting list, and providing up to date, culturally and linguistically appropriate information on oral health to correct misconceptions, and encourage seeking earlier, preventive treatment.

Prof Victor Minichiello, at University of New England, Dr Rodrigo Marino, Anne Pirdas, Laura Mason

How to prevent hip fractures in residential aged care

There is a strong case for introducing large scale hip fracture prevention programs, including fall prevention, hip protectors, increased Vitamin D exposure and osteoporosis management in residential aged care, according to a Melbourne pilot study.The benefits both to individual reduction in painful and debilitating hip fractures, and to health costs in reduced hospitalisation and ongoing treatment and care suggest that further work and evaluation of larger scale projects along similar lines would be worthwhile.

Contact: Dr Sam Scherer, Royal Freemasons' Homes of Victoria

Blood Pressure levels should be taken standing up as well as sitting or lying down

Two specialist geriatricians have recommended that blood pressure of elderly patients should be routinely measured when they are standing up as well as or instead of sitting or lying down, to test for orthostatic hypotension (low standing blood pressure), an extremely common and very serious condition in the elderly. It can lead to falls, strokes, confusion and fitting and can be caused by adverse drug reactions particularly drugs used for heart disease and Parkinson's disease, dehydration and a combination of these and other conditions. It is completely treatable but often ignored.

Dr Peter Lipski

GP survey of driving and dementia– new South Australian study

South Australian GPs are concerned about the safety of their patients with dementia who drive. They are not all familiar with the current law relating to driving and dementia, and are reluctant to be responsible for the assessment of fitness to drive in such patients. The report suggests that patient reviews of fitness to drive should be conducted at six monthly intervals.

Carol Snellgrove, Department of Rehabilitation and Aged Care

September 2002 issue - NEWS ITEMS FROM RESEARCH ON AGEING
Australasian Journal on Ageing presents research on ageing from Australia, Asia and the Pacific. It is published quarterly by Council on the Ageing (Australia), Aged and Community Services Australia, Australian Association of Gerontology and the Australian Society for Geriatric Medicine.

The September 2002 issue has articles and reports on a number of economic, social and medical issues of concern and interest to the government, policy makers, those caring for older people and for the community generally. They include a study showing the economic contribution made by older people, the likelihood of using nursing home care over a lifetime, legal problems and risks of abuse due to lack of understanding of law, use of ageist terms in hospitals, health and social needs of recently widowed older women, hearing loss unnoticed and untreated in nursing homes, and impact of stopping driving. Highlights are summarised below. Full copies of any article are available for media from COTA (A), by phoning 03-98202655, email aja@cota.org.au , or by contacting the author. Please acknowledge source of information in any article or report.

Ageing and the economy: benefits far outweigh costs

Many of the current commentators (including politicians and economists) on the costs of caring for a growing, ageing society, assume that the elderly are a burden on the rest of the community. A new South Australian study firmly debunks this fallacy.

It estimates the total value of productive activities undertaken by people over the age of 65 years (about 200,000 in SA) as being between A$4.9 and A$8.1 Billion. The estimated value of work performed for others was between A$0.82 and A$1.3 Bn. Set against this was the cost of their health and aged care, calculated to be about A$1.8 Bn.

The research concludes that older South Australians make essential contributions to society, contributions that have a very large economic value.

Dr Rob Ranzijn, School of Psychology, University of South Australia

Probability of using an aged care home over a lifetime

A much larger proportion of older people than has often been recognized are likely to be admitted to residential aged care at some point in their lives. Two in five women can expect to be admitted after turning 65, compared to one in four men. However, only seven percent of women and three percent of men over 65 were residents on any one day in 1999-00.

The older a person is, the higher the probability of entering residential care.

This analysis by staff at the Australian Institute of Health and Welfare is of great importance to government planners for long term planning purposes and insurance and superannuation companies considering long term insurance products.

Mrs Frieda Rowland AIHW

Older people face legal problems and risk of financial abuse due to lack of understanding of laws relating to substitute decision-making.

Despite the increasing need for understanding and future use of legal decision making arrangements in the event of incapacity, there is a lack of understanding to make informed legal choices amongst most older people surveyed in this Queensland study.

It looks at experiences surrounding the operation of the State's Power of Attorney Act and reports that low income, cultural background, disability, rural location, nursing home residence and gender can all limit the ability of older people to make informed choices about substitute decision making (i.e. enduring power of attorney - EPA).

There is general lack of knowledge of the law and legal rights, limited access to legal services, high legal costs and ageist assumptions about the needs and capacities of older people. e.g. many, particularly those on lower incomes did not realize that once 'capacity' was lost, it was not then possible for them to appoint a family member to manage their affairs. Some thought that management of one's affairs did not occur until after death. EPA awareness and use was highest in retirement village residents.

It recommends raising community awareness and undertaking education about the advantages and disadvantages of EPAs. Older people in rural areas may need specially targeted strategies to increase use of Power of Attorney laws.

Dr Deborah Setterlund, School of Social Work and Social Policy, University of Qld

Need for new terminology to replace ageist terms in hospitals

Terms such as GOMER (get out of my emergency room) and 'geris' or 'crumble' are brutal hospital slang used to stigmatise elderly patients admitted to hospital with what the attending doctors believe are trivial illnesses or symptoms. These conditions often mask serious disease or functional decline. Slang terminology to describe illnesses of the elderly is being used more frequently in hospitals, even by consultant geriatricians. The author suggests developing new more accurate and less demeaning terms to improve classification systems (and perhaps even treatment and care) for acutely ill older patients.

Associate Prof. David Bruce, Department of Community and Geriatric Medicine, Fremantle.

Health and social needs of recently widowed older women in Australia

Widowhood is a 'normal' phase in the life of many older women, as they tend to live longer than men. Widowhood has been stereotyped as a crisis, a personal affliction with long term mental health problems. This study argues that while it is stressful the challenges facing older women are more complex than just coping with the grief and painful loss of a partner. It can signal a positive shift into a new life phase. Many women actively seek more social contact within the community after the death of their husbands.

The increased incidence of medication to assist with bereavement, including 'to help them sleep' is a concern due to side effects including a higher risk of falls. Widowed women have broad needs for practical help and advice, especially legal services including financial advice and home maintenance services which, if lacking, can often drive them to move into to smaller accommodation.

Assoc. Prof. Julie Byles, Director, Centre for Clinical Epidemiology and Biostatistics, Royal Newcastle Hospital.

Earwax at high levels and hearing loss unnoticed and untreated in nursing homes

An assessment of hearing impairment in residential aged care facilities has shown that despite 87% of participants having significant hearing loss only 43% currently wore hearing aids, with almost half of these requiring maintenance. Over 40% of people's ears had so much ear wax that medical assistance was needed. Lip reading is essential for most of the residents but in social situations, especially meal times, this was difficult due to how they were seated in relation to others (e.g. too far away, next to, instead of opposite), and the associated noise from floors, cleaning etc.

Dr Mark Flynn

Cessation of driving in later life may not result in dependence.

The cessation of driving in later life, whether forced on a person by frailty or specific condition such as sight loss, has been seen as a major loss of independence and barrier to staying active within their community for personal, social and living needs. It can even force a change in accommodation.

The authors argue that the process of ceasing driving in later life may represent a 'rite of passage' that does not necessarily lead to a loss of independence. While they reported convenience and freedom as changing when driving stopped, they also reported a sense of acceptance of the loss of driving, and discovery of new networks and ways of getting about so that independence is retained (particularly for older people living in a metropolitan area). They hope that doctors will feel more positive about suspending an older person's licence based on this research.

However they do recommend more research on specifically rural experiences and on developing programs to actively assist older adults making the transition after ceasing driving.

Dr. Laurie Buys, `Centre for Community and Cross Cultural Studies, QUT

June 2002 issue - NEWS ITEMS FROM RESEARCH ON AGEING
Australasian Journal on Ageing presents research on ageing from Australia, Asia and the Pacific. It is published quarterly by Council on the Ageing (Australia), in association with Aged and Community Services Australia, Australian Association of Gerontology, and the Australian Society for Geriatric Medicine.

The June 2002 issue has articles and reports on a number of social and medical issues of concern and interest to those caring for older people and for the community generally. Ageism, by nurses caring for older people, for doctors providing medical care, and nursing home residents are examined, as are Doctors allowing patients with dementia to continue driving, fear of crime among the elderly, and equity in distribution of aged care services between metropolitan, regional and rural Australia. Highlights are summarised below. Copies of any article are available for media from the Council on the Ageing (Australia) by phoning 03-98202655 or email aja@cota.org.au. Please acknowledge source of information in any article or report.

Doctors let people with dementia continue driving

A survey of NSW Central Coast GPs has shown that many are allowing unfit drivers (those with dementia) to continue to drive. Not all GPs are adequately trained in, or aware of the regulations for medical driver assessments. They are not routinely screening older drivers, and are concerned about the consequences of cancelling a vulnerable, frail, older person's driving licence when they could possibly be physically and socially stranded as a result. They believe that others should handle medical driver assessments.

The researchers estimate that up to 80,000 demented drivers could be on Australian roads, a potential major public health problem.

Dr Peter Lipski, Dept Health NSW

Urgent action needed to combat ageism and negative attitudes by nurses towards older people

Along with other medical and health professionals, some nurses have negative and incorrect stereotypes about older people, in their personal attributes and capabilities. This affects the care they provide. All nurses, not just those in aged care, urgently require education to dispel these stereotypes and enable them to differentiate between conditions that are an inevitable part of ageing and those that can be treated. This will improve the quality of care they provide and also help them feel more positive about their own ageing.

Dr Lindsay Gething, Univ Sydney

Ageism alive and well in use of evidence based medicine: life saving and life enhancing interventions decline as patients get older.

Gains in life expectancy with a resulting ageing patient population has not been accompanied by an interest and motivation to provide the best quality evidence based care for older people. This reflects the ageism prevalent in the community, according to this author.

He shows a refusal to use evidence based medical decisions in the treatment of systolic hypertension, (affecting 50% of people over 60 years), atrial fibrillation resulting in strokes, osteoporosis, and older aged immunizations.

Professor B. Nair, Newcastle University

Equity in distribution of aged care services in Australia

Isolation and social conditions in rural and remote Australia often mean greater difficulty and costs in providing aged care services. This study by the Australian Institute of Health and Welfare comparing the distribution of aged care services between capital cities, outer metropolitan areas, rural and remote areas, shows that the pattern of services varies considerably on a state and territory basis but that when the variety of aged care services is taken into account (including all forms of residential and home based care), rural and remote areas have more home based care to balance less residential care.

As a whole remote regions have the highest expenditure or residential care and care packages per 1,000 persons over 70, while rural areas have a lower level of expenditure. Some areas, especially rural WA, NSW and SA all had a lower than average residential care without the compensation of more HACC services. There is a need for more detailed studies of regional data to improve planning for future aged care services throughout Australia.

Dr Diane Gibson, AIHW

Smoking bad for some tasks while alcohol good for others in older person's study

Research into smoking and alcohol use of a major longitudinal study of older people in South Australia shows that a history of smoking may have a negative effect on effortful cognitive tasks, while moderate alcohol use may have a positive effect on naming and working memory.

Janet Bryan, CSIRO

Fear of crime not related to age but to gender

A South Australian study into the extent of fear of crime and the use of protective behaviours has shown a moderately high level of self-reported fear of crime but there were no differences between older and younger age-groups. Women felt significantly less safe than men, at all ages. There was no apparent relationship between protective behaviours and fear of crime. The authors have concluded that while crime prevention programs may have reduced the incidence of crime they do not appear to have reduced the level of fear.

Dr Rob Ranzijn, Univ SA

March 2002 issue - NEWS ITEMS FROM RESEARCH ON AGEING

The March 2002 issue includes articles and reports on a number of important economic, social and medical issues of concern to the Government, those caring for older people and for the community generally. They include articles on doctors' failure to discuss impotence with elderly men, policy problems of women and those in poor health unable to save enough for retirement, age discrimination in prescribing life saving drugs, and medical criticisms of current government residential care policies. Highlights are summarised below. Copies of any article are available for media from the Council on the Ageing (Australia) by phoning 03 9820 2655 or email aja@cota.org.au. For further details or comments contact the author as shown in article. Please acknowledge AJA as source of information in any article or report.

Impotence in older men - doctors won't discuss it

Impotence, or erectile dysfunction is the commonest health disorder affecting older men. It has a major impact on the social and personal functioning of those affected. But geriatricians who focus on the health care of this group do not address this issue adequately, according to a new study.

Most patients responding to an anonymous survey said they would have liked the opportunity to discuss the subject with their geriatrician, and that it should be a routine part of their assessment. Most patients said they would feel comfortable with such a discussion. Yet only one of the 11 specialists said they routinely asked all new male patients about erectile dysfunction. Only three thought it should be a routine part of a geriatrician's full assessment.

The study recommends that enquiries regarding erectile dysfunction should be a routine part of a geriatrician's full assessment.

Dr Andrew Grange

Gender roles and health are keys to adequate retirement income

Women are less likely to save for retirement because their income tends to be less than that of men. Those women who are divorced or caregivers are also less likely to make provision for their own retirement. But poor health can be a major barrier to retirement savings; it lowers the likelihood of saving and also of continued employment prospects.

These findings from a NZ study of Pakeha (NZedders of white origin) could be replicated in Australia. The feminisation of poverty and over-representation of older women below poverty lines are internationally recognised phenomena, particularly where pensions or superannuation are linked to length of work or the level of earnings.

Factors affecting women, savings and poverty include women's greater life expectancy, their tendency to outlive their partners and their lower earnings. The study reports that…."Despite the increasing economic independence achieved by women, they were still more likely to rely on their partners for retirement savings….Women's financial outcome in retirement will depend in a large degree on their spouse's behaviour related to money management."

Since the 80's, as in Australia, there has been a greater emphasis on private provision for retirement. So it is increasingly important to identify the characteristics of those who are less likely to be able to save for their retirement, as they may be at greater risk of disadvantage in later life.

The more reliance is placed on personal savings for ensuring security in retirement, the more the gaps between the advantaged and disadvantaged will widen in retirement. The results draw attention to the potential role of policies in alleviating the consequences of gender inequalities in income, divorce, care-giving and parenthood on women's financial security to prevent increasing feminisation of poverty.

Dr Susan Gee, School of Psychology, Victoria University.

For an Australian comment on women's access to superannuation and retirement income Contact: Veronica Sheen at COTA on 03 98202655 or Dr Diana Olsberg, Uni. of NSW

Geriatricians unhappy with Accreditation

An urgent review of the Accreditation system, on its own, and for its inconsistencies and duplications with the Resident Classification Scale, is called for by the Australian Society for Geriatric Medicine(AGSM) along with the number and adequacy of nursing home beds and capital funding requirements . The AGSM also make many recommendations covering the entire scope of the residential aged care system in its Position Paper No.10 and a background paper. It is a powerful critique of the existing system in Australia, from the low international position in international research and practice, lack of basic data, and a funding instrument which is 'the antithesis of a funding system that generates incentives for quality health outcomes'.

(The last edition of AJA published the ASGM Position Paper 9). Contact: Dr Sam Scherer

Ageism in prescribing Warfarin

A Sydney study has discovered that warfarin is prescribed less frequently in people over 80 years of age for anti stroke treatment, than for younger people at similar risk. Although definite contraindications to anticoagulation were a significant influence on prescribing, 'old age' was the largest contributing factor. The authors query this potential underutilisation in the target elderly population and suggest further studies to determine whether this is appropriate.

Ms Beata Bajorek, Faculty of Pharmacy,Uni. of Sydney.

'The stroke in bed three'

Peter Baume, Honorary research Associate at the Social Policy Research Centre at the University of NSW and former Liberal Senator, has, at the invitation of AJA, written an article on Dying.

He argues that teaching people how to give bad news should not just be a task for those interested in older people, but for everyone in the helping professions and that it should be taught, and examined, a lot more and in greater depth in medical, nursing and allied health schools. However "medical students I have taught have not been examined in these things at all" he writes.

Two health surveillance programs for elderly

The Commonwealth Dept. of Veterans Affairs, and the Victorian Dept of Human Services, have funded two separate but similar studies on developing health surveillance programs for the community-dwelling elderly.

Although both studies were conducted prior to the introduction of the Medicare benefit changes providing a rebate for GP assessments of patients over 75 years of age, they are both relevant to this reform, as they examine and evaluate tools to conduct the assessments.

Both studies identified a large number of similar health problems and care needs to be addressed to enable them to continue living at home. Hearing and feet problems featured prominently on both lists. The DVA research is more extensively reported.

DVA supported research Contact: Meredith Tavener,Uni. of Newcastle,
DHS supported research Contact: Angela Greenway-Crombie, Bendigo Health Care Group,

Hip protectors may help in falls injury

Hip fractures in older people lead to loss of mobility, independence, home living and even of life. They are a significant health cost with 15,000 people admitted to hospital each year with hip fractures, costing approximately $15,000 per patient, and taking up 13 days each in acute care wards.

The Commonwealth Government has established a National Falls Prevention for Older People initiative as part of its enhanced primary care program. Preventing falls is a major focus but preventing fall injury is also possible.

This study looks at use of hip protectors which are positioned over the bone at the top of the thigh and held in place by an underwear type garment. They indicate some level of protection against falls injury.

Ian Cameron, Rehabilitation Studies Unit, Dept. of Medicine, Uni. of Sydney

Quality in aged care

Relations with aged care workers can be central in the lives of people living in aged care facilities and their only opportunity for personal validation. This must be recognised in any evaluation of the quality of care provided, and workers must be recruited and trained with this in mind. Relational deprivation and abuse is not addressed by current evaluation procedures in nursing homes. There can also be potential for conflict between the ethics of the worker and the demands of the system.

Assoc. Prof. Ruth Marquis, Occupational Therapy, Curtin Uni.of Technology, WA.

December 2001 - NEWS ITEMS FROM RESEARCH ON AGEING

Australasian Journal on Ageing presents research on ageing from Australia, Asia and the Pacific. It is published quarterly by Council on the Ageing (Australia), in association with Aged and Community Services Australia, Australian Association of Gerontology, and the Australian Society for Geriatric Medicine.

The December 2001 issue has articles and reports on a number of social and medical issues of interest to those caring for older people and for the community generally. They include an important critique of medical care for people in residential aged care services by the Australian Society for Geriatric Medicine, articles on new developments in computerised monitoring of elderly people at home, how older, single, males of lower socio-economic status living in Sydney have less social support than other residents, levels of depression in those living in retirement villages, suicides of older people in Asian societies, and the myth of generational conflict. Highlights are summarised below. Full copies of any article are available for media from the Council on the Ageing (Australia) by phoning 03 9820 2655 or email aja@cota.org.au or by contacting the author. Please acknowledge source of information in any article or report.

Medical Care for People in Residential Aged Care Services - Policy statement by the Australian Society for Geriatric Medicine

The ASGM has released a Position Paper calling for urgent reform of medical service provision in residential aged care.

It states that most people are admitted to residential aged care because of complex medical service needs which have largely been neglected by policy makers- political and bureaucratic- from both the residential care and general practice sectors.

It refers to reports of sub-optimal care, and says the fact that there is no data to say whether these events are isolated or part of a pattern "is of itself a cause for alarm".

It criticises the current medical service provision which leaves the medical care of each resident to his or independent GP with no structural interrelationship of the medical service to the individual facility or residential sector.

The ASGM calls for the development of a high quality medical service for people in residential aged care as a matter of urgency, to achieve better outcomes for frail older Australians.

Highest elderly suicide rates in world found in Chinese and other Asian societies

The cultural tradition in Asian societies of venerating older people has been giving way to a social reality of self-worth in society.

A study by Hong Kong and English academics has found that the highest male elderly (75 years +) suicide ratios to the total population were found in Urban China, Rural China, Singapore, and Hong Kong. Singapore, Urban China and Hong Kong had the worst elderly female suicide ratios. There were also high rates found in Korea and Japan.

The study was undertaken to see if the Chinese tradition of venerating older people resulted in lower suicide rates compared to other countries. To the contrary, the findings raise questions about the adequacy of support to older Asian people. The authors were surprised at the high elderly suicide rates in Hong Kong, Korea, Japan and Singapore, all relatively affluent societies.

The authors speculate that the high suicide rates in Asian countries are probably the result of several factors, including population ageing, western influences, rapidly changing social systems and a move towards nuclear families. These changes have not been matched by an increase in formal resources or services.

The Caring Computer

The CSIRO reports on a significant technological initiative to assist older people to remain at home while still being monitored for health and safety reasons. Their 'Hospital Without Walls' is a miniature wearable device which contains vial signs sensors and a radio link for making this information easily available to their doctors or caregivers. The sensor can both record continuously to detect patterns or trends which appear only intermittently, while also automatically raising alarms in the event of a medical emergency.

HWW can incorporate a voice channel which can connect the wearer instantly to a health professional in an emergency notified by the wearer or detected by the system. It can be used in aged care, chronic disease, diagnostic ambulatory monitoring or observation following hospital discharge. HWW can monitor falls, or near falls, and can 'learn' a patient's daily routine so as to raise the alarm at any changes.

The possible applications of such systems in aged care are limited only by the imagination and ingenuity of the collaborations between technologists and health workers.

Myth of Generational Conflict: The Family and State in Ageing Societies.

David Devaus from Latrobe University reviews this important book on generational relations in Europe which also has implications for Australian policy development. It poses serious questions about how governments are responding to concerns about the effect of demographic ageing on future public expenditures and challenges the generational conflict arguments used to justify reduction in publicly funded age pensions and a move to reliance on private pension plans.

Rather than undermining family solidarity and creating generational conflict state support of the elderly promotes family solidarity and interdependence as well as placing older people in a more equitable and less dependent position within their families.

The second important theme of the book is the linking of generation and gender. Any move away from state supported pensions and health care to private pensions which are based on years in workforce and earnings will disadvantage women since their caring work for children and parents compromises their capacity to accrue private benefits. Women will become reluctant to bear and rear children, affecting fertility and replacement rates and to provide care for older family members.

Devaus' review concludes that 'these are important arguments that challenge the conventional wisdom on which public policy is being formulated in many western countries.

Myth of Generational Conflict: The Family and State in Ageing Societies. Sara Arber and Claudine Attilia-Donfut, Routledge, London, 2000. $150 ISBN 0-415-20770-3.

In Brief: Other Articles

Inner Sydney study on social support for older people shows that while most of the elderly living at home were socially active and received adequate social support, these supports lessened if the person was older, male, single and of lower socioeconomic status. Lower levels of social support have been associated with higher mortality, poor health and lower levels of well-being.

Behaviour rating scales for older people with dementia: which is the best for use by nurses? By Christine C. Neville and Gerard J.A. Byrne. Reviews 31 rating scales and identifies five as suitable for use by nurses in measuring disruptive behaviour in older people with dementia.

Cost Effectiveness of a Pharmacist reviewing medication among the elderly in the community. By A.H.Harris and E.Gospodareveskaya, Health Economics Unit, Monash University. Study found that the addition of a pharmacist may be cost reducing in some settings, especially if inpatient episodes for assessment and treatment can be avoided but there was no statistically significant reduction in overall costs associated with a pharmacist review and advice.

******

October 2001 - NEWS ITEMS FROM RESEARCH ON AGEING

Australasian Journal on Ageing presents research on ageing from Australia, Asia and the Pacific. It is published quarterly by Council on the Ageing (Australia), Aged and Community Services Australia, Australian Association of Gerontology and the Australian Society for Geriatric Medicine.

The September 2001 issue includes articles and reports on a number of social and medical issues of concern to those caring for older people and for the community generally. They include articles on demoralisation as a separate condition from depression, nutrition and ageing, ethical issues in clinical drug trials in Alzheimer's Disease, use of housing wealth by older Australians, and the benefits of swimming exercise. Highlights are summarised below. Full copies of any article - FOR MEDIA ONLY - from Council on the Ageing (Australia) by phoning 03-9820 2655 or email at aja@cota.org.au. Please acknowledge source of information in any article or report.

Grandma, get healthy, go swimming

Not just grandmas, but grandpas too can improve their flexibility and mobility, and quality of life, by taking part in regular water exercise classes.

According to a new study by Queensland physiotherapists, a comparison of a group of 70 year olds and older who regularly undertook water exercises in a heated pool, with a similar group who did not undertake any regular exercises, showed that the water exercise group performed ' significantly better' on four functional tests of flexibility, mobility and ability to maintain postural control (balance).

Given that one of the major causes of illness and injury in older people are falls, the researchers believe that water exercise has the potential to " prevent or perhaps reverse the effects of ageing on balance" and hence improve the quality of life of older people.

The study points out that the properties of water ideally meet the needs of older people who require physical activity. Because of its buoyancy water exercise suits people who can't participate in land based exercise programs because of existing balance problems, fear of falling or a physical disability. Water can also provide resistance for strength training, which is recommended for older people to stay fit.

Demoralisation Syndrome - different from depression in older people and possible justification for suicide?

Demoralisation in older people occurs at double the rate of depression, according to Professor David Kissane, from the Victorian Centre for Palliative Care.

Demoralisation syndrome is a separate psychiatric state which covers hopelessness, helplessness, meaningless and existential distress, and often includes suicidal thoughts. It can be caused by social isolation, declining physical health, disfigurement, disability (e.g. deafness), dependency, perceived loss of dignity and concern about being a burden to family.

Prof. Kissane argues that such patients may not be judged to be clinically depressed and thus "could be perceived by clinicians to rationally choose suicide as a merciful conclusion to their life." It has significant implications for informed consent.

Is it right to clinically test drugs for Alzheimer's Disease (AD)?

The ability of new drugs to improve or delay symptoms of AD raises the question of whether withholding their benefits to some participants in clinical trials is ethically unacceptable. There is also the problem of informed consent, as the participants could be potentially vulnerable and cognitively impaired older people. Conflict of interest can arise when a principal investigator has the dual role of clinician and researcher in AD trials.

The SA authors conclude that patient rights must be protected whilst scientific integrity is maintained.

Healthy Eating while Ageing - Professional Practice Update

A review of the dietary guidelines for older Australians, the importance of continued activity through the ageing process and special needs of the frail aged and bed bound groups. Covers all the areas as they relate to older Australians including energy, protein, vitamin and mineral requirements, food variety, healthy body weight, regular meals and food hygiene, specific types of food, and fluid requirements, special attention to alcohol, salt, sugar, and calcium intake, and relationship to medication, exercise and nutrient needs.

A useful summary of expert advice and opinion and best practice.

Use of Housing Wealth by Older Australians

Australians, particularly older ones have an extremely high home ownership rate by world standards, and homes constitute a very high proportion of individual wealth.

But older people still do not favour using their housing wealth- largely unencumbered, large family homes- to fund more comfortable retirements, according to new research, although half of the total number - covering all age groups - are now prepared to consider this. Governments seeking to amend inconsistent tax and welfare policy involving " the family home", attempts which have caused political upheaval in the past, such as in nursing home bonds, will still face strong opposition.

Two Year Review of Aged Care - Author looks to future

Professor Len Gray, the author of the Two Year Review of the Aged Care Reforms (May 2001) which looked back at the operation of the Act, has chosen the AJA to "reflect on future challenges for the medium term" in aged care.

He admits his review may have disappointed some who might have expected a more comprehensive review and setting of potential new directions. He agrees there is room for further advancement, and refers to threats to quality of care through diminishing access to professional nurses, access to respite care, demand for places outstripping supply in some areas, and funding problems. The cornerstone of the Government's policy - Ageing in place - is still only a possibility, not a right.

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JULY 2001 - NEWS ITEMS FROM RESEARCH ON AGEING

The June 2001 issue includes articles and reports on a number of social and medical issues of concern to those caring for older people and for the community generally. They include articles on productive ageing, bad news on falls, oldest patient with bronchial asthma, cutting inappropriate drug use in hospitals, dementia treatment developments, infection resistant organisms in aged care, and hearing loss. Highlights are summarised below.

Productive ageing

Rich and passionately told stories of productive involvement of Australian individuals aged between 55-84, able to identify and fulfil their needs and eager to remain an individual. Report is based on group sessions and interviews held in Adelaide, Mt Gambier, Renmark and Whyalla.

Amongst comments:

Psychological and practical barriers to voluntary work eg new food handling regulations make cake stalls etc difficult, plus demand for formal qualifications.

Financial barriers to part time work. Emotional barriers-don't want to take jobs from younger people

Sense of generativity - wanting to leave a lasting contribution

Picture story opportunity from study: Older adults help to reinforce the social fabric/ Maintaining social fabric through the use of fabric quilting group in Mt. Gambier. 80 members aged between 35-82. Group is 'like a second family'. Quilts go to local families in need and orphans in Albania. Group shares skills, emotions, experiences. One suicidal man was helped by group to develop skills and self esteem and has gone on to establish successful business. Conclusion: 'Older people in the study possess a talent for identifying needs and organizing themselves to fulfill them.'

Bad news on Falls following hip fractures - after the first, more may follow

Over 30% of those aged over 65 fall each year, rising to 40% in those aged over 80. This accounts for 4% of hospital separations. Falls lead to loss of mobility and independence, and increasing risk of death. They are a strong predictor of those who will require residential care placement.

Study looked at whether people who had had hip fractures (PHP) fell more than those who had not. It showed a similar incidence of falls but those with hip fractures fell more often and had more significant injuries whereas control group tripped more.

Other findings included:

PHP no more likely to fall but different and more severe pattern of injury and greater use of GP services.

PHP compensate for diminished balance and strength-They became less active- modified their lifestyle to decrease the risk of a fall. But reduced mobility increases the risk of falls.

Older people are reluctant to admit to a fall ( they 'trip' or 'stumble')

There is increased risk due to musculo-skeletal properties of individual. There are useful predictors who falls in older persons( Berg balance test).

Recommendation: Strategies that target functional performance as well as absolute fall rate may be more effective in preventing fractures

Oldest patient ever with bronchial asthma?

Asthma is not uncommon in old age and has significant morbidity and mortality rates. Asthma commencing after age 50 is more severe and less reversible than asthma in children. By 65 years, majority of asthma patients have substantial degree of irreversible impairment of lung function.

Treatment is frequently complicated by other diseases and pharmacological interactions.

This study reports on a 96 year old man who has had bronchial asthma for over 46 years. Interesting not only because of age, but also because he continues to have significant reversibility.

Anaphylaxis to Oxybutynin(Ditropan)

Oxybutynin(Ditropan) has been used in the treatment of incontinence since 1992. Amongst 200 case reports of adverse reactions include nausea, dizziness, drowsiness, insomnia and decreased sweating. A Sydney study reports a case of anaphylaxis reaction- an "unusual and serious side effect to ditropan which, although rare should be considered in the prescribing of such medication in the elderly."

Inappropriate drug usage cut in care of older people in hospital

Study evaluates effectiveness of drug rationalization program in reducing incidence of polypharmacy and inappropriate medication (210 retrospective case notes study ) after introduction of drug rationalization program in a Hong Kong Hospital.

Major finding was that by reducing the number of inappropriate medications there was reduction in the incidence of adverse drug reactions, hospital admissions and bed day costs. Education of physicians as well as patients is much needed. Clinical pharmacists must be involved in drug rounds.

Other findings included:

- High prevalence of inappropriate medication - one or more of : use of drug with no apparent indication, duplicate drug use, interacting drugs, contra-indicated drug use, drug therapy to treat adverse drug reaction of another drug, inappropriate dose, frequency or duration of medication
- Drugs for gastro intestinal and respiratory system most commonly encountered inappropriate items
- mean medication: on admission 4.65, on discharge 3.56
- mean inappropriate medication: on admission 0.50,on discharge –0.13
- 73 patients with inappropriate medication on admission, only 26 on discharge(12.4% of patients)
- % of inappropriate medication on discharge significantly reduced - 18.3% to 3.62.

Importance of Dementia diagnosis

Dementia with Lewy Bodies(DLB) is now the second most common cause of dementia after Alzheimer's.

It is still not certain if DLB is a distinct entity or part of a spectrum of disease involving Alzheimer's and Parkinson's Disease (PD). There is an earlier onset of dementia in DLP than in PD. DLB is important to diagnose as acetylcholinesterase inhibitor treatment may improve cognitive and psychiatric symptoms.

Donepezil useful in treatment of Dementia with Lewy Bodies (DLB)

A reduction in aggression, a drop in psychosis and improved mood awareness and co-operativeness were the main results of the use of donepezil in the treatment of an elderly man with DLB could benefit others. It is currently licensed in the UK for symptomatic treatment of mild to moderate Alzheimer's disease only.

Given the difficulty in managing this group of patients due to their distressing symptoms and problematic behaviour, as well as their documented sensitivity to neuroleptics, donepezil and related compounds may have a significant role to play in their management.

Vancomycin Resistant Enterococcus in aged care

Infection with resistant organisms is a growing problem in geriatric institutions and Vancomycin Resistant Enterococcus (VRE) infection is perhaps the most serious of all, in recent times.

It is a growing problem in geriatric hospitals and long term care facilities (LTCFs) as it is in hospitals generally. North American experience suggests that LTCFs "serve as reservoirs for VRE infection…

(and)….failure to identify and target these patients is…one of the main reasons for the rapid increase in the prevalence of VRE in the last decade."

VRE poses practical problems in these facilities including difficulties and confusion in interpreting infection control guidelines. This study shows mismanagement of VRE despite elaborate guidelines.

The author recommends that

The use of antibiotic prophylaxis with vancomycin or third generation cephalosporins should be reviewed.

One designated person co-ordinates all infection control activities

Guidelines should more clearly distinguish between geriatric hospitals and LTCFs, and

15 point plan for managing VRE in geriatric hospitals and LTCFs as shown in Table 1, be adopted.

Australia can learn from Japan about Aged Care

While Australia is a world leader in age care policy, we have to learn some important lessons from Japan, according to Prof John McCallum of the University of Western Sydney.

In response to similar issues faced by Australia- including growing participation in the workforce by women who had been traditional providers of family care, and decreasing birthrates combined with a rapidly growing and ageing population, Japan has introduced long-term care insurance and restructured long term care to emphasise community services. These reforms have caused fast and dramatic shifts in service use as planned, including a drop in 'social' hospital admissions.

Early intervention provides best outcomes when treating hearing loss in older people

In Australia and New Zealand 50-60% of people aged 60+ have some degree of hearing impairment. Prevalence in nursing homes is 70-80%. Hearing loss is second only to dementia of the 10 leading causes of years lost due to disability, among older Australians.

While hearing loss may be invisible, its effects are not. It often causes withdrawal from social, vocational and cultural activities, reduces self esteem and affects relationships with family and friends. Undetected and untreated hearing impairment may affect delivery of medical and psychiatric services by interfering with one's ability to obtain a valid case history, misinterpretation of symptoms, and compounding problems such as depression.

Researchers have found significant quality of life differences between users and non-users of hearing aids. Early hearing aid fitting affords the best chance for rehabilitation, promotes healthy communications, enhances lives and well-being, and may reduce effects of other serious health issues for older people.

Despite prevalence of hearing loss in residential care facilities, there is minimal use of amplification (which may be due to lack of motivation), but maximal potential for residents to benefit from aural rehabilitation programs. Education of all care staff is fundamental to success.

Recommendations
- Look for signs of hearing loss in older people because they are reluctant to admit it. It is difficult for GP to identify as GPs practise in ideal listening situations
- Need to include pure tone hearing screening in primary care doctor's evaluation of older people
- Encourage people to try hearing aids
- Empower person to self manage hearing loss
- Educate communication partners
- Improve listening environments
- Develop aural rehabilitation skills of staff in nursing homes.

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COTA National Seniors Policy Secretariat [formerly Council on the Ageing (Australia)]
Level 2, 3 Bowen Crescent, Melbourne Vic 3004
Tel (03) 9820 2655 Fax (03) 9820 9886
email cota@cota.org.au
www.cota.org.au