Australasian Journal on Ageing最新文献

{"title":"Prevalence of Potentially Inappropriate Apixaban Prescribing Within a Single-Centre Tertiary Hospital.","authors":"Katherine J Creeper, Grace Lenaghan, Aaron Stockwell, Matthew Schmidt, Katharine Ingram, Andrew C Stafford","doi":"10.1111/ajag.70166","DOIUrl":"10.1111/ajag.70166","url":null,"abstract":"<p><strong>Objective: </strong>Apixaban is widely recommended as first line therapy for atrial fibrillation (AF) and venous thromboembolism (VTE). Despite the widespread availability of dosing guidelines, anecdotal evidence suggests clinicians do not routinely follow these recommendations. Inappropriate dose reduction is associated with suboptimal patient outcomes. This project aimed to review current prescribing practices of apixaban 2.5 mg against guidelines to identify potentially inappropriate prescribing.</p><p><strong>Method: </strong>A single-centre, retrospective review of all adult patients admitted to a large tertiary hospital in Perth, Australia, who were dispensed apixaban 2.5 mg between 1 January 2023 and 31 December 2024, was undertaken. Patients were identified via dispensing records. Demographics, indication, comorbidities, concurrent medications and laboratory data were collated. Each case was assessed against current guidelines to determine whether dosing was appropriate or potentially inappropriate. Data were analysed using quantitative statistics.</p><p><strong>Results: </strong>A total of 303 patients were dispensed apixaban 2.5 mg in the audit period. Of these 178 (59%) were newly initiated. The mean age of the cohort was 79 years (standard deviation [SD] 12.6), with 49% female. Of the 128 patients (72%) newly initiated on apixaban 2.5 mg for non-valvular AF, 53 (41%) patients received a potentially inappropriate dose. A further 19 patients (11% of the entire cohort) received a potentially inappropriately low dose for acute VTE treatment.</p><p><strong>Conclusions: </strong>A significant proportion of patients initiated on apixaban 2.5 mg received potentially inappropriate doses. These findings highlight the need for targeted anticoagulation stewardship and clinician education to optimise patient outcomes.</p>","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"45 2","pages":"e70166"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13087822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aspiration Pneumonia as a Marker of a High Healthcare Utilisation Trajectory in Older Adults With Dementia: A Retrospective Cohort Study.","authors":"Junsong Xu, Ran Meng, Wei Zheng, Yuquan Wu","doi":"10.1111/ajag.70187","DOIUrl":"10.1111/ajag.70187","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether recorded aspiration pneumonia in older adults with dementia was associated with subsequent high inpatient use and to estimate its associations with all-cause mortality, any hospital admission and cumulative length of stay.</p><p><strong>Methods: </strong>This single-centre retrospective cohort study examined electronic medical records from a single tertiary hospital to identify 500 adults aged 65 years and older with Alzheimer's disease, vascular dementia or mixed dementia. Participants were followed for up to 36 months (median 20 months). Recorded aspiration pneumonia was analysed as an exposure available in the analytic dataset. Multivariable Cox, logistic and negative binomial models were adjusted for age, sex, dementia subtype, baseline dementia severity and baseline Mini-Mental State Examination (MMSE) score. Exact aspiration-event dates and clinically important domains including frailty, functional status, residence before admission, swallowing assessment, oral-health measures, medication burden and comorbidity burden were not available in the dataset.</p><p><strong>Results: </strong>Recorded aspiration pneumonia occurred in 24% of participants. After adjustment, the cohort-level mortality signal remained imprecise (HR 1.65, 95% CI 0.85-3.21). In contrast, aspiration pneumonia was independently associated with higher odds of hospitalisation (OR 2.02, 95% CI 1.29-3.16) and greater cumulative length of stay among those admitted (IRR 1.54, 95% CI 1.17-2.01).</p><p><strong>Conclusions: </strong>In this dementia-specific cohort, recorded aspiration pneumonia was common and consistently associated with greater subsequent inpatient use. The findings support interpreting recorded aspiration pneumonia as a pragmatic clinical marker of heightened service dependence within a broader frailty and illness context and underscore the value of multidisciplinary review and anticipatory care planning after such events.</p>","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"45 2","pages":"e70187"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147990280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finding the Right Time: Aged Care Staff Perspectives on Communicating With Families About Residents' End-of-Life Care Planning.","authors":"Priyanka Vandersman, Lenore de la Perrelle, Jennifer Tieman","doi":"10.1111/ajag.70184","DOIUrl":"10.1111/ajag.70184","url":null,"abstract":"<p><strong>Objectives: </strong>This study describes the perspectives of aged care staff on when and how they communicate with families to plan end-of-life care.</p><p><strong>Methods: </strong>This qualitative descriptive study sought the perspectives of aged care staff about end-of-life care conversations with families, using interviews, focus groups and inductive thematic analysis.</p><p><strong>Results: </strong>Interviews were conducted with 64 aged care staff, predominantly females, representing 14 different aged care sites. Participants included registered nurses, enrolled nurses, care managers and support workers. Five key themes were identified: (1) timing as a staged and adaptive process, (2) building expectations over time prepares families for decision-making, (3) clear communication helps manage mismatch in family perceptions of decline, (4) family dynamics and cultural context shape the communication process, and (5) confidence, role clarity and medical endorsement influence communication.</p><p><strong>Conclusions: </strong>Aged care staff are committed to engaging with families early but often face barriers when talking about end-of-life. When there is no prognosis or families are reluctant to discuss end-of-life plans, staff use various strategies to describe symptoms and changes in an older person's functions, with experienced clinical staff being more direct about deterioration. Findings highlight the need for training to build staff confidence to initiate early and ongoing communication with families. Resources for both staff and families may facilitate discussions and enhance the quality of end-of-life communication and care outcomes in aged care settings.</p>","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"45 2","pages":"e70184"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Deprescribing Information Should Be Communicated on Discharge and How? A Qualitative Study of Pharmacists' Perspectives on Deprescribing at Transitions of Care.","authors":"Katherine Desforges, Aili V Langford, Aisling M McEvoy, Majd Abu Al Shieh, Justin P Turner, Michael Dooley, Cristina P Roman, Emily Reeve","doi":"10.1111/ajag.70173","DOIUrl":"10.1111/ajag.70173","url":null,"abstract":"<p><strong>Objective: </strong>Hospitalisation provides an opportunity to deprescribe (withdraw inappropriate medications), however, safe and effective deprescribing relies on good communication between relevant stakeholders. The aim of this study was to explore the perspectives of Australian hospital and community pharmacists on communicating information about deprescribing at transitions of care and their role in the deprescribing process.</p><p><strong>Methods: </strong>A diverse group of hospital and community pharmacists was purposively recruited. Data were collected via individual semi-structured interviews and focus groups that were audio-recorded and transcribed verbatim using NVivo. Each transcript was thematically analysed using an inductive coding approach, performed by two independent coders.</p><p><strong>Results: </strong>Thirty-two pharmacists were recruited between June and August 2023. Seventeen participants worked in hospitals, 10 in community pharmacies, and five across both settings. Four themes with 12 subthemes were identified, pertaining to (i) how pharmacists communicate about deprescribing on hospital discharge, (ii) how pharmacists collaborate with other healthcare professionals and patients to optimise deprescribing, (iii) how the role of the pharmacist in deprescribing at transitions of care can be optimised, and (iv) how pharmacists feel about their current and future role in deprescribing.</p><p><strong>Conclusions: </strong>Challenges in communicating deprescribing recommendations and ensuring continuity of care when patients transition between care settings were identified. Development of new tools (e.g., templates and guidance on how and what should be communicated) and processes to support communication at the transition of care from hospital to the community are needed to support deprescribing activities.</p>","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"45 2","pages":"e70173"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13137400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Home Care Packages: A Content and Usability Analysis of Consumer-Facing Information on Aged Care Provider Websites.","authors":"Alexandria Parker, Michael Lawless, Jolene Thomas, Alison Yaxley","doi":"10.1111/ajag.70201","DOIUrl":"10.1111/ajag.70201","url":null,"abstract":"<p><strong>Objectives: </strong>The global population of people aged 60 years and above is growing. With this, there is a rising need for home care services and demand for online health information to facilitate the decision-making among older adults and promote consumer-directed care. This exploratory study aimed to examine how aged care provider websites present and structure information about Home Care Packages (HCPs) to support consumer decision-making.</p><p><strong>Methods: </strong>A web-based content analysis of Australian provider websites was conducted by accessing websites using Google Chrome in incognito mode and using an evaluation tool that assessed language readability (Flesch Reading Ease and Flesch-Kincaid Grade Level scores), usability features Web Content (Accessibility Guidelines V2.0) and the relevance and depth of HCP information. Descriptive statistics were calculated using SPSSv.29. Qualitative data were analysed using deductive content analysis. Data were extracted into Microsoft Excel and deductively coded using the structured evaluation tool developed for this study. Coded content was then narratively synthesised, augmented by researcher notes and illustrative quotes.</p><p><strong>Results: </strong>From 25 systematically sampled websites, the median Flesch Reading Ease score was 52.5 (IQR 12.52) corresponding to a high school reading level of 10th-12th grade. Most sites featured small text (n = 21) and inconsistent information regarding services, pricing and case management. None of the websites in this analysis was found to be both user-friendly and comprehensive in their HCP content.</p><p><strong>Conclusions: </strong>Poor usability and inconsistent information may limit older adults' ability to access and understand HCP details, reducing engagement with these online resources.</p>","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"45 2","pages":"e70201"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13304273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148334519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining HbA1c in Frail Older Adults: A Linked Data Cohort Study.","authors":"Gideon Meyerowitz-Katz, Julee McDonagh, Scott William, Reejamol John, Tien-Ming Hng, Mark McLean, Mary Bul, Richard I Lindley, Caleb Ferguson","doi":"10.1111/ajag.70163","DOIUrl":"10.1111/ajag.70163","url":null,"abstract":"<p><strong>Objective: </strong>Diabetes and frailty pose a significant issue for society. Previous research has shown a mixed relationship between diabetes and frailty in older people, indicating a complex interrelationship. The aim of this study was to examine the association between routinely collected HbA1c testing data and frailty in a large cohort from Western Sydney.</p><p><strong>Methods: </strong>Data from the Western Sydney Frailty Registry Study were linked to the Blacktown and Mount Druitt hospital HbA1c testing datasets. These datasets include information on patient outcomes, pathological metrics, hospitalisation indicators, and a range of morbidity and demographic information. This was then analysed in Stata using multivariable regression.</p><p><strong>Results: </strong>Diabetes was more common in frail patients than in pre-frail or non-frail patients. Those with both diabetes and frailty did not have an increased risk of death or rehospitalisation in age and sex corrected analyses (OR: 0.66, 95% CI: 0.36-1.21 and 0.90, 95% CI: 0.37-2.17, respectively) compared to those with frailty alone. There was a reduced risk of death associated with higher HbA1c for frail people (OR: 0.58, 95% CI: 0.37-0.90).</p><p><strong>Conclusions: </strong>There is a complex interrelationship between diabetes and frailty. For frail people with diabetes, there are important lessons for management. These include the possibility that HbA1c is not a useful metric and that overtreatment with hypoglycaemic agents must be considered.</p>","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"45 2","pages":"e70163"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Epidemiological Profile of Older Adults of Pacific Peoples Ethnicity in New Zealand Assessed for Home Support and Aged Residential Care.","authors":"Xaviour Walker, Rebecca Abey-Nesbit, Julia Kayes, Hans Ulrich Bergler, Gary Cheung, Debra Waters, Corina Grey, Marise Stuart, Hamish Jamieson","doi":"10.1111/ajag.70143","DOIUrl":"10.1111/ajag.70143","url":null,"abstract":"<p><strong>Objective: </strong>To provide a descriptive analysis of the overall health and well-being of older adults of Pacific Peoples ethnicity using the interRAI-Home Care assessments, compared with NZ Europeans.</p><p><strong>Methods: </strong>A cross-sectional retrospective analysis was conducted of interRAI-Home Care assessments assessed between 5 July 2016 and 31 December 2020. Basic descriptive information was gathered from Pacific Peoples and NZ Europeans separately. The frequency and percentage of the health conditions of interest were reported. Binary and multinomial logistic regression models adjusted for age and sex were used to investigate any differences between the prevalence of health conditions.</p><p><strong>Results: </strong>A total of 123,023 interRAI-HC assessments were examined, of which 5390 (4%) were Pacific Peoples and 117,633 (96%) NZ Europeans. The mean age of Pacific Peoples was 75.8 years (SD 8.4) and NZ Europeans 82.6 years (SD 7.5). After adjusting for age and sex, Pacific Peoples were less likely to smoke, consume alcohol, have coronary heart disease, fall, report loneliness or have difficulty hearing than NZ Europeans. In contrast, Pacific Peoples were more likely to have diabetes, cognitive impairment, congestive heart failure, require a mobility aid or be bed bound, experience bladder incontinence, have difficulty understanding others or have poorer vision than NZ Europeans.</p><p><strong>Conclusions: </strong>Older Pacific Peoples who were assessed for home support and aged residential care have more complex needs and require services at an earlier age than NZ Europeans. There is a need for improvements in equity in the health system and underlying social determinants of health to raise the earlier age and lower the high burden of chronic diseases that Pacific Peoples face.</p>","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"45 2","pages":"e70143"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13088211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"45 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148097386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"45 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148097387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"45 2","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148099397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}