Hepatitis C virus prevalence and associated risk factors among Indigenous Australians who inject drugs

Objective: To examine factors associated with hepatitis C virus (HCV) infection among a national sample of Indigenous and non‐Indigenous people who inject drugs (PWID) in Australia. Methods: Respondents were recruited from Australia's Needle Syringe Program Survey; an annual bio‐behavioural surveillance project that monitors HCV antibody prevalence among PWID. Data from 2006–2015 were de‐duplicated to retain only one record where individuals participated in >1 survey round. Univariate and multivariable logistic regression examined demographic characteristics and injection‐related behaviours associated with exposure to HCV. Results: Among 17,413 respondents, 2,215 (13%) were Indigenous Australians. Compared to their non‐Indigenous counterparts, Indigenous respondents were significantly more likely to be exposed to HCV infection (53% vs. 60% respectively, p<0.001). Among Indigenous respondents, HCV antibody positivity was independently associated with a history of imprisonment (Adjusted Odd Ratio [AOR] 2.13, 95%CI 1.73–2.64), opioid injection (AOR 1.53, 95%CI 11.43–2.16), recruitment in a metropolitan location (AOR 1.27, 95%CI 1.02–1.59), engagement in opioid substitution therapy (AOR 2.83, 95%CI 2.23–3.59) and length of time since first injection (p<0.001). Conclusion: Indigenous PWID are more likely to be exposed to HCV infection than their non‐Indigenous counterparts. Implications for public health: Increased access to culturally sensitive harm reduction programs is required to prevent primary HCV infection and reinfection among Indigenous PWID. Given recent advances in HCV treatment, promotion of treatment uptake among Indigenous PWID may reduce future HCV‐related morbidity and mortality.     

我国中老年人群主要慢性病及危险因素分析

目的 了解我国中老年人群主要慢性病的患病情况及危险因素。方法 利用世界卫生组织\     

Program sustainability of a community-based intervention to prevent falls among older Australians

Multi-strategy interventions have been demonstrated to prevent falls among older people, but studies have not explored their sustainability. This paper investigates program sustainability of Stay on Your Feet (SOYF), an Australian multi-strategy falls prevention program (1992-1996) that achieved a significant reduction in falls-related hospital admissions. A series of surveys assessed recall, involvement and current falls prevention activities, 5 years post-SOYF, in multiple original SOYF stakeholder groups within the study area [general practitioners (GPs), pharmacists, community health (CH) staff, shire councils (SCs) and access committees (ACs)]. Focus groups explored possible behavioural changes in the target group. Surveys were mailed, except to CH staff and ACs, who participated in guided group sessions and were contacted via the telephone, respectively. Response rates were: GPs, 67% (139/209); pharmacists, 79% (53/67); CH staff, 63% (129/204); SCs, 90% (9/10); ACs, 80% (8/10). There were 73 older people in eight focus groups. Of 117 GPs who were practising during SOYF, 80% recalled SOYF and 74% of these reported an influence on their practice. Of 46 pharmacists operating a business during SOYF, 45% had heard of SOYF and 79% of these reported being 'somewhat' influenced. Of 76 community health staff (59%) in the area at that time, 99% had heard of SOYF and 82% reported involvement. Four SCs retained a SOYF resource, but none thought current activities were related. Seven ACs reported involvement, but no activities were sustained. Thirty-five focus group participants (48%) remembered SOYF and reported a variety of SOYF-initiated behaviour changes. Program sustainability was clearly demonstrated among health practitioners. Further research is required to assess long-term effect sustainability.     

江苏省老年人跌倒发生情况及危险因素分析

目的探讨江苏省老年人跌倒的流行病学特征及危险因素,为制定相应的干预措施提供科学依据。方法采用多阶段分层整群抽样的方法,以问卷方式调查江苏省老年人过去1年跌倒发生情况。结果共调查6 245人,跌倒发生率为2.79%。家庭是老年人跌倒的好发地点。随着年龄的增长,跌倒发生率增高。单因素Logistic回归分析结果显示,年龄高、生活在农村、丧偶、文化程度低、家庭经济状况较差、住房类型为楼房、体育锻炼较少、行走能力较差为老年人跌倒的危险因素。结论老年人跌倒是一个严重的公共卫生问题,与许多因素相关,对于高危人群应该采取一系列针对性的预防措施。     

Development and preliminary examination of the predictive validity of the Falls Risk Assessment Tool (FRAT) for use in primary care

BACKGROUND: There is no validated assessment of an older person's risk of falling that is easily applied in primary care. We aimed to develop a two-part tool for use in primary care or the community. Part 1 includes a rapid assessment of the individual's risk of falling for administration by clinical or non-clinical staff. Part 2 (for clinical staff) includes guidance on further assessment, referral and interventions. We assessed the predictive validity of part 1. METHODS: The tool was developed by an expert panel following the updating of an existing systematic review of community-based prospective studies identifying risk factors for falling and modified in accordance with the feedback from extensive piloting. We assessed predictive validity by a questionnaire survey sent at baseline and 6 months to a random sample of 1000 people aged over 65 in one Primary Care Group area. RESULTS: Five items were included in part 1: history of any fall in the previous year, four or more prescribed medications, diagnosis of stroke or Parkinson's disease, reported problems with balance, inability to rise from a chair without using arms. The presence of three or more risk factors had a positive predictive value for a fall in the next 6 months of 0.57 (95 per cent confidence interval 0.43-0.69). Less than three risk factors had a negative predictive value of 0.86 (0.82-0.89), and a specificity of 0.92 (0.88-0.94). CONCLUSION: The tool may be useful for identifying people who would benefit from further assessment of their risk of falling and appropriate intervention.     

Predisposing and precipitating factors for falls among older people in residential care

Falls and their consequences are serious health problems among older populations. To study predisposing and precipitating factors for falls among older people in residential care we used a cross-sectional study design with a prospective follow up for falls. Fifty-eight women and 25 men, with a mean age of 79.6 y, were included and prospectively followed up regarding falls for a period of 1 y after baseline assessments. All those who fell were assessed regarding factors that might have precipitated the fall. The incidence rate was 2.29 falls/person years. Antidepressants (selective serotonin reuptake inhibitors, SSRIs), impaired vision and being unable to use stairs without assistance were independently associated with being a 'faller'. Twenty-eight (53.8%) of the fallers suffered injuries as a result of their falls, including 21 fractures. Twenty-seven percent of the falls were judged to be precipitated by an acute illness or disease and 8.6% by a side effect of a drug. Acute symptoms of diseases or drug side effects were associated with 58% of the falls which resulted in fractures. We conclude that SSRIs seem to constitute one important factor that predisposes older people to fall, once or repeatedly. Since acute illnesses and drug side-effects were important precipitating factors, falls should be regarded as a possible symptom of disease or a side-effect of a drug until it is proven otherwise.     

Health outcomes associated with participating in community care centres for older people in Taiwan

Community care centres (CCCs) are widespread across Taiwan and have provided health promotion and social activities for older people in communities since 1995. The purpose of this study was to describe the status of the delivery and management of CCCs for older people, and to explore the effects of individual factors and the organisational factors on the health‐related outcome of older people's participation in CCCs. The sample was taken from participants at CCCs in Taichung, Taiwan. Twenty‐five CCCs participated in the study. The managers and the elderly participants of CCCs underwent face‐to‐face interviews. In total, 417 elderly participants and 25 chiefs completed the face‐to‐face interviews. The participants reported that self‐reported health, sleep quality, memory, family relationships, care for health, and health literacy improved after they participated in the programme. There were no consistent organisational factors related to the outcomes. However, management style was related to sleep quality improvement and staffing getting paid was related to family relationship improvement. Policy recommendations are provided.     

广州市越秀区社区老年人营养不良风险评估及影响因素分析

目的 通过研究掌握越秀区社区老年人的膳食营养状况和主要影响因素,探讨老年人营养不良干预适宜措施,为制订老年人营养改善策略提供科学依据.方法 选取广州市越秀区作为调查点,于2018-2020年,随机抽取4个社区,招募474名65岁及以上老年人参与问卷调查及体格检查.采用卫生行业标准《老年人营养不良风险评估(WS/T 55...     

Planning older people's discharge from acute hospital care: linking risk management and patient participation in decision-making

This paper reports findings from a pilot qualitative study which aimed to develop a methodology to explore older patients' participation in discharge decision-making. The study involved 5 months' ward-based observation and formal interviews with older patients and ward staff in a care of the elderly department of a district general hospital in Scotland. A purposive sample of 22 older patients was recruited, selected to give adequate representation across age, gender, condition and type of ward. Findings suggest that participation in decision-making was linked to systems of risk management. Discharge planning relied to a large extent on formal assessments of patients' cognitive and physical ability. This system prevented older patients from expressing their views in terms which came naturally to them, and staff had therefore little reason to trust patients' competence to manage and to take part in decision-making. This, in turn, meant that ambiguous or difficult decisions about risk were circumvented or postponed through referral and assessments, rather than openly addressed. These dynamics excluded both patients and staff from active decision-making, something which, in turn, removed all parties' control of the situation and produced new risks. Two case studies are presented to illustrate and support this analysis.     

广东省老年人跌倒及其影响因素和平衡能力受损现况

目的  调查广东省社区老年人跌倒和平衡能力受损现状及跌倒影响因素。方法  采用多阶段分层整群随机抽样的方法进行抽样调查,共有5 503名≥60岁老年人纳入分析。采用χ²检验分析老年人跌倒发生率和平衡能力受损率在不同特征老年人之间的差异,采用多因素Logistic回归分析模型分析跌倒的影响因素。结果  本研究中老年人过去1年的跌倒发生率为11.90%,平衡能力受损率为58.37%。跌倒和平衡能力受损情况在女性、农村、文盲、无配偶和独居的老年人中较为常见(均有P＜0.05)。多因素分析显示,女性跌倒的危险性较男性高,跌倒发生情况随年龄的增加而愈发严重。农村老年人跌倒危险性高于城市老年人。老年人在家走动或做家务时最常发生跌倒(35.11%),因跌倒造成擦伤/挫伤、骨折、扭伤/拉伤、脑震荡/脑挫裂伤和其他受伤类型的比例分别为55.77%、22.22%、17.09%、1.07%和3.85%。结论  广东省社区老年人在过去1年内发生跌倒的情况较多,平衡能力受损现状严重,应加强对老年人的防跌倒健康宣教和以家庭防护为主的综合干预措施。     

Baseline indicators for measuring progress in preventing falls injury in older people

Objective: Over recent years, there has been increasing attention given to preventing falls and falls injury in older people through policy and other initiatives. This paper presents a baseline set of fall injury outcome indicators against which these preventive efforts can be assessed in terms of monitoring the rate of fall-related deaths and hospitalisations.
Methods: ICD-10-AM coded hospital separations, Australian Bureau of Statistics (ABS) mortality and ABS population data were used to determine the rate of fall-related injury mortality and hospitalisations occurring in people aged 65+ years in New South Wales (NSW), Australia, over the six-year period from 1998/99 to 2003/04, inclusive.
Results: Baseline trends for one fatality and five separations-based metrics are presented. Overall, fall mortality rates increased over the six years, with higher rates in males. Falls hospitalisation rates also increased slightly, with higher rates in females. The rates of hip fracture and pelvic fracture hospital separations generally declined over the six years and were highest in females. The level of unspecified and missing information about the place where falls occur increased by 1.5%.
Conclusion: Baseline trends in fall injury outcome metrics highlight the severity and frequency of fall injuries before wide scale implementation of the Management Policy to Reduce Fall Injury Among Older People in NSW.
Implications: Future use of these metrics will help to evaluate and monitor the progress of falls prevention in older people in NSW. They could also be adopted in other jurisdictions.     

中国老年人跌倒现状及影响因素研究

目的  了解中国老年人跌倒现状及其影响因素,为预防老年人跌倒提供参考。方法  收集2018年中国健康与养老追踪调查(China Health and Retirement Longitudinal Study,CHARLS)中≥60岁的7 070名老年人的相关数据,采用χ²检验和二分类Logistic回归分析模型分析老年人跌倒现状及其影响因素。结果  1 652人在过去两年内发生过跌倒,跌倒率为23.4%。714人跌倒后情况较重需要就医,跌倒就医率为10.9%。二分类Logistic回归分析模型分析结果显示,没有配偶、自评健康一般和不好、患慢性病、有抑郁症状、日常生活能力受损、视力较差、听力较差和使用辅助工具(OR=1.187、1.319、1.435、1.154、1.433、1.730、1.230、1.488、1.503)是老年人跌倒的危险因素(P < 0.05)。结论  老年人跌倒是多种因素综合作用的结果。应全面评估危险因素,采取综合预防措施,预防和减少导致跌倒的隐患,保护老年人健康。     

Hospitalization risk factors of older cohorts of home health care patients: A systematic review

Nearly one million Medicare home health care beneficiaries are hospitalized annually of which one-quarter are considered preventable. Older hospitalized patients are at risk for nosocomial complications and poorer outcomes and incur higher health care costs. This paper reports the results of a systematic review of 28 studies on hospitalization risk factors of older home health care patients. It found that males, Blacks, and non-Asian minorities are at greater hospitalization risk. Factors associated with higher risk included skin ulcers, psychiatric conditions, dyspnea/COPD, cardiovascular conditions, diabetes, functional deficits, more comorbidities, and higher medication usage. These findings can inform practice, research, and policy.     

Anemia increases risk for falls in hospitalized older adults: an evaluation of falls in 362 hospitalized, ambulatory, long-term care, and community patients

OBJECTIVE: The objective of this study was to determine if a relationship exists between the presence of anemia and the occurrence of falls during hospitalization in ambulatory older adults from long-term care and community settings. All individuals were hospitalized for acute conditions not related to a fall. PARTICIPANTS: Three hundred sixty-two hospitalized, ambulatory older (59-104 years) adults. MEASUREMENTS: Laboratory values (hemoglobin [Hb], hematocrit [Hct]), routine laboratory tests, pertinent medical history, and demographics. RESULTS: Ambulatory hospitalized patients who fell were compared to controls (no falls during hospitalization) of similar age (P = .283) and gender distribution (P = .554). Patients who fell had significantly lower Hb (P < .00005), lower Hct (P < .00005) and were more likely to be anemic (56% vs 38%, P = .001) than controls. A logistic regression model examined the effect of Hb level and anemia on falls and included the covariates of age, gender, place of residence, and race. The model described a 22% decreased risk of falls for every 1.0 g/dL increase in Hb (P < .0005) and an overall 1.9-fold increased risk of falls in anemic patients (P < .001). Patient age, gender, and place of residence were not related to the risk of falls during hospitalization. CONCLUSIONS: These findings suggest a potentially important link between anemia and the risk of falls during hospitalization in ambulatory older patients. Further studies are needed to determine if the risk of falls can be modified by correction of anemia and to determine the applicability of these findings to older adults in different settings.     

Nutrition risk screening in community-living older people attending medical or falls prevention services

Aim: To identify the prevalence of nutrition risk among community-living older people in Christchurch, New Zealand and to establish the frequently occurring risk factors for poor nutrition. Methods: A convenience sample of 152 community-living older people was recruited from five medical centres and a falls prevention service. Interview in the home included nutrition risk assessment as measured by the Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire. All participants at nutrition risk were either provided dietary advice at the time of interview or offered referral to a nutrition-related intervention. Results: Of the participants, 23% (n = 35) were ‘at risk’ of poor nutrition and 31% (n = 47) were ‘at high risk’. The four frequently occurring risk factors for those ‘at high risk’ were: unintentional weight change (79%), eating alone (72%), perception of own weight (68%) and low milk product intake (66%). Conclusion: Seniors in the Community: Risk Evaluation for Eating and Nutrition questionnaire identified that approximately half of a sample of community-living older people in Christchurch were at risk of poor nutrition. The implications of low scores on the nutrition risk screening questionnaire deserve further exploration.     

Mild anemia and the risk of falls in older adults from nursing homes and the community

OBJECTIVES: The objectives of this study were to determine if a relationship exists between a history of falls and anemia in older adults and to compare the findings by place of residence. DESIGN: The authors conducted a retrospective and observational study. PARTICIPANTS: One hundred forty-five adults (60-97 years of age) from nursing homes and the community hospitalized for hip fracture over a 2-year period were included in this study. MEASUREMENTS: Laboratory values (hemoglobin [Hb], hematocrit [Hct]), medical history, and demographics were measured. RESULTS: Falls occurred similarly in both nursing home patients and community patients (19% vs. 17%, P=0.785). Nursing home and community patients also had similar Hb (P=0.0899), Hct (P=0.1929), and rates of anemia (P=0.187). Nursing home residents were older (P=0.0188) and had lower serum albumin levels (P=0.0007) than community patients. When the two groups were combined, falls were more common in anemic individuals (30% vs. 13%; P=0.028). Furthermore, those with a history of falls were older (P=0.0447), had lower Hb (P=0.0257) and Hct levels (P=0.0310). After controlling for age, gender, place of residence, and arthritis in a logistic regression model, anemia predicted a threefold increased risk of falls (P=0.041), and a 45% decreased risk of falls was predicted for every 1.0-g/dL increase in Hb (P=0.005). Falls risk increased 7% per year of age (P=0.040), whereas musculoskeletal disease increased the falls risk 3.2-fold, both increases being independent of Hb levels or anemia. Finally, falls were not associated with gender or other comorbidity, nor did these variables alter the falls risk attributed to low Hb or anemia. CONCLUSIONS: These findings suggest a new and potentially important link between anemia and the risk of falls in patients sustaining hip fractures from both nursing homes and the community. Further studies will help determine if this risk is modified or eliminated with treatment of anemia and if the relationship applies to larger samples of older adults in different settings.     

Prevention of falls,malnutrition and pressure ulcers among older persons – nursing staff's experiences of a structured preventive care process

A structured and systematic care process for preventive work, aimed to reduce falls, pressure ulcers and malnutrition among older people, has been developed in Sweden. The process involves risk assessment, team‐based interventions and evaluation of results. Since development, this structured work process has become web‐based and has been implemented in a national quality registry called ‘Senior Alert’ and used countrywide. The aim of this study was to describe nursing staff's experience of preventive work by using the structured preventive care process as outlined by Senior Alert. Eight focus group interviews were conducted during 2015 including staff from nursing homes and home‐based nursing care in three municipalities. The interview material was subjected to qualitative content analysis. In this study, both positive and negative opinions were expressed about the process. The systematic and structured work flow seemed to only partly facilitate care providers to improve care quality by making better clinical assessments, performing team‐based planned interventions and learning from results. Participants described lack of reliability in the assessments and varying opinions about the structure. Furthermore, organisational structures limited the preventive work.