Adverse drug reactions in older Australians, 1981-2002

OBJECTIVE: To examine trends in adverse drug reactions (ADRs) in people aged 60 years or over causing admission to or an extended stay in Western Australian hospitals between 1981 and 2002. DESIGN AND SETTING: Secondary data analysis of case series. PATIENTS: 43,380 patients admitted to WA public and private hospitals with an (International Classification of Diseases) ICD external cause code for an ADR, identified by the population-based WA Hospital Morbidity Data System. MAIN OUTCOME MEASURES: Age-specific, age-standardised and drug-specific rates of ADR-related hospital stays. RESULTS: The age-standardised rate of ADR-related hospital stays increased from 2.5 per 1000 person-years (py) in 1981 to 12.9 per 1000 py in 2002. The largest increases occurred in those aged 80 + years (tenfold in men and sevenfold in women). The most common drug group involved was cardiovascular agents (17.5%), while anticoagulants (7.5%), cytotoxics (7.4%) and antirheumatics (6.8%) were the more specific drug classes most often implicated. ADRs from the last three classes of drugs were still rising at the end of the study, whereas ADRs from corticosteroids and antihypertensives peaked in 1996 and from opioids in 2000. CONCLUSIONS: Increases in hospital admissions or extended lengths of stay due to ADRs in WA have continued despite programs to promote rational and safer use of medicines. The sharp increase in ADRs from anticoagulants warrants attention to revised clinical guidelines.     

A web-based normative data tool for assessing cognitive performance in healthy older Australians

A decline in cognition greater than expected with ageing and accompanied by subjective cognitive concerns or functional changes may be indicative of a dementing disorder. The capacity to correctly identify cognitive decline relies on comparisons with normative data from a suitably matched healthy reference group with relatively homogeneous demographic features. Formal assessment of cognition is usually performed by specialist neuropsychologists trained in administration and interpretation of psychometric tests. With a scarcity of normative data from large cohorts of older adults, Australian neuropsychologists commonly use representative data from small international studies. Data from 727 healthy older Australians participating in the Australian Imaging, Biomarkers and Lifestyle (AIBL) Flagship Study of Ageing have been used to create a normative dataset. A web-based calculator was developed to simplify the time-consuming process of comparing cognitive performance scores with these representative data.     

Ten-year incidence of diabetes in older Australians: the Blue Mountains Eye Study

OBJECTIVE: To estimate the incidence of diabetes and impaired fasting glucose (IFG), and increased risk associated with the metabolic syndrome, in a representative population-based sample of older Australians. DESIGN, SETTING AND PARTICIPANTS: The Blue Mountains Eye Study examined 3654 residents aged 49 + years (82.4% response rate) during 1992-1994, and re-examined 2335 (75.1% of survivors) during 1997-1999 and 1952 (75.6% of survivors) during 2002-2004; 2123 participants with normal blood glucose levels at baseline were considered at risk of developing incident diabetes. Main outcome measures: Incident diabetes (or IFG) was defined in participants at risk who were newly diagnosed by a physician during the follow-up or found to have a fasting blood glucose level >or= 7.0 mmol/L (or 5.6-6.9 mmol/L). Kaplan-Meier cumulative 10-year incidence was calculated. RESULTS: The overall 10-year incidence of diabetes and IFG was 9.3% and 15.8%, respectively. Participants with metabolic syndrome at baseline had a higher risk of incident diabetes than those without metabolic syndrome (29.2% v 8.6%). Baseline factors associated with incident diabetes were elevated fasting glucose level (adjusted odds ratio [OR], 4.5; 95% CI, 3.4-6.1 per mmol/L), obesity (OR, 2.0; 95% CI, 1.3-2.8), diabetes family history (OR, 1.7; 95% CI, 1.2-2.5), current smoking (OR, 1.6; 95% CI, 1.0-2.7) and high density lipoprotein cholesterol level < 1.0 mmol/L (OR, 2.4; 95% CI, 1.5-3.8). Similar baseline factors were associated with incident IFG. CONCLUSION: This population-based study provides data on the incidence of diabetes and IFG in an older, predominantly white population, and confirms that metabolic and lifestyle factors are major risk factors for diabetes.     

Self-reported bowel screening rates in older Australians and the implications for public health screening programs

Background

This paper sought to determine the status of older Australians with regard to Bowel Cancer screening practices occurring outside of the National Bowel Cancer Screening Program.

Method

A random sample of N=25,511 urban Australians aged 50 to 74 years received a questionnaire via mail asking questions relating to bowel screening. N=8,762 (34.3%) returned a completed questionnaire.

Results

Approximately 33% (N=2863) of respondents indicated they had undergone colonoscopy in the preceding five years and 21% (N=1840) had used a Faecal Occult Blood Test (FOBT) in the preceding 12 months. Furthermore, 27% (N=497) of those who had completed an FOBT had also undergone colonoscopy.

Conclusion

A significant proportion of older Australians might be participating in bowel screening practices outside of the national program (NBCSP). Moreover, the proportion of individuals reporting use of both FOBT and endoscopic services is much higher than the positivity rate of FOBT. Large population FOBT screening programs, such as the NBCSP, that do not consider participation in screening external to the program may underestimate true population screening rates.     

Prevalence of heart failure and systolic ventricular dysfunction in older Australians: the Canberra Heart Study

OBJECTIVE: To estimate the prevalence of heart failure (HF) and left ventricular (LV) systolic dysfunction in a population-based sample of older Australians. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional survey of 2000 randomly selected residents of Canberra, aged 60-86 years, conducted between February 2002 and June 2003. Participants were assessed by history, physical examination by a cardiologist, and echocardiography. MAIN OUTCOME MEASURES: Age- and sex-specific prevalence rates of clinical HF and LV systolic dysfunction (defined as LV ejection fraction < or = 50%). RESULTS: Of 1846 people eligible for our study, 1388 (75%) agreed to participate and 1275 completed all investigations (mean age, 69.4 years; 50% men). In the study sample, 72 subjects (5.6%; 95% CI, 4.4%-7.1%) had clinical HF that had been previously diagnosed and was confirmed by our assessment. A further 0.6% (95% CI, 0.3%-1.2%) had undiagnosed clinical HF (ie, evidence of structural heart disease and symptoms/signs of cardiac insufficiency without a previous diagnosis of clinical HF). Thus, the overall prevalence of clinical HF in the sample was 6.3% (95% CI, 5.0%-7.7%). Clinical HF increased in prevalence with advancing age (a 4.4-fold increase from the 60-64-years age group to the 80-86-years age group; P < 0.0001). Of the 75 subjects (5.9%; 95% CI, 4.7%-7.3%) with LV systolic dysfunction, 44 (59%) were in the preclinical stage of disease. CONCLUSION: Diagnosed HF cases represent the "tip of the iceberg" for the national burden of HF and LV systolic dysfunction. Clinically identifiable HF cases can remain undiagnosed, and the majority of people with LV systolic dysfunction are in a preclinical stage of the disease.     

Cardiovascular disease burden in acute public hospitals in Ireland: estimates for 2021 and 2031

Background

Ireland is undergoing a demographic shift to a higher proportion of older people in the population. It is expected that this demographic shift will significantly increase the burden of care on an already overstretched acute hospitals system.

Aim

This study was conducted to estimate the future burden of care on acute public hospitals pertaining to ‘diseases of the circulatory system’ and ‘procedures on cardiovascular system’ in Ireland using Hospital In-Patient Enquiry (HIPE) data for 2006 and population projections for 2021 and 2031.

Methods

Age-specific rates derived from HIPE data for 2006 and census figures for the same year were applied to population projections for 2021 and 2031 to get case number estimates in those years.

Results

The number of discharges with a primary diagnosis of diseases of the circulatory system is estimated to increase by 51 % by 2021 and 97 % by 2031 relative to 2006 figures. For people aged 65+ years, case numbers are estimated to increase by 65 % by 2021 and 133 % by 2031 relative to 2006 case numbers. The number of procedures performed is estimated to increase by 47 % by 2021 and 82 % by 2031 relative to 2006 figures. For people aged 65+ years, case numbers are estimated to increase by 63 % by 2021 and 120 % by 2031 relative to 2006 case numbers.

Conclusion

The results reflect the aging of the Irish population. The expected increases in case numbers will pose significant burden on acute public hospitals and the cost of providing care.     

Immunisation: reducing health inequality for Indigenous Australians

Vaccination programs can act as a paradigm for effective health programs in Indigenous people.     

Epidemiology of chikungunya in Malaysia: 2006-2009

This is a retrospective cross-sectional study based on the database of clusters of patients with clinical diagnosis of chikungunya (CHIK) that were referred to the National Public Health Laboratory for diagnostic investigations from January 2006 to December 2009. Of the 13,759 referred patients, a total of 6314 (45.9%) patients were laboratory confirmed to have CHIK and 7445 (54.1) patients were considered as clinical cases of CHIK by epidemiological link. Epidemic curves plotted using date of onset of illness for all referred clusters of cases showed that there were three unrelated outbreaks of CHIK in Malaysia from 2006 to 2009. There were two small outbreaks that occurred within the state of Perak in 2006. The cluster of cases in 2008 and 2009 were of related outbreak which started in Johor state and subsequently spread to various parts of Malaysia. The mean age of the patients was 37.0 years old and those patients in the laboratory confirmed group were significantly younger than those in the epidemiological linked group. The main presenting clinical features recorded in this study were fever, arthralgia, myalgia and rashes. Those patients in the laboratory confirmed group had a significant higher incidence of fever, arthralgia and rash than those in the epidemiological linked group.     

Diabetes in Indigenous Australians: possible ways forward

Reducing the burden of diabetes will require action well beyond the health service sphere.     

Occupational deaths in West Virginia's older workers: 1980-1998

West Virginia has an average of 69 work-related deaths per year from 1980 through 1998. Seventeen percent of these deaths occurred in workers age 55 or older. The death rate among these workers was 12.5 deaths per 100,000 workers compared to 9.5 for workers ages 16-54. Older workers died from traumatic machinery-related incidents at a rate nearly three times higher than that for younger workers and from homicide at a rate 2.3 times higher than the younger group. With a workforce that is increasingly older, it is important for employers to identify occupations and job activities that place older workers at risk, and to develop appropriate intervention strategies to protect them from injury.     

我国儿童急性中毒临床流行病学现状:1994年至2006年发表论文的荟萃分析

目的:研究我国儿童急性中毒的临床流行病学特点。方法:通过文献检索和搜集,采用Meta(荟萃)分析,对我国1994年至2006年间中国医院知识仓库(CHKD)发表的有关研究儿童急性中毒的临床流行病学调查结果进行汇总、归纳和统计分析。结果:共检索到文献142篇,有62篇进入Meta分析,总计报告9335例;男女比例为1.46:1,城乡比例为1:1.95。急性中毒患儿1岁～3岁占36.03%,4岁～6岁占34.51%。中毒物种以农药、药物和灭鼠药三类为主,共占73.03%。中毒原因以误服误食为主(76.13%);中毒途径以消化道为主(88.19%)。死亡率达4.38%,死亡中毒毒种以灭鼠药为主(70.27%);中毒致残率为6.07%。结论:本报告提供了近期我国儿童急性中毒的临床流行病学模式,为今后制定儿童急性中毒临床快速诊治和预防措施具有重要意义。