Preliminary evaluation of the prevalence of falls,pain and urinary incontinence in remote living Indigenous Australians over the age of 45 years

Aims: To report on the prevalence of falls, urinary incontinence, pain and associated factors in remote living Indigenous Australians over the age of 45 years. Methods: A cross‐sectional, semi‐purposeful sample of 363 indigenous men and women aged over 45 years living in six remote communities and one town in Kimberley, Australia. Participants were assessed for self‐ or informant‐reported rates of falls, urinary incontinence and pain. Results: The prevalence of self‐ or informant‐reported falls was 31% (95% CI 25.3, 36.7), pain 55% (95% CI 47.4, 62.6) and urinary incontinence 9% (95% CI 5.9, 12.1%). Associations with falls after adjustment for age, sex and education included alcohol use (OR 2.4, 95% CI 1.4, 4.2), stroke (OR 2.4, 95% CI 1.1, 5.0), epilepsy (OR 3.5, 95% CI 1.1, 11.6), head injury (OR 2.1, 95% CI 1.3, 3.3) and poor hearing (OR 2.5, 95% CI 1.4, 4.1); for urinary incontinence epilepsy (OR 6.0, 95% CI 1.7, 21.2) and stroke (OR 16.7, 95% CI 6.0, 46.3); and for pain, poor hearing (OR 1.9, 95% CI 1.0, 3.3) and female sex (OR 1.8, 95% CI 1.2, 2.7). Conclusions: Falls, urinary incontinence and pain are common and reported for the first time in older indigenous people living in remote regions. The presence of these syndromes in ages over 45 may be due to accumulation of health insults during the life course.     

Food insecurity among older Australians: prevalence,correlates and well‐being

Objectives: The purpose of this study is to examine (i) the prevalence of food insecurity among older persons, (ii) the characteristics of the food insecure and (iii) the association between food insecurity and well‐being. Methods: The 2001 National Health Survey is used to measure the prevalence of food insecurity. Multivariate analysis is conducted using rare events logistic regression. Results: Almost 3% of Australians aged 55 years and over, and 7% of those aged under 55 are estimated to be food insecure. Lone males and females are more likely to experience food insecurity when compared to couples. Low‐income earners and those with multiple long‐term conditions are at a heightened risk of food insecurity. The probability of food insecurity decreases with age. Persons who are food insecure perform poorly against self‐reported measures of well‐being. Conclusions: Although the prevalence of food insecurity is low, a definite social gradient exists in those at risk.     

Older Indigenous Australians: their integral role in culture and community

This review explores the social and cultural roles played by older Indigenous Australians within their communities. In the absence of a body of conventional academic literature on this topic, we used a broad range of sources including stories, articles, videos, and other narratives to present the lived experiences of older Indigenous Australians illustrated in their own words. The intention is to move beyond the usual negative focus of reporting the significant health and social problems experienced by older Indigenous Australians, whilst still recognising that their present‐day roles within the society have to be understood against a backdrop of such lifetime disadvantage. The major underlying theme of this review is the crucial roles played by older Indigenous people and how these roles have adapted over time to contemporary circumstances. Roles include kinship relationships, support for the young, transmission of cultural knowledge, as well as the key concept of respect for older people as ‘survivors’.     

Cardiometabolic risk and disease in Indigenous Australians: The heart of the heart study

Objectives

This study assessed the burden and determinants of cardiovascular and metabolic risk in a community sample of high risk Indigenous Australians.

Background

Indigenous Australians are over-represented in the most disadvantaged strata of Australian society. The role of psychosocial and socioeconomic factors in patterning cardiometabolic disease in this population is unclear.

Methods

The Heart of the Heart Study was a cross sectional study of 436 Aboriginal adults from remote, urban and peri-urban communities around Alice Springs (Northern Territory, Australia). Participants underwent detailed assessments of socio-demographic, psychosocial, cardiovascular and metabolic status.

Results

Individuals with depression were twice as likely to have cardiovascular disease (OR 2.03; 1.07–3.88; p < 0.05). Chronic kidney disease (39.7%, 37.2% and 18.2%) and diabetes (28.4%, 34.0% and 19.2%) were more common in peri-urban and remote compared to urban communities. Cardiovascular disease did not vary across locations (p = 0.069), but coronary artery disease did (p = 0.035 for trend). Unemployed individuals were more likely to have cardiovascular disease (OR 2.32; 1.33–4.06; p < 0.001). Socioeconomic gradients in coronary artery disease, all cardiovascular disease and diabetes, as measured by income, operated differentially across locations (p for location/socioeconomic status interactions 0.002; 0.01 and 0.04 respectively).

Conclusion

Participants had high rates of pre-existing cardiovascular disease, diabetes and chronic kidney disease. Cardiovascular risk in these communities was associated with psychosocial factors and socioeconomic indicators. However, gradients operated differentially across location. These data provide a strong foundation for better understanding key drivers of increased levels of cardiovascular and other common forms of non-communicable disease in Indigenous people.     

Leadership and management in the aged care sector: A narrative synthesis

The aim of this study is to examine the issues and the progress being made in leadership and management with relevance for the residential aged care workforce. A systematic review was conducted using scientific journal databases, hand searching of specialist journals, Google, snowballing and suggestions from experts. After a seven‐tiered culling process, we conducted a detailed review of 153 papers relevant to leadership and management development in aged care. Strong, effective leadership and management promotes staff job satisfaction and retention, high care quality and the well‐being of care recipients, and reduces associated costs. Good leadership and effective management also play a key role in bringing about a successful change to a positive workplace culture through innovative programs and research projects. Organisational investment in improving leadership and management skills and capabilities can only improve outcomes for staff stability and productivity, care quality and budgets, and better prepare the aged care sector.     

Research on tuberculosis in tribal areas in India: A systematic review

Background

Tuberculosis (TB) remains a major public health problem in resource-poor countries including India. Scientific knowledge is used to guide policy and practice. There is however, a limited, systematically collected data required for guiding the scale-up of interventions particularly amongst vulnerable populations including tribal groups in the country. In view of this, a systematic review of the TB research studies carried out in tribal areas of different parts of the country was undertaken.

Depression and quality of life in Brazilian and Portuguese older people communities: Analysis of association

We aimed to compare the association of depression with aspects of quality of life (QoL) among older people users of primary health care (PHC) living in Brazil and Portugal.We carried out an observational, cross-sectional and comparative study with a quantitative approach in the PHC scope in Brazil and Portugal, where we obtained a nonrandom sample of 150 participants aged 65 years or older (100 Brazilians and 50 Portuguese). We used the socioeconomic and health data questionnaire, the Medical Outcomes Short-Form Health Survey QoL (SF-36) questionnaire and the Beck Inventory.Among the socioeconomic profiles, most were females aged between 65 and 80 years in both countries. There was a significant difference between groups in the income variable, with 100.0% of Portuguese people earning up to 1 minimum wage (P value <.001), and the presence of chronic diseases in 92.0% of respondents in Portugal (P value = .033). In the association analysis, most aspects of QoL had a higher median score (>50.0) within the categorical variables of “absent” and “mild” depression. The Emotional role functioning, Physical role functioning, Physical functioning, Mental health, Total score domains and the Mental health and Physical health summary measures stood out with this behavior in Brazil and in Portugal, where these latter 2 presented moderate to strong correlation values (ρ > 0.400) in Portugal. Greater associations of depression on QoL were revealed in Portugal than in Brazil. Among their most expressive associations, the Physical role functioning (odds ratio [OR] = 4.776; 95.0% confidence interval [CI]: 2.41–9.43), Physical functioning (OR = 3.037; 95.0% CI: 3.037), Vitality (OR = 6.000; 95.0% CI: 1.56–23.07) and Total score (OR = 3.727; 95.0% CI: 2.24–6.17) domains and the Mental health summary measure (OR = 3.870; 95.0% CI: 2.13–7.02) stood out.Aspects related to the emotional, physical, functional and mental health components stood out. The association and correlation with depression were more expressive in Portugal compared to Brazil. However, similar results were obtained in Brazil but with less relevance.