Lynne C. Giles

Effect of social networks on 10 year survival in very old Australians: the Australian longitudinal study of aging

Study objectives: To examine if social networks with children, relatives, friends, and confidants predict survival in older Australians over 10 years after controlling for a range of demographic, health, and lifestyle variables. Design: Prospective longitudinal cohort study (the Australian longitudinal study of aging) Setting: Adelaide, South Australia. Participants: 1477 persons aged 70 years or more living in the community and residential care facilities. Main results: After controlling for a range of demographic, health, and lifestyle variables, greater networks with friends were protective against mortality in the 10 year follow up period. The hazard ratio for participants in the highest tertile of friends networks compared with participants in the lowest group was 0.78 (95%CI 0.65 to 0.92). A smaller effect of greater networks with confidants (hazard ratio = 0.84; 95%CI  = 0.71 to 0.98) was seen. The effects of social networks with children and relatives were not significant with respect to survival over the following decade. Conclusions: Survival time may be enhanced by strong social networks. Among older Australians, these may be important in lengthening survival.

Demographic, health, cognitive, and sensory variables as predictors of mortality in very old adults.

Cognitive and sensorimotor predictors of mortality were examined in the Australian Longitudinal Study of Ageing, controlling for demographic and health variables. A stratified random sample of 1,947 males and females aged 70 and older were interviewed, and 1,500 were assessed on measures of health, memory. verbal ability, processing speed, vision, hearing, and grip strength in 1992 and 1994. Analyses of incident rate ratios for mortality over 4- and 6-year periods were conducted using Cox hierarchical regression analyses. Results showed that poor performance on nearly all cognitive variables was associated with mortality, but many of these effects were explained by measures of self-rated health and disease. Significant decline in hearing and cognitive performance also predicted mortality as did incomplete data at Wave 1. Results suggest that poor cognitive performance and cognitive decline in very old adults reflect both biological aging and disease processes.

Corrected Arm Muscle Area: An Independent Predictor of Long-Term Mortality in Community-Dwelling Older Adults?

OBJECTIVES: Older people are at risk of undernutrition because of a number of physiological conditions and lifestyle factors. The purpose of this study was to explore the predictive relationship of corrected arm muscle area (CAMA) with 8‐year mortality in a representative sample of older Australians.

Perinatal Outcomes by Mode of Assisted Conception and Sub-Fertility in an Australian Data Linkage Cohort

Background Fertility treatment is associated with increased risk of major birth defects, which varies between in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI), and is significantly reduced by embryo freezing. We therefore examined a range of additional perinatal outcomes for these exposures. Methods All patients in South Australia receiving assisted conception between Jan 1986–Dec 2002 were linked to the state-wide perinatal collection (all births/stillbirths ≥20 weeks gestation or 400 g birth weight, n = 306 995). We examined stillbirth, mean birth weight, low birth weight (<2500 g, <1500 g), small size for gestational age (<10th percentile, <3rd percentile), large size for gestational age (>90th percentile), preterm birth (32–<37 weeks, <32 weeks gestation), postterm birth (≥41 weeks gestation), Apgar <7 at 5 minutes and neonatal death. Results Relative to spontaneous conceptions, singletons from assisted conception were more likely to be stillborn (OR = 1.82, 95% Confidence Interval (CI) 1.34–2.48), while survivors as a group were comprehensively disadvantaged at birth, including lower birth weight (−109 g, CI −129–−89), very low birth weight (OR = 2.74, CI 2.19–3.43), very preterm birth (OR = 2.30, CI 1.82–2.90) and neonatal death (OR = 2.04, CI 1.27–3.26). Outcomes varied by type of assisted conception. Very low and low birth weight, very preterm and preterm birth, and neonatal death were markedly more common in singleton births from IVF and to a lesser degree, in births from ICSI. Using frozen-embryos eliminated all significant adverse outcomes associated with ICSI but not with IVF. However, frozen-embryo cycles were also associated with increased risk of macrosomia for IVF and ICSI singletons (OR = 1.36, CI 1.02–1.82; OR = 1.55, CI 1.05–2.28). Infertility status without treatment was also associated with adverse outcomes. Conclusions Births after assisted conception show an extensive range of compromised outcomes that vary by treatment modality, that are substantially reduced after embryo freezing, but which co-occur with an increased risk of macrosomia.

Gambling and problem gambling among recently sentenced male prisoners in four New Zealand prisons.

Recently sentenced inmates in four New Zealand male prisons (N = 357) were interviewed to assess their gambling involvement, problem gambling and criminal offending. Frequent participation in and high expenditure on continuous forms of gambling prior to imprisonment were reported. Nineteen percent said they had been in prison for a gambling-related offence and most of this offending was property-related and non-violent. On the basis of their SOGS-R scores, 21% were lifetime probable pathological gamblers and 16% were probable pathological gamblers during the six months prior to imprisonment. Of the “current” problem gamblers, 51% reported gambling-related offending and 35% had been imprisoned for a crime of this type. Gambling-related offending increased with problem gambling severity. However, only five percent of problem gamblers said their early offending was gambling-related. The large majority reported other types of offending at this time. Few men had sought or received help for gambling problems prior to imprisonment or during their present incarceration. This highlights the potential for assessment and treatment programs in prison to reduce recidivism and adverse effects of problem gambling and gambling-related offending.

Self-management and peer support among people with arthritis on a hospital joint replacement waiting list: a randomised controlled trial

INTRODUCTION To evaluate the efficacy of a self-management support program including a 6 week self-management course, individualised phone support and goal setting in osteoarthritis patients on a waiting list for arthroplasty surgery. METHOD Randomised controlled trial of 152 public hospital outpatients awaiting hip or knee replacement surgery who were not classified as requiring urgent surgery. Participants were randomised to a self-management program or to usual care. The primary outcome was change in the Health Education Intervention Questionnaire (HeiQ) from randomisation to 6 month follow-up. Quality of life and depressive symptoms were also measured. Changes in pain and function were assessed using the Western Ontario and McMaster Universities (WOMAC) Arthritis Index. RESULTS At 6 month follow-up, health-directed behaviour was significantly greater in the intervention [mean 4.29, 95% confidence interval (CI) 3.99-4.58] than the control (mean 3.81, 95% CI 3.52-4.09; P=0.017). There was also a significant effect on skill and technique acquisition for the intervention (mean 4.37, 95% CI 4.19-4.55) in comparison to control (mean 4.11, 95% CI 3.93-4.29; P=0.036). There was no significant effect of the intervention on the remaining HeiQ subscales, WOMAC pain or disability, quality of life or depressive symptoms. DISCUSSION The arthritis self-management program improved health-directed behaviours, skill acquisition and stiffness in patients on a joint replacement waiting list, although the observed effects were of modest size (Cohens d between 0.36 and 0.42). There was no significant effect on pain, function or quality of life in the short term. Self-management programs can assist in maintaining health behaviours (particularly walking) in this patient group. Further research is needed to assess their impact on quality of life and over longer periods.

Home versus day rehabilitation: a randomised controlled trial

Objective: to assess the effect of home versus day rehabilitation on patient outcomes. Design: randomised controlled trial. Setting: post-hospital rehabilitation. Participants: two hundred and twenty-nine hospitalised patients referred for ambulatory rehabilitation. Interventions: hospital-based day rehabilitation programme versus home-based rehabilitation programme. Main Outcome Measures: at 3 months, information was collected on hospital readmission, transfer to residential care, functional level, quality of life, carer stress and carer quality of life. At 6 months, place of residence, hospital re-admissions and mortality status were collected. Results: there were significant improvements in the functional outcomes from baseline to 3 months for all participants. At discharge, carers of patients in day hospital reported higher Caregiver Strain Index (CSI) scores in comparison to home rehabilitation carers (4.95 versus 3.56, P = 0.047). Patients in day hospital had double the risk of readmission compared to those in home rehabilitation (RR = 2.1; 95% CI 1.2–3.9). This effect persisted at 6 months. Conclusions: day hospital patients are more likely to be readmitted to hospital possibly due to increased access to admitting medical staff. This small trial favours the home as a better site for post-hospital rehabilitation.

Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial

Abstract Objective To assess the effectiveness of moving patients who are waiting in hospital for a long term care bed to an off-site transitional care facility. Design Randomised controlled trial. Setting Three public hospitals in Southern Adelaide. Participants 320 elderly patients (mean age 83 years) in acute hospital beds (212 randomised to intervention, 108 to control). Interventions A transitional care facility where all patients received a single assessment from a specialist elder care team and appropriate ongoing therapy. Main outcome measures Length of stay in hospital, rates of readmission, deaths, and patients functional level (modified Barthel index), quality of life (assessment of quality of life), and care needs (residential care scale) at four months. Results From admission, those in the intervention group stayed a median of 32.5 days (95% confidence interval 29 to 36 days) in hospital. In the control group the median length of stay was 43.5 days (41 to 51 days) (95% confidence interval for difference 6 to 16 days). Patients in the intervention group took a median of 21 days (6 to 27 days) longer to be admitted to permanent care than those in the control group. In both groups few patients went home (14 (7%) in the intervention group v 9 (9%) in the control group). There were no significant differences in death rates (28% v 27%) or rates of transfer back to hospital (28% v 25%). Conclusions For frail elderly patients who are awaiting a residential care bed transfer out of hospital to an off-site transitional care unit with focus on aged care “unblocks beds” without adverse effects.

The Effects of Social Networks on Disability in Older Australians

Objective: To investigate the effects of total social networks and specific social net-works with children, relatives, friends, and confidants on disability in mobility and Nagi functional tasks. Methods: Six waves of data from the Australian Longitudinal Study of Ageing were used. Data came from 1,477 participants aged 70 years or older. The effects of total social networks and those with children, relatives, friends, and confidants on transitions in disability status were analyzed using binary and multinomial logistic regression. Results: After controlling for a range of health, environmental, and personal factors, social networks with relatives were protective against developing mobility disability (OR = 0.89; 95% CI = 0.79 to 1.00) and Nagi disability (OR = 0.85; 95% CI = 0.74 to 0.96). Other social subnetworks did not have a consistent effect on the development of disability. Discussion: The effects of social relationships extend beyond disability in activities of daily living. Networks with relatives protect against disability in mobility and Nagi tasks.

Depression in older Chinese migrants to Auckland

Objective: This study was conducted to identify risk factors for depressive symptomatology among older Chinese migrants. Method: One hundred and sixty-two Chinese migrants aged 55 years or older, living in the community and recruited via Chinese community organizations and general practitioners, were interviewed using a Chinese version of the Geriatric Depression Scale and measures of stressful life events, morbid conditions, self-rated health, acculturation, social support and service utilization. Result: Twenty-six percent of participants met the criteria for depressive symptomatology. No recent migrants showed symptoms of depression. Multiple logistic regression analysis showed that lower emotional support, greater number of visits to a doctor, difficulties in accessing health services and low New Zealand cultural orientation increased the risk of showing symptoms of depression. Conclusion: Significant numbers of older Chinese migrants appear to be depressed or at risk for depression and, while participants with depressive symptoms consulted general practitioners more than their counterparts without such symptoms, they reported greater difficulty in accessing health services. The findings point to the need for further epidemiological study of this growing sector of the population and investigation of the nature of its engagement with health services. Social support and aspects of acculturation may play a significant role in preventing depression. This also requires further investigation.