Susan Quine

Effects of High-Intensity Progressive Resistance Training and Targeted Multidisciplinary Treatment of Frailty on Mortality and Nursing Home Admissions after Hip Fracture: A Randomized Controlled Trial

RATIONALE Excess mortality and residual disability are common after hip fracture. HYPOTHESIS Twelve months of high-intensity weight-lifting exercise and targeted multidisciplinary interventions will result in lower mortality, nursing home admissions, and disability compared with usual care after hip fracture. DESIGN Randomized, controlled, parallel-group superiority study. SETTING Outpatient clinic PARTICIPANTS Patients (n = 124) admitted to public hospital for surgical repair of hip fracture between 2003 and 2007. INTERVENTION Twelve months of geriatrician-supervised high-intensity weight-lifting exercise and targeted treatment of balance, osteoporosis, nutrition, vitamin D/calcium, depression, cognition, vision, home safety, polypharmacy, hip protectors, self-efficacy, and social support. OUTCOMES Functional independence: mortality, nursing home admissions, basic and instrumental activities of daily living (ADLs/IADLs), and assistive device utilization. RESULTS Risk of death was reduced by 81% (age-adjusted OR [95% CI] = 0.19 [0.04-0.91]; P < .04) in the HIPFIT group (n = 4) compared with usual care controls (n = 8). Nursing home admissions were reduced by 84% (age-adjusted OR [95% CI] = 0.16 [0.04-0.64]; P < .01) in the experimental group (n = 5) compared with controls (n = 12). Basic ADLs declined less (P < .0001) and assistive device use was significantly lower at 12 months (P = .02) in the intervention group compared with controls. The targeted improvements in upper body strength, nutrition, depressive symptoms, vision, balance, cognition, self-efficacy, and habitual activity level were all related to ADL improvements (P < .0001-.02), and improvements in basic ADLs, vision, and walking endurance were associated with reduced nursing home use (P < .0001-.05). CONCLUSION The HIPFIT intervention reduced mortality, nursing home admissions, and ADL dependency compared with usual care.

Suicide and unemployment in Australia 1907-1990

Ever since Durkheim postulated a relationship between economic change and suicide there has been evidence of a general association between aggregate data on unemployment and the frequency of suicide. Quantitatively, however, the association has been variable and it is clear that due to differing cultural, social and individual determinants of suicide, the relationship is complex. Methodological difficulties abound with interpretation of aggregate data. Australian records for most of the present century are suitable for examining secular trends in suicide and unemployment by age group and gender to gain an indication of the extent to which both parameters may be causally related. An aggregate/ecological study was designed to incorporate quantitative and qualitative strategies. Annual age-adjusted male and female suicide rates and annual unemployment rates were derived for the period 1907-1990. Female suicide rates were generally stable throughout the period, whereas those for males demonstrated sharp fluctuations with the peaks coinciding with times of high unemployment. The association between suicide and unemployment for 15-24 year old males was comparatively high for the recent period, 1966-1990. The increasingly youthful contribution to male suicide was demonstrated by a rise in the loss of life years during 1973-1984. Despite the inability of any investigation based on aggregate data to establish an unequivocable causal relationship, no evidence was detected to suggest that relatively high population levels of unemployment were not related to the occurrence of suicide.

Australian baby boomers’ expectations and plans for their old age

The ageing of Australias 5.5 million baby boomers (born 1946–1965) will significantly change Australian society, yet it is unclear what is known about the expectations and plans of this cohort for their retirement and old age. This paper provides a first step by reviewing the Australian literature, focusing on the areas of health, housing, work and income, and responsibility. Information from the peer‐reviewed literature and the Internet published during 1996–2005 was reviewed. One hundred ninety‐five Australian references were retrieved, of which only 94 were relevant. The review identified that, despite agreement about the significance of baby boomers ageing, empirical work directly addressing the research topics was rare. In particular, there was little coverage of baby boomers’ ascription of responsibility for their welfare in older age. If policies are to be effective, empirical research obtaining information directly from baby boomers is required to fill the gaps identified through this review.

A cohort study of unemployment as a cause of psychological disturbance in Australian youth

Data from the Australian Longitudinal Survey, conducted by the Commonwealth Department of Employment, Education and Training, were analysed to estimate relative risk of psychological disturbance accompanying unemployment in young people aged 15-24 years. Two cohorts were surveyed annually over 4 years during the mid-to-late-1980s; one from the general 15-24 year-old population (N = 8995), and the other selected from Commonwealth Employment Service records (N = 2403). Such large respondent numbers allowed control of confounding by exclusion to isolate employment transition groups suitable for hypothesis testing and quantification of causal relationships. Psychological morbidity was measured using binary outcomes of the 12 item psychological component of the General Health Questionnaire. Excluded from the analysis were those who: suffered from pre-existing physical health problems; were dissatisfied in their job; were self-employed; underwent marriage breakdown during the inter-survey period; had become widowed during the inter-survey period. A Bayesian probabilistic approach was used to calculate probabilities of psychologically normal respondents becoming psychologically morbid, given prior transition from employment to unemployment. Mantel-Haenszel analysis was utilised to estimate relative risks in comparison to a control group of those remaining employed, after controlling for age and gender. An overall relative risk of becoming psychologically disturbed as a consequence of becoming unemployed was estimated to be 1.51 (95% CI: 1.15-1.99). The overall relative risk of recovery from psychological disturbance upon re-employment in those with psychological disturbance was estimated to be 1.63 (95% CI: 1.08-2.48). Residual psychological effects of past unemployment experience and the effects of long-term unemployment were investigated, but found to be non-significant in this study. There was some evidence of psychological adaptation to unemployment, but this was statistically insignificant. Unemployment was a significant cause of psychological disturbance in young people who were initially employed, not suffering physical ill-health, and psychologically normal; conversely, re-employment reversed the effect.

A randomised trial of hip protector use by frail older women living in their own homes

Objectives: To investigate the efficacy and effectiveness of hip protectors in frail community living older women. Design: Randomised controlled trial. Setting: Aged care health services in New South Wales, Australia. Patients: 600 women 74 years of age or more (mean age 83 years), who had two or more falls or one fall requiring hospital admission in the previous year, and who lived in their own homes. Intervention: Use of hip protectors. Main outcome measures: Adherence with use of hip protectors, falls, incidence of hip fracture, and adverse effects of use of hip protectors. Results: Adherence was approximately 53% over the duration of the study and hip protectors were worn at the time of 51% of falls in the intervention group. The risk of hip fracture when falling while wearing hip protectors, compared with a fall with no hip protectors in place, was significantly reduced (relative risk (RR) 0.23, 95% confidence interval (CI) 0.08 to 0.67). On an intention to treat analysis, 21 and 22 hip fractures occurred in the intervention and control groups respectively (adjusted RR 0.92, 95% CI 0.51 to 1.68). Three users of hip protectors sustained a hip fracture while wearing properly applied protectors, while 16 hip protector users (5%) developed minor local complications. Conclusions: Hip protectors prevent hip fractures in community dwelling older women if worn at the time of a fall. The overall effectiveness of hip protectors was not established in this study, because of incomplete adherence with use of the protectors, and limited statistical power.

Accelerated rehabilitation after proximal femoral fracture: a randomized controlled trial.

This randomized controlled trial compared accelerated rehabilitation after surgical treatment of proximal femoral fracture with conventional care and was conducted in a general hospital in an outer urban area. Participating were 261 sequentially admitted patients over the age of 50 years who met predetermined inclusion criteria and all were followed up until death or 4 months after fracture. Patients who were treated with the accelerated rehabilitation programme had a 20% reduction in length of hospital stay. Improved physical independence (as measured by Barthel Index) was observed after fracture in accelerated rehabilitation programme patients with limited pre-existing disability. Non-nursing-home patients receiving accelerated rehabilitation were also less likely to be discharged to nursing-home care or die in hospital. Accelerated rehabilitation led to a substantial reduction in length of hospital stay with a modest short-term improvement in level of physical independence and accommodation status after discharge.

Cost effectiveness of accelerated rehabilitation after proximal femoral fracture.

A randomised controlled trial comparing an accelerated rehabilitation program after proximal femoral fracture with conventional care and rehabilitation was conducted with 252 elderly patients treated at an Australian general hospital in 1989/1990. This paper presents a cost-effectiveness analysis of the accelerated rehabilitation program. The measure of cost was all direct costs of treatment and subsequent care (medical and non-medical) incurred during the 4 months after fracture. Effectiveness was defined as whether the patient returned to semi-independent living; or if moderately or severely disabled prior to the fracture to the premorbid level of physical independence. The cost for treatment up to 4 months after fracture was estimated at A

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10,600 per accelerated rehabilitation patient and A

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12,800 per conventional care patient (1990 Australian dollars, A

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). Thus, accelerated rehabilitation releases resources equivalent to approximately 17% of costs for treatment per patient. When cost effectiveness is considered, the potential cost savings rise to 38% per recovered patient.