As the population ages more people are experiencing chronic conditions, placing substantial burden on the healthcare system. General practice plays a crucial role in managing chronic health conditions and early interventions to support healthy ageing. This study explored patients' perceptions of early intervention initiatives to support healthy ageing in Australian general practice settings. Using a qualitative descriptive design, semi-structured interviews were conducted with general practice patients aged 40 years and older living with chronic conditions, in Adelaide, South Australia. Interview data were analysed using inductive content analysis. Twenty participants from eight general practices were interviewed. Three themes were developed: (1) General practice consultations enable management planning but show gaps in ageing-related support; (2) Management plans promote early problem identification, reinforce self-management and foster positive healthcare relationships; and (3) Addressing gaps in management plans requires improved access, affordability and more comprehensive support. Patients perceive their general practice enables care and management of chronic conditions for healthy ageing. There is a need for proactive healthy ageing interventions including increased uptake of chronic disease management Medicare Benefit Schedule (MBS) items into routine general practice care. Primary care policies should address multidisciplinary team-based care to facilitate optimal comprehensive care for healthy ageing. Further exploration and strategies to address barriers to proactive, comprehensive care for chronic conditions earlier in the ageing trajectory are needed.
High-risk medications are medications associated with significant patient harm or death if misused or used in error. This study aimed to develop a national consensus high-risk medication list for use in Australian residential aged care. A 3-round modified Delphi study involving Australian healthcare professionals was conducted. In Round 1, participants indicated their level of agreement, on a 9-point Likert scale, whether 60 medications/medication classes were considered high-risk and should be included in a high-risk medication list for Australian residential aged care. Round 2 included medications/medication classes that did not reach consensus and new medications identified by participants. Consensus was defined as 70% or more of participants responding at 7 or higher on the Likert scale. In Round 3, participants were asked to prioritise medications/medication classes that reached consensus in Round 1 or 2. In total, 42 participants completed Round 1, and 35 (83%) completed all three rounds. Participants included pharmacists (n = 21), prescribers (n = 15), nurses (n = 5) and a paramedic (n = 1), with representation from all Australian states and mainland territories. Overall, 26 medications reached consensus (21 in Round 1, five in Round 2) and were categorised into 15 medications/medication classes for prioritisation in Round 3. The final prioritisation list was opioids, insulin, benzodiazepines, anticoagulants, z-drugs, antipsychotics, lithium, sulfonylureas with high risk of hypoglycaemia, chemotherapeutic agents, methotrexate, digoxin, narrow therapeutic range antiepileptics, tricyclic antidepressants, immunosuppressants for transplant and sedating antihistamines. This is the first, national consensus list of high-risk medications developed specifically for Australian residential aged care. It can be used to implement targeted strategies to minimise medication-related harm.
Cognitive interventions, including cognitive stimulation therapy, cognitive rehabilitation and cognitive training, are increasingly recommended as key components of non-pharmacological post-diagnostic support for people with dementia. Cognitive interventions may help delay cognitive decline, enhance goal-directed functional abilities and improve quality of life. Despite inclusion in clinical guidelines and recommendations, guidance on the delivery of these interventions within Australian community settings remains limited and is underutilised. This article addresses a critical translation gap in cognitive interventions for people with dementia, synthesises the evidence through an Australian practice and policy lens, examines current uptake in community settings and identifies barriers, enablers and delivery models to inform implementation strategies. Community settings are defined as memory clinics, primary care, hospital outpatient services, allied health providers, community aged care and non-government providers. Current evidence indicates cognitive interventions have varying benefits across different outcomes, including cognitive function, social engagement, everyday functioning, quality of life and goal attainment. International practices related to implementation are explored, along with future directions for expanding access through technology, flexible delivery models, group-based approaches and integrating these interventions into existing care structures. Addressing the gap between recommendations and current practices requires building community awareness, improving access to professional education and training, and careful resource allocation. Cognitive interventions should be part of comprehensive rehabilitation and can be personalised to individual needs and goals. Expanding access and improving the availability of a range of cognitive interventions in community settings is crucial to ensure people with dementia receive best practice post-diagnostic support.
Although frailty appears higher in rural and socioeconomically disadvantaged areas, existing evidence often lacks adjustment for possible population confounders. This study examined the independent associations between geographic remoteness and area-level socioeconomic status with frailty. We constructed a 33-item frailty index using data from 5740 participants of the Island Study Linking Ageing and Neurodegenerative Disease (ISLAND), a web-based longitudinal cohort of adults aged 50 years and over in Tasmania, Australia. After linking participant postcodes to Modified Monash Model remoteness and Index of Relative Socioeconomic Advantage and Disadvantage, we examined frailty distribution and its associations with geographic and sociodemographic factors using descriptive statistics, spatial mapping and multivariable linear regression models. The analytical sample mean age was 69.3 years (SD = 8.0) and most were women (72%). Frailty index scores followed a gamma distribution (mean score = 0.16, SD = 0.09), increased with age and were highest in central and western areas of Tasmania. After adjustment for age, gender, education, retirement and migrant status, frailty index scores were significantly higher in rural towns (β = 0.011 [95% confidence interval, CI = 0.005, 0.016]) and remote communities (β = 0.023 [95% CI = 0.009, 0.038]) than regional centres. Similarly, after full adjustment, compared with areas of the highest socioeconomic advantage, frailty was significantly higher in areas of middle (β = 0.013 [95% CI = 0.007, 0.018]) or low (β = 0.024 [95% CI = 0.018, 0.030]) socioeconomic advantage. The distribution of frailty across Tasmania varied by geographic remoteness and socioeconomic disadvantage. Integrating frailty assessment into regional health planning may support targeted interventions for vulnerable subpopulations, particularly in rural and disadvantaged communities.
Residential Medication Management Review (RMMR) is a government-funded pharmacist-led service to address medication-related problems, such as polypharmacy, which are prevalent in aged care. Despite known benefits, concerns remain about the service's effective implementation to benefit residents. We aimed to explore stakeholders' perspectives of the service and identify challenges and improvement opportunities. A qualitative study was conducted using individual interviews and focus groups with 21 stakeholders, including general practitioners (GPs), a nurse practitioner, registered nurses, pharmacists and consumers. Audio transcripts of the discussions were thematically analysed using inductive coding. Seven interconnected themes were identified, highlighting complexities in RMMR implementation and its role in medication optimisation in aged care. Consumer participation was limited, with low awareness and engagement despite a strong desire for involvement. General practitioners played a central role, acting as both enablers and gatekeepers. Despite the recognised value of interdisciplinary collaboration, professional silos and communication gaps created tensions. Review quality varied, with resident-centred and contextualised recommendations seen as more impactful. Improved integration of digital systems was viewed as a key enabler, though existing systems were often fragmented. Workforce and funding constraints limited provider motivation and service delivery. Finally, RMMRs were often reactive, highlighting opportunities to shift towards more proactive and transparent processes. Overall, RMMRs are a complex system-dependent process. Initiatives addressing identified challenges and strengthening consumer participation, improving interdisciplinary collaboration, integrating digital solutions and targeted policy reforms may enhance RMMR uptake and impact in Australian aged care.
To explore what is known about the attitudes, beliefs and perceptions of appropriate prescribing from the view of older First Nations Peoples (aged 45 years or older, residing in the community or residential care), substitute decision-makers and health-care professionals working with First Nations Peoples. The scoping review was conducted in accordance with the JBI methodology for scoping reviews and PRISMA-ScR. Databases and grey literature sources were searched with no limitations from inception until 12 May 2025. Titles and abstracts were screened by two independent reviewers, with full-text assessment for inclusion and data extraction undertaken by two independent reviewers. Study characteristics were described descriptively. Five articles were included for analysis. First Nations Peoples represented included Māori, American Indians and Australian Aboriginal and/or Torres Strait Islander Peoples. Health-care workers represented included Aboriginal Health Workers, general practitioners and nurses. From the older First Nations People's perspective, themes regarding traditional medicine use, lack of medication information provision and concerns about adverse effects were identified. Dominant themes from health-care workers included medication information, compliance to medications and continuity of care. Older First Nations Peoples expressed a desire for more medication information and culturally appropriate care. Included studies indicated most health-care workers supported interventions to increase knowledge and understanding of medications for First Nations Peoples. Unfortunately, paternalistic attitudes remain, which limit the provision of information and prevent a trusted partnership from forming.
Delirium, an acute medical emergency, significantly impacts older adults, increasing morbidity, mortality and healthcare costs (estimated at $8.8 billion annually in Australia). Environmental modifications in hospital wards are underexplored despite their potential to mitigate delirium's effects. This study evaluated a multidimensional occupational therapy environmental checklist's impact on functional and service outcomes for hospitalised delirium patients compared to standard care. A quasi-experimental design was employed, collecting pre- and post-intervention data from 100 electronic medical records (50 comparison, 50 intervention) on a Geriatric Evaluation and Management ward in Melbourne, Australia. The checklist, implemented by occupational therapists and allied health assistants, targeted orientation, object accessibility, daily routines and safety. Outcomes included length of stay, adverse events (e.g., falls, pressure injuries) and Functional Independence Measure (FIM) scores. Descriptive statistics, t-tests and χ2 tests were conducted using SPSS Statistics 28 (p < 0.05). The intervention group showed a 27% reduction in total adverse events (comparison: n = 37; intervention: n = 27) and significantly higher FIM scores at discharge (motor: t = -2.38, p = 0.02; cognitive: t = -2.62, p = 0.01; total: t = -3.24, p < 0.001). However, length of stay (comparison: M = 28.2 days; intervention: M = 29.36 days; t = -0.20, p = 0.84) and adverse event rates (χ2 = 1.48, p = 0.22) did not differ significantly. The intervention group had a higher fall admission rate (36% vs. 2%; χ2 = 20.38, p < 0.001). The checklist enhances functional recovery in older adults with delirium, reducing adverse events. Larger, multi-site studies are needed to confirm efficacy and generalisability, supporting occupational therapy's role in delirium management.
Calcium supplementation is widely used in older adults, but its long-term effects on cognitive function remain unclear. This study assessed the association between pharmacological calcium supplementation and cognitive decline over 7 years in cognitively healthy older women. This prospective cohort study included 227 women (mean age 79.9 ± 3.6 years) from the Toulouse centre of the EPIDOS study. Cognitive function was assessed using the Short Portable Mental Status Questionnaire (SPMSQ) at baseline and after 7 years. Cognitive decline was defined as a decrease of at least one point in SPMSQ score. Calcium supplement use at baseline was recorded. Multivariable logistic regression was used to evaluate the association between supplementation and cognitive decline, adjusted for age, obesity, physical activity, instrumental activities of daily living (iADL) score, education level, dietary calcium and vitamin D intake, number of comorbidities and selected chronic conditions. Cognitive decline occurred in 26% of participants. Calcium supplementation was reported by 12% of patients and was independently associated with an increased risk of cognitive decline (OR = 3.64; 95% CI: 1.47-9.01; p = 0.005). Obesity and comorbidity burden were also significant risk factors. Calcium supplementation was associated with a threefold increased risk of cognitive decline in older women over a 7-year follow-up. These results suggest caution in prescribing calcium supplements and underscore the need for further research on their neurological safety in ageing populations.
To determine whether recorded aspiration pneumonia in older adults with dementia was associated with subsequent high inpatient use and to estimate its associations with all-cause mortality, any hospital admission and cumulative length of stay. This single-centre retrospective cohort study examined electronic medical records from a single tertiary hospital to identify 500 adults aged 65 years and older with Alzheimer's disease, vascular dementia or mixed dementia. Participants were followed for up to 36 months (median 20 months). Recorded aspiration pneumonia was analysed as an exposure available in the analytic dataset. Multivariable Cox, logistic and negative binomial models were adjusted for age, sex, dementia subtype, baseline dementia severity and baseline Mini-Mental State Examination (MMSE) score. Exact aspiration-event dates and clinically important domains including frailty, functional status, residence before admission, swallowing assessment, oral-health measures, medication burden and comorbidity burden were not available in the dataset. Recorded aspiration pneumonia occurred in 24% of participants. After adjustment, the cohort-level mortality signal remained imprecise (HR 1.65, 95% CI 0.85-3.21). In contrast, aspiration pneumonia was independently associated with higher odds of hospitalisation (OR 2.02, 95% CI 1.29-3.16) and greater cumulative length of stay among those admitted (IRR 1.54, 95% CI 1.17-2.01). In this dementia-specific cohort, recorded aspiration pneumonia was common and consistently associated with greater subsequent inpatient use. The findings support interpreting recorded aspiration pneumonia as a pragmatic clinical marker of heightened service dependence within a broader frailty and illness context and underscore the value of multidisciplinary review and anticipatory care planning after such events.
The present study aimed to explore the preparedness of speech-language pathologists (SLPs) enrolled in a graduate programme in South India on serving the ageing population, including their preparedness, practice patterns, challenges faced and prospects. A total of 122 SLPs enrolled in a graduate programme in South India voluntarily participated in a cross-sectional online survey. The survey questionnaire gathered information on the following aspects in the context of serving the ageing population: caseload characteristics, assessment and diagnosis, management, challenges faced and future perspectives. The survey results revealed that approximately 50% of the participants' caseloads included older adults. However, the participants reported being moderately prepared for the assessment and management of communication and swallowing disorders in the ageing population. Further, the survey reports the perceived barriers to their preparedness and practice, including physical health issues, cognitive decline and lack of support from caregivers among significant others. Overall, the survey findings indicate growing recognition of the increasing demand for speech-language pathology services for older adults in India in the coming years, particularly for cognitive-communication and swallowing disorders. The survey highlights the need for the inclusion of courses related to the communication and swallowing needs of older adults in the graduate curriculum, specialised training in the use of evidence-based practices for addressing age-related conditions and greater use of technology to improve service delivery.
This study aimed to co-design, with key stakeholders, a digital dementia risk reduction application (app) for Chinese older migrant adults and carers residing in Australia, and to address the challenges of this proposed intervention. A four-stage co-design process was conducted, followed by one usability testing session. Each workshop focussed on core domains of healthy ageing and included guided discussions, interactive app testing and structured feedback activities. Thematic analysis was used to identify key themes. The app prototype was refined between sessions and changes were guided by participant feedback. A total of 20 end-users and 18 usability testers participated in this study (mean age = 74.8 years, SD = 8.2, range = 61-89). Participants expressed strong preferences for culturally tailored, interactive and visually clear app features. Eight themes emerged: health prioritisation in later life, designing for simplicity, functional needs in brain health testing, goal setting and motivation, brain training preferences, dietary preferences, preventive health monitoring and trusted medical information, and iterative design feedback. Older adults demonstrated high receptivity to health tracking and goal setting features when framed as personally relevant and adjustable. Feedback informed design features such as icon clarity, font size, navigation simplicity, motivational rewards and culturally specific content. This study highlighted the importance of co-design in developing effective digital tools for older adults. The active involvement of Chinese older adults in shaping the app supported cultural sensitivity, usability and individual motivational alignment. The final prototype reflected both sociotechnical responsiveness and real-world relevance and offers a potential, scalable model for culturally-tailored digital health interventions.
To evaluate the implementation of the Australian Hip Fracture Clinical Care Standard for patients with low-trauma hip fracture. This study aimed to (1) document facility-level adoption, (2) explore healthcare providers' perspectives on Standard delivery and (3) describe patient engagement with post-acute discharge care recommendations, including outcomes for culturally and linguistically diverse (CALD) and limited English proficiency subgroups. A mixed-methods approach was undertaken. Community-dwelling adults who underwent surgical treatment for low-trauma hip fractures at a tertiary hospital over 1 year were included. Facility-level adoption was determined by auditing medical records against the Clinical Care Standard. Patient engagement with post-discharge recommendations was assessed by structured telephone follow-up at 16 weeks and English proficiency. An electronic survey explored healthcare providers' perspectives of Standard implementation. Of 189 patients admitted, 136 (72%) were eligible; 127 completed follow-up assessment. The cohort was predominantly female (66%), with a mean age of 79 years and 80% migrants. Most components of the Care Standard were implemented with high fidelity (> 90% for four of seven indicators). Acute care data indicated effective implementation of most components of the Care Standard, supported by responses from 28 healthcare providers (28% response rate). However, healthcare providers highlighted the need for enhanced interprofessional training and resourcing for refracture prevention. Patient engagement with refracture prevention recommendations was low (44% participated in strength exercises, 26% in balance, 11% sought dietary advice and 44% consumed calcium supplementation), with no significant differences by CALD status or English proficiency. Despite high facility-level implementation of the Care Standard, patient adoption of post-discharge refracture prevention strategies remains suboptimal. Bridging this gap requires multi-faceted, consumer-centred solutions and improved interdisciplinary training to enhance outcomes and reduce refracture risk, particularly in diverse and multicultural populations.
The aim of this study was to assess the longitudinal association between transitioning to adult caregiving, grandparent childcare and mental health outcomes (depressive symptoms, life satisfaction and cognitive functioning) and physical health outcomes (pain interference) in South Africa from 2015 to 2022. We used information from three waves of the 'Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI)'. To evaluate within-person changes over time, symmetric and asymmetric linear fixed-effects (FE) regressions were employed and also stratified by sex. Adjusted FE regression analysis found a positive association between the change in grandchild care and beginning to provide grandchild care and depressive symptoms in the total sample and among women. Onset of adult caregiving, change in grandchild care and beginning to provide grandchild care were negatively associated with life satisfaction and positively associated with pain interference, while ceased grandchild care was positively associated with life satisfaction and negatively associated with pain interference. Onset of adult caregiving was negatively associated with cognitive functioning, and change in grandchild care and beginning to provide grandchild care were positively associated with cognitive functioning. Transitions into caregiving-both for grandchildren and adults-are associated with poorer well-being, including higher depressive symptoms (especially among women), lower life satisfaction and greater pain interference, supporting a role-strain perspective. However, initiating or changing grandchild care is linked to better cognitive functioning, suggesting potential stimulation benefits. In contrast, ceasing grandchild care is associated with improved life satisfaction and reduced pain.
This study examined how changes in activities of daily living (ADL) and instrumental activities of daily living (IADL) relate to living arrangement transitions among older adults in China, and whether associations differ by urban and rural settings. Data came from the 2008-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) of adults aged 65 years and older. Cox two-state regression models assessed associations between functional transitions and living arrangement changes, stratified by community type. Among 12,560 respondents, 81% lived with household members. Decline in ADL was associated with a higher hazard of transitioning to co-residence (Hazard ratio (HR) = 1.16, 95% confidence interval (CI): 1.10-1.23) and a higher hazard of remaining in co-residence (HR = 1.09, 95% CI: 1.01-1.17). The association with transitioning was observed in both urban (HR = 1.13) and rural (HR = 1.19) areas, while the association with remaining in co-residence was significant only among rural older adults (HR = 1.23). Functional decline is longitudinally associated with a higher likelihood of transitioning to and remaining in co-residence. This association is more pronounced in rural areas. Although ADL decline appears to be associated with subsequent changes in living arrangement, future research should explore its potential bidirectional nature to better inform community-specific interventions.
The study aimed to examine the relationship between dynapaenic abdominal obesity (D/AO) and fall risk in Chinese middle-aged and older adults. We analysed data from 9364 participants in the China Health and Retirement Longitudinal Study (CHARLS 2011-2018). Participants were categorised into four groups: non-dynapaenia and non-abdominal obesity (ND/NAO), only abdominal obesity (ND/AO), only dynapaenia (D/NAO), and D/AO. Cox regression, sensitivity, subgroup and geographic analyses were conducted. During follow-up, 2989 falls were reported. After full adjustment, D/NAO and D/AO significantly increased fall risk by 44% (HR = 1.44, 95% CI: 1.25-1.65) and 28% (HR = 1.28, 95% CI: 1.05-1.57), respectively. Stratified analysis revealed significant sex differences: among males, the association between D/AO and fall risk was most pronounced (HR = 2.26, 95% CI: 1.58-3.23); among females, the risk was primarily driven by D/NAO (HR = 1.32, 95% CI: 1.07-1.62). Diabetes significantly interacted with D/AO status (p < 0.05), intensifying the risk. Geographically, Northeast China exhibited high D/AO-associated fall risk despite having the optimal baseline muscle strength. Both D/NAO and D/AO are important risk factors for falls in middle-aged and older adults. The effect of abdominal obesity on fall risk differs significantly by sex and diabetes status, demonstrating a notable synergistic pathogenic effect. Fall prevention strategies should focus on comprehensive body composition management. In particular, for men and individuals with diabetes, greater emphasis should be placed on muscle strength training and the control of central obesity. For high-risk regions (e.g., Northeast China), in addition to physiological interventions, multidimensional public health prevention strategies should be developed that take into account local environments.
To examine whether self-reported motor difficulties (walking, stair climbing and rising from a chair) are independently associated with self-reported osteoarthritis (OA) risk among older European adults, utilising propensity score matching (PSM). This work utilised data from Waves 1, 2 and 4-9 of the large cross-national Survey of Health, Ageing and Retirement in Europe (SHARE) dataset representing 127,372 adults aged 50 years and older. Osteoarthritis and motor difficulties were self-reported based on participants' reports of physician diagnosis and functional limitations. Propensity score matching was applied to balance covariates and try to improve causal inference. Individuals with motor difficulties had extensively higher OA prevalence (28.4% vs. 10.8%), with prevalence increasing in a dose-dependent manner. PSM score-adjusted analysis showed motor difficulty was associated with a 17.1 percentage points (OR = 3.1) higher prevalence of OA, a stronger association than traditional models. We also confirmed higher OA and motor difficulties in women, older age and people with obesity, low handgrip strength, chronic conditions and reduced quality of life. Self-reported motor difficulties are strongly associated with self-reported OA in older European adults. These findings highlight the close link between lower-limb functional limitations and OA reporting in population-based surveys. Given the cross-sectional and self-reported nature of the measures, the results should be interpreted as associations rather than evidence of temporality or causality.
The rapid growth in the use of online platforms for obtaining health-related information, together with the increasing incidence of Alzheimer's disease (AD), has made the evaluation of online information quality essential. The purpose of this research was to assess the quality and reliability of the more likely to be viewed YouTube videos related to exercise in individuals living with AD. This descriptive study evaluated the quality and reliability of YouTube videos related to AD and exercise. Fifty-six English language videos were selected from the top search results based on keywords. Video sources, view rate metrics and content characteristics were recorded. The quality and reliability of the videos were independently evaluated by three physiotherapists using the Global Quality Scale (GQS) and DISCERN tool. High-quality videos had higher DISCERN scores and greater view rate (p = 0.02), whereas low-quality videos showed minimal interaction (p < 0.001). Dislike rates were similar across all groups. In addition, Pearson correlation analysis indicated a very strong positive relationship (r = 0.97, p < 0.001) between views and likes, indicating that more viewed videos tend to receive more likes. Video quality may have an influence on both the reliability of the information and viewer interaction, as reflected by view and like metrics. A considerable number of YouTube videos on exercise for individuals living with AD were shown to be of low or moderate quality. The findings highlight the need for improved oversight, collaboration between healthcare professionals and content creators, and the promotion of evidence-based digital health information to protect vulnerable populations.
To examine the prevalence, trends and geographic variation of informal care reported by individuals accessing long-term home care support between 2012 and 2019 in Australia. Population-based national cross-sectional study using the Registry of Senior Australians (ROSA) National Historical cohort. Non-Indigenous individuals 65-105 years old who accessed long-term home care through a Home Care Package between 01 January 2012 and 31 December 2019 in Australia were included. Informal carer availability was ascertained from individuals' aged care eligibility assessments. Informal carers are individuals who provide unpaid care and support to others. Socio-demographic and clinical characteristics of those with and without informal carers were examined. Yearly trends and geographic variation in the proportion of individuals reporting a carer were examined. The effect of a 1-year increase in receiving initial long-term home care on the probability of having a carer over time was described using an odds ratio (OR) and 95% confidence interval (95% CI) from a logistic regression model, adjusted for age, sex and dementia status. Overall, 233,567 long-term home care recipients with known carer status were studied. The proportion of care recipients with an informal carer decreased from 86% in 2012 to 78% in 2019 (adjusted OR: 0.95, 95% CI 0.95-0.95). The decrease in informal care reported over time was more pronounced in females (OR: 0.96, 95% CI 0.95-0.97) than in males and in individuals without dementia (OR: 0.95, 95% CI 0.94-0.95). Visualisations of informal care prevalence showed substantial geographical (range: 60%-98%) variation nationally. There was a decline in reported informal care availability for older Australians entering long-term home care between 2012 and 2019, with substantial national variation. Lower informal carer availability likely translates in greater formal care needs.
This review synthesises evidence on pharmacological interventions for secondary osteoporosis in older patients with hip fractures. A systematic review of five databases-Embase, Medline ALL, Cochrane Library, Web of Science Core Collection and Web of Science Preprint Citation Index-for articles published between January 2010 and July 2024. Abstracts and full texts were screened independently by multiple reviewers and critically appraised. Health outcomes, including refractures, follow-up bone mineral density (BMD) scans and treatment adherence, were synthesised, and adverse effects were examined in relation to study characteristics. A total of 60 articles met the inclusion criteria, and 40% were retrospective cohort studies. The median sample size within the included studies was 775 patients, with a median age of 78.7 years. Bisphosphonates (87%), anabolic agents (52%) and other antiresorptive agents (47%) were common pharmacological interventions. The average follow-up duration was 12 months. The cumulative refracture rate over 12 months was 3%, with a median incidence rate of 8%. Among patients who did not receive pharmacological treatment, the average refracture rate was 10%, compared with 4% in those who did receive treatment. Only 13 studies (22%) reported follow-up BMD. The implementation of fracture liaison services (FLS) was associated with an average of 44% increase in treatment initiation rates across four studies. Pharmacological treatment reduces refracture rates in older adults with hip fractures, especially when initiated through FLS. Although bisphosphonates are most commonly studied, anabolic and other antiresorptive agents also show benefits. Improved reporting on BMD follow-up and adherence is needed to guide long-term osteoporosis management.
Ending the abuse of older people in Australia is a national policy priority. Harmonisation of financial enduring power of attorney (FEPOA) legislation is regularly called for to protect against financial elder abuse. A FEPOA is a legal instrument by which an adult appoints one or more people to manage their legal obligations, money and property, particularly during periods of incapacity. Although older Australians are urged to make FEPOAs, and a majority of those over age 65 report having one, these instruments are implicated in an estimated 50%-85% of cases of financial elder abuse. This commentary offers a critical perspective on legislative harmonisation as a policy intervention to prevent financial abuse committed via FEPOA arrangements. We address three main issues. First, we explain several approaches to harmonisation, illustrated with examples from different areas of law-making, noting that harmonisation is often a slow process that does not achieve uniformity. Second, we argue that deficiencies in knowledge and practices that create risks of financial abuse via FEPOAs will not be cured by harmonisation alone. Third, we highlight that the legislative variation across states and territories provides opportunities for innovation in research. Further investment in high-quality research is essential to guide effective legislative and compliance strategies to prevent the financial abuse of older people.