Ageing

Objectives To identify sex-specific multimorbidity patterns in Australia, using the Rx-Risk index (a medication-based measure), to: (i) estimate the prevalence of chronic treated conditions; (ii) map network-based multimorbidity clusters; and (iii) examine how these clusters vary by age, socio-economic status and geographic remoteness.DesignAustralian nationwide cross-sectional study using linked Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) data.SettingAustralian residents aged ≥ 65 years with at least one PBS and/or MBS claim between 1 July 2022 and 30 June 2023.Main Outcome MeasuresSex-specific network-based multimorbidity clusters and cluster profiles by age, socio-economic status and geographic remoteness.ResultsA total of 4,435,784 individuals (mean age, 74.8 years; 53.2% female) were included. Multimorbidity (≥ 2 conditions) was present in 76.1% of the cohort. Three consistent multimorbidity clusters were identified in both sexes: cardiovascular–metabolic, neuropsychiatric–functional decline and inflammatory–musculoskeletal–cancer. The prevalence of these clusters and their component conditions varied across sociodemographic groups, with higher prevalence observed in individuals aged ≥ 85 years and those living in socio-economically disadvantaged areas. Minimal differences were observed between metropolitan and non-metropolitan regions.ConclusionsMultimorbidity was highly prevalent among older Australians with at least one PBS and/or MBS claim during the study year, with multimorbidity clusters showing marked sociodemographic variation in prevalence. These findings highlight the heterogeneity in treated conditions captured in administrative claims and provide insights to inform future research and policy planning for prevention and management of multimorbidity in an ageing population.

Weisi Chen, Christine Y. Lu, Sarah N. Hilmer, Alice A. Gibson, Edwin C. K. Tan

Objectives To quantify factors associated with paramedic transport to hospital for older people in residential aged care facilities (RACFs) and supported accommodation, and to identify modifiable drivers of non-transport. Study Type Retrospective cohort study using routinely collected electronic patient care records, analysed with gradient boosting models and multivariable logistic regression. Setting Ambulance Tasmania attendances to RACFs and supported accommodation across Tasmania, 1January 2018 to 31 December 2024. Study Population All eligible ambulance attendances for people aged 65years or older at these facilities. Main Outcome Measures The primary outcome was transport to hospital. Scene time and clinical status at first assessment, summarised using the National Early Warning Score 2 (NEWS2) and Shock Index, were descriptive variables and candidate predictors. Results Of 23,317 attendances, 19,386 (83.1%) resulted in transport and 3931 (16.9%) did not. Most attendances were low risk. Crew skill set, calendar month, initial pain score, respiratory rate and NEWS2 category were the strongest predictors of transport. In adjusted logistic regression, extended care paramedic attendance was associated with markedly lower odds of transport than attendance by standard paramedic crews (adjusted odds ratio, 0.09 [95% CI, 0.07–0.12]), corresponding to an adjusted transport probability of 0.50 compared with 0.85 for intensive care paramedic crews, 0.86 for standard paramedic crews and 0.69 for other crews. Conclusions Paramedic transport decisions for RACF residents were strongly associated with acute illness severity, but crew skill set was also independently associated with transport. Attendances managed by extended care paramedics had lower adjusted probabilities of hospital transport. These findings suggest that extended-scope paramedic models warrant prospective evaluation in this setting.

Sharon Andrews, Pieter F. Fouche, Belinda Flanagan, Michael McDermott, Melanie Greenwood

Elder abuse can lead to serious physical injuries and long-term psychological consequences, but its recognition and documentation in healthcare settings remain limited. This study used linked data from four Australian states to examine elder abuse coded during emergency department presentations and hospitalisations among 965,986 older people assessed for aged care services between 2010 and 2019. Only 580 people (0.06%) had elder abuse coded during an emergency department presentation or hospitalisation, highlighting substantial under-recognition and under-reporting in hospital settings.

Stephanie L. Harrison, Sahar Barmomanesh, Bryan Morden, Maria C. Inacio, Gillian E. Caughey, on behalf of the ROSA Consumer and Community Advisory Committee

Davide R Tomassoni · Iftah Amith

For decades much has been made of Australia's ageing population, particularly how best to manage the arrival of the baby‐boomer generation from a health, economic and societal perspective.1 At the same time, the individual people who interact with the aged care system have distinct priorities; for people in aged care this includes maintaining their independence, being treated with respect, and the management of medical conditions.2 Addressing the system‐wide, indeed society‐wide, stressors, while delivering service and health outcomes that align with the expectations of the ageing population remains a key challenge to the Australian health system. This Healthy Ageing issue of the MJA contains a series of articles that shine a light on the diverse elements of a modern multifaceted approach to healthy ageing and contribute to the evidence base that will drive the adjustments and changes needed to deliver an effective, efficient and respectful aged care system. The Royal Commission into Aged Care Quality and Safety highlighted experiences of substandard care of people accessing residential aged care and home care services.3 In a cross‐sectional population‐based study using data from the Registry of Senior Australians, Eshetie and colleagues4 analysed indicators of quality and safety of aged care for older Australians receiving long term residential aged care or home care packages during 2019. Their findings of marked variation in quality of care, particularly regarding antibiotic use, high sedative load, emergency department presentations, home medicines reviews, chronic disease management plans and waiting time for home care services suggest areas that may benefit from targeted quality improvement strategies. A narrative review by Inacio and colleagues5 discusses recent evidence of aged, community and health care models that may support older people to “age in place”. Evidence for the models supporting ageing in place is limited, although there is evidence for other benefits such as improving wellbeing. Complex multifactorial care interventions have the most compelling evidence for delaying or avoiding entry into long term residential aged care. The authors concluded that “No panacea exists for supporting all people to age in place, but care integration, collaboration among care settings, and multidisciplinary person‐centred clinical care that addresses health‐related decline and challenges are consistently reported to contribute to its success”. As the leading cause of hospitalised injuries and injury deaths among older Australians, falls remain a major public health issue in Australia;6 however, strategies to improve mobility and reduce falls in aged care are often limited by under‐resourcing of appropriate health services such as physiotherapy. In the era of telehealth, Dawson and colleagues report on the effectiveness of the TOP‐UP program, a co‐designed randomised controlled trial where participants in the intervention arm received a six‐month program of ten telephysiotherapy sessions for delivery of a tailored exercise program aimed at improving mobility and balance.7 Fewer intervention participants experienced falls during the program, and they also showed improvements in sit‐to‐stand performance, balance, gait speed, mobility goal attainment, and quality of life. These results provide robust evidence for the implementation of supported telephysiotherapy exercise programs to prevent falls and improve health and quality of life for people living in aged care. Delbaere and colleagues discuss the need for a comprehensive, system‐wide approach to falls prevention.8 Their perspective highlights recent innovations such as remote exercise programs delivered by telehealth, simulation‐based balance training such as safe landing techniques, and caregiver training, as well as summarising the evidence for a more traditional approach to falls prevention. Equity, cross‐sector collaboration, funding and ongoing evaluation are all important to measure the impact of new and emerging fall prevention strategies. There is also a need for further study of the efficacy and safety of tailored interventions for those in higher risk groups such as people living with dementia, osteoarthritis or Parkinson disease. Finally, the perspective by Foundas provides a timely and thought‐provoking discussion of dignity and respect in residential aged care.9 The new rights‐based Aged Care Act 2024 (Cwlth) that has recently come into effect brings with it new mandates to support residents of aged care facilities to have choices and take risks.10 Through such change, there is potential to enhance quality of life and gain enrichment through independence, empowerment and self‐determination. However, putting this into practice is likely to be challenging as we try to navigate legal, moral, and duty of care obligations. Acknowledging the benefits of risk taking and fostering a supportive environment as we move away from a paternalistic approach to risk, will assist aged care facilities, and indeed the broader aged care sector, in maintaining dignity of older people while providing both safety and autonomy.

Michael Skilton · Alison Williams · Wendy Morgan

Telephysiotherapy could be incorporated into aged care to improve the lives of older Australians

Rik Dawson · Marina Pinheiro · Juliana Oliveira · Abby Haynes · Vasikaran Naganathan · Morag E Taylor · Nina Bowes · Karn Nelson · Jenny Rayner · Catherine Sherrington

Impaired intrinsic capacity in older Aboriginal people in the Kimberley was most frequent in the sensory and locomotion domains

Zoë Hyde · Kate Smith · Roslyn Malay · Dina C LoGiudice · Dawn C Bessarab · David N Atkinson · Edward Strivens · Leon Flicker

Meeting demand for higher care level support will require a larger aged care workforce particularly in regional and remote areas

Johannes Schwabe · Gillian E Caughey · Steve L Wesselingh · Craig Whitehead · Renuka Visvanathan · Keith Evans · Maria C Inacio

Natasha Reid · Leonard C Gray