International responses addressing the under-representation of older people in clinical research.

Older people (aged 65 years +) are under-represented in clinical research across many disease areas. Such exclusions limit the generalisability of trial results and can lead to a gap in critical knowledge regarding the efficacy and safety of interventions in older age groups. International bodies and regulators have addressed this issue to varying degrees. The USA's Food and Drug Administration (FDA) has produced regular non-binding guidance about the inclusion of older trial participants, while the National Institutes of Health's (NIH) binding regulations mean that those seeking research funding must include participants of all ages unless there are scientific or ethical reasons to exclude them. European regulations governing clinical trials of new medications require that participants represent the population groups that are likely to use the product being tested, while Britain highlights the need to improve trial participation of under-served groups, which include older people. Australian clinical trial guidelines point to the potential problem of excluding some groups from research but do not specifically address older participants. While current international approaches may provide some improvements in trial representation, additional strategies are required to promote clinical research that better reflects populations seen in clinical practice. Australia could benefit from clinical trial guidance that highlights the specific issue of the under-representation of older participants and outlines strategies to facilitate greater inclusion. This article provides an overview and critique of the current approaches to the inclusion of older people in clinical research and highlights policy gaps and limitations of current strategies.

Best care options for older prisoners with dementia: a scoping review.

INTRODUCTION: The prisoner population is ageing, and consideration is needed for how to best support those with age-related health conditions in the system. Existing work practices and organizational structures often fail to meet the needs of prisoners with dementia, and prison staff experience high levels of burden because of the increased needs of these prisoners. Little is known about the best method of responding to the needs of this growing subpopulation of prisoners. METHOD: A scoping review was conducted to answer the question: what are the perceived best care options for prisoners with dementia? To be included, publications had to be publicly available, reported on research findings, or viewed opinions and commentaries on care practices relevant to older prisoners with dementia. Searches were conducted in 11 databases to identify relevant publications. Data from the included publications were extracted and summarized into themes. RESULTS: Eight themes were identified that could support better care practices for prisoners with dementia: (1) early and ongoing screening for older prisoners; (2) specialized services; (3) specialized units; (4) programs or activities; (5) adaptations to current contexts; (6) early release or parole for older prisoners with dementia deemed at low risk of reoffending; and (7) training younger prisoners (8) as well as staff to assist older prisoners with dementia. Besides practical strategies improving care practice, costs, prison-specific resources, and staff skills were highlighted as care barriers across all themes. A lack of empirical evidence supported these findings. CONCLUSION: One of the implications of the international ageing prison population is the higher number of people living with dementia being incarcerated. Suggestions for best care approaches for prisoners with dementia now need to move from opinion to empirical approaches to guide practice.

Carer Characteristics and Health, Wellbeing and Employment Outcomes of Older Australian Baby Boomers.

Supporting caregivers and enabling continued workforce participation are central strategies in Australia's response to an ageing population, however these strategies have potential disadvantages for carers, particularly women, including reduced workforce participation and retirement income, and poorer health status. This paper explores the nexus between paid work and caregiving for Australia's baby boomer cohort as this group faces unprecedented pressures to manage paid work alongside caring longer and more intensively for family members, including grandchildren. A sample of 1261 men and women aged 60 to 64 completed the 2011-12 Life Histories and Health survey, a sub-study of the New South Wales 45 and Up Study. The survey collected data on sociodemographic, psychosocial, life history and health-related variables including caregiving and employment status. Around a third (32.5%) of the sample (52.2% female) were involved in some type of caregiving at the time. Compared to non-carers, carers reported lower workforce participation (45.8% versus 54.7% for non-carers) as well as poorer health, more mobility difficulties, lower quality of life and lower self-rated SES. Carers who also cared for grandchildren were more likely to be in part-time or no paid work compared to other carers. Working carers tended to be more highly educated, have fewer mobility difficulties, better self-rated health and higher SES than non-working carers. Male carers were more likely than female carers to be in full-time or no paid work. Results indicate that reduced workforce participation and health status of caregivers varies by gender and type of caregiving. Policy reforms are recommended to mitigate these adverse consequences on those providing care, their families, employers and the community.

Adapting data collection methods in the Australian Life Histories and Health Survey: a retrospective life course study.

OBJECTIVE: Ideally, life course data are collected prospectively through an ongoing longitudinal study. We report adaptive multimethod fieldwork procedures that gathered life history data by mail survey and telephone interview, comparable with the face-to-face methods employed in the English Longitudinal Study on Ageing (ELSA). DESIGN: The Australian Life Histories and Health (LHH) Survey was a substudy of the Australian 45 and Up Study, with data collection methods modified from the ELSA Study. A self-complete questionnaire and life history calendar were completed by the participants, followed by a computer-assisted telephone interview recording key life events. RESULTS: The LHH survey developed and tested procedures and instruments that gathered rich life history data within an ongoing Australian longitudinal survey on ageing. Data collection proved to be economical. The use of a self-complete questionnaire in conjunction with a life history calendar and coordinated computer-assisted telephone interview was successful in collecting retrospective life course information, in terms of being thorough, practical and efficient. This study has a diverse collection of data covering the life course, starting with early life experiences and continuing with socioeconomic and health exposures and outcomes during adult life. CONCLUSIONS: Mail and telephone methodology can accurately and economically add a life history dimension to an ongoing longitudinal survey. The method is particularly valuable for surveying widely dispersed populations. The results will facilitate understanding of the social determinants of health by gathering data on earlier life exposures as well as comparative data across geographical and societal contexts.

Australian baby boomers retiring 'early': understanding the benefits of retirement preparation for involuntary and voluntary retirees.

The first of the baby boomers have reached retirement age, but some have retired 'early' with varying degrees of personal choice. Preparation for retirement can lead to well-being in later life, but few studies have considered the preparations of involuntary retirees or the pathways that link their preparations with retirement outcomes. This research draws on a sample of 304 retirees from the Ageing Baby Boomers in Australia Study (2009) to examine how preparedness for retirement relates to voluntary and involuntary retirees' life satisfaction and how this relationship is explained by psychological, activity-based, and economic theories. Preparedness predicted life satisfaction for voluntary and involuntary retirees and each of theoretical pathways was supported. Although those retiring involuntarily were less prepared than voluntary retirees, their preparatory behaviours were still associated with life satisfaction. These results suggest that retirement policy and planning initiatives should aim to facilitate a holistic approach to retirement planning for future retirees, particularly those facing an early and unexpected retirement.

Australian baby boomers face retirement during the global financial crisis.

This paper examines the impact in Australia of the global financial crisis on the baby boom cohort approaching later life. Data from national focus groups of people aged 50 to 64 years (N = 73), conducted in late 2008, found widespread but variable concern and uncertainty concerning work and retirement plans and experiences. A national survey (N = 1,009) of those aged 50 to 64 years in mid-2009 reported lower levels of financial satisfaction compared with other life domains; many planned to postpone retirement. Findings are interpreted in the context of policies and markets that differed significantly from those in the United States, notwithstanding the global nature of the financial crisis.

Socioeconomic, psychological and demographic determinants of Australian baby boomers' financial planning for retirement.

AIM: Research from around the Western World has shown that psychological, socioeconomic and demographic factors can influence levels of financial planning. This study aims to determine how these factors interrelate to predict planning outcomes. METHOD: Data from the Ageing Baby Boomers in Australia Study were used to examine the effects of multiple factors on financial planning for 709 employed Australians nearing retirement. RESULTS: The results showed that higher income, future time perspective (FTP) and financial knowledge independently predicted levels of retirement planning. The effects of FTP and financial knowledge on financial planning were consistent across levels of socioeconomic status. CONCLUSIONS: While similar issues in financial planning appeared across socioeconomic status, a 'one size fits all' approach to retirement policy may not be effective. Instead, policy should be targeted towards the diverse needs of different groups. Raising public awareness of FTP and financial knowledge may provide a useful starting point.

Australian baby boomers talk about the global financial crisis.

AIM: The aim of this qualitative study was to explore baby boomers' views and plans in the early days of the global financial crisis (GFC) in 2008. METHODS: Informants from National Seniors Australia were interviewed in 15 focus groups conducted nationally. Transcripts were analysed by themes from semi-structured questions. RESULTS: The GFC was found to shake the confidence and plans of boomers. Many workers decided to delay retirement and save longer following losses in superannuation. Those retired on market-linked superannuation felt forced to reduce expenses and restrain lifestyles. Those on full pensions were relatively unaffected. CONCLUSION: The GFC called into question boomers' expectations for retirement. While financial markets are showing signs of recovery, the GFC had precipitated a decision to work longer and to draw conservatively on retirement savings that may take many years to recover. The volatility of financial and employment markets underscores the value of the Age pension.

Trial of an injury reporting system for surf lifesavers in Australia.

OBJECTIVE: To pilot an injury reporting form designed for use in Australian surf lifesaving; the need for such a form is to meet legislative requirements and as an initial step in developing an injury prevention program for volunteer surf lifesavers [4]. PARTICIPANTS: Competitors at the National Surf Life Saving Championships (NSLSC) held at Kurrawa Beach, Queensland, in 1998/1999 who reported to the medical tent over the course of the five-day event. Twenty-five volunteers of varying experience staffed the medical tent and included one paramedic coordinator, two doctors, three nurses, three physiotherapists and 16 first-aid officers. METHOD: An injury reporting form was designed using the Australian Sports Injury Data Dictionary [1] and pilot tested at the NSLSC in 1998/1999. The layout and format were based on similar forms used in other sports (eg skiing) with a number of the items altered to be more specific to surf lifesaving competition events. Four strategies were used to assess if the form provided interpretable data: number of forms returned; completeness of data recorded in each section; detailed analysis of difficulties in coding and entering data; detailed feedback from the medical tent personnel about the usability of the form. RESULTS: A total of 433 completed forms were returned and from these both descriptive and injury incidence data were obtained. Medical tent personnel reported the form to be generally usable, though they suggested some changes to it. CONCLUSIONS: The injury reporting form was found to be an effective tool to describe injuries and calculate injury incidence. Following minor revisions, a modified form was designed to improve the quality and accuracy of the information obtained; this form has been used nationally since 2001.

Impact of the global financial crisis on employed Australian baby boomers: a national survey.

AIM: This paper examines the impact of the global financial crisis (GFC) on employed Australian baby boomers. METHODS: A nationally representative sample of 1009 boomers aged 50-64 years completed a survey by telephone interview mid 2009. RESULTS: Compared with 1 year ago, 38.9% of working boomers reported being financially worse off and this was more so for women (42.4%) than men (35.6%). Following the GFC, 41.4% of women and 31.9% of men had decided to postpone their retirement plans. CONCLUSION: The GFC is affecting the retirement preparations and plans of Australia's baby boomers. Policy implications include reduced resources for retirement needs, and uneven and differential impacts for those with interrupted employment histories, notably women.

The health of Australian baby boomers.

The large baby boomer cohort is beginning to reach retirement age. This paper reviews recent Australian literature on baby boomers' health and health behaviours. Databases were searched for peer-reviewed literature and the Internet for online studies and reports. The boomers can expect an increased life span compared to those in later life now. Boomers' health behavioural risks include physical inactivity, low vegetable consumption, obesity and rising medical risk due to increasing prevalence of diabetes. Their health will impact on workforce participation and retirement timing. There is substantial scope for health improvement and consequent quality of life as boomers age. However, little is known about health decision-making, inequalities between social groups and health information sources. Future research can yield a better understanding of the health trajectories of baby boomers in order to plan for health and service needs for an ageing Australia.