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BACKGROUND: Rates of dementia for Aboriginal and Torres Strait Islander peoples are three to five times greater compared to non-Indigenous Australians, with earlier age of onset. However, the risk and protective factors that drive these higher rates vary across existing cohort studies, with minimal findings on the role of vascular risk factors beyond stroke. Harmonisation of data across studies may offer greater insights through enhanced diversity and strengthened statistical capabilities. This study aims to combine three landmark cohort studies of Aboriginal and Torres Strait Islander participants to better understand the determinants of cognitive health and dementia. METHODS/DESIGN: Three cohort studies - the Kimberley Healthy Adults Project (KHAP, N = 363), Koori Growing Old Well Study (KGOWS, N = 336) and Torres Strait Dementia Prevalence Study (TSDPS, N = 274) - share a similar research methodology with demographic, medical history, psychosocial factors, cognitive tests and consensus clinical diagnoses of cognitive impairment and dementia. Associations between risk and protective factors of interest and the presence of dementia and/or cognitive impairment diagnoses will be evaluated by univariable and multivariable logistic regression in a harmonised cross-sectional cohort of 898 participants. Factors associated with incident dementia and/or cognitive impairment will be assessed in a subset of KHAP (n = 189) and KGOWS participants (n = 165) who were available in longitudinal follow-up, after exclusion of those with baseline dementia or cognitive impairment. Analyses in relation to outcome measure of death or dementia will be conducted to account for the competing risk of death. Logistic regression will be used to evaluate the association between the individual components of the 16-component Kimberley Indigenous Cognitive Assessment (KICA) tool and the presence of dementia and cognitive impairment determined by independent consensus diagnoses. Multivariable binary logistic regression will be used to adjust for the effect of confounding variables. Results will be reported as odds ratios (OR) with 95% confidence intervals (95% CI). DISCUSSION: Greater understanding of risk and protective factors of dementia and cognitive impairment relevant to Aboriginal and Torres Strait Islander peoples may improve approaches across the life course to delay cognitive decline and reduce dementia risk.
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Aborigenas Australianos e Isleños del Estrecho de Torres , Disfunción Cognitiva , Demencia , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Australia/epidemiología , Australia/etnología , Disfunción Cognitiva/etnología , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/diagnóstico , Estudios de Cohortes , Estudios Transversales , Demencia/epidemiología , Demencia/etnología , Demencia/diagnóstico , Factores Protectores , Factores de RiesgoRESUMEN
INTRODUCTION: To better tailor prevention and care strategies, there is a need to identify modifiable factors associated with functional impairment in older Aboriginal people, and related service needs. OBJECTIVE: To investigate the prevalence and associated factors for functional impairment in older Aboriginal people, and related service needs. DESIGN: Cross-sectional survey of 289 Aboriginal people aged ≥45 years living in the remote Kimberley region of Western Australia. Factors associated with functional impairment were explored with logistic regression. FINDINGS: 41.2% (95% CI 35.6%-47.0%) of participants required assistance with at least one I/ADL, and 26.0% (95% CI 21.2%-31.3%) required assistance with two or more I/ADLs. A core activity limitation (required assistance with showering, dressing or cooking) was reported by 15.9% (95% CI 12.1%-20.6%). In multivariable logistic regression analyses, older age, diabetes, difficulty walking, head injury, higher depression score and worse cognition were associated with needing help with two or more I/ADLs, while older age, history of stroke, higher depression score and worse cognition were associated with the presence of a core activity limitation. The proportion of participants receiving support with I/ADLs ranged from 71.2% to 97.6%. Support was generally provided by family and friends rather than service providers. DISCUSSION: The key modifiable factors associated with functional impairment in older Aboriginal people living in remote regions are diabetes, depression and cognitive impairment. Services required are transport and socio-cultural activities, and ensuring support for family providing the majority of care. CONCLUSIONS: This study highlights the need for holistic prevention strategies and care for older Aboriginal people with functional limitations and their families.
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Actividades Cotidianas , Aborigenas Australianos e Isleños del Estrecho de Torres , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Transversales , Prevalencia , Población Rural/estadística & datos numéricos , Australia Occidental/epidemiologíaRESUMEN
BACKGROUND: Aboriginal and Torres Strait Islander people are ageing with high rates of comorbidity, yet little is known about suboptimal prescribing in this population. AIM: The prevalence of potentially suboptimal prescribing and associated risk factors were investigated among older patients attending primary care through Aboriginal Community Controlled Health Services (ACCHSs). METHODS: Medical records of 420 systematically selected patients aged ≥50 years attending urban, rural and remote health services were audited. Polypharmacy (≥ 5 prescribed medications), potentially inappropriate medications (PIMs) as per Beers Criteria and anticholinergic burden (ACB) were estimated and associated risk factors were explored with logistic regression. RESULTS: The prevalence of polypharmacy, PIMs and ACB score ≥3 was 43%, 18% and 12% respectively. In multivariable logistic regression analyses, polypharmacy was less likely in rural (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.24-0.77) compared to urban patients, and more likely in those with heart disease (OR = 2.62, 95% CI = 1.62-4.25), atrial fibrillation (OR = 4.25, 95% CI = 1.08-16.81), hypertension (OR = 2.14, 95% CI = 1.34-3.44), diabetes (OR = 2.72, 95% CI = 1.69-4.39) or depression (OR = 1.91, 95% CI = 1.19-3.06). PIMs were more frequent in females (OR = 1.88, 95% CI = 1.03-3.42) and less frequent in rural (OR = 0.41, 95% CI = 0.19-0.85) and remote (OR = 0.58, 95% CI = 0.29-1.18) patients. Factors associated with PIMs were kidney disease (OR = 2.60, 95% CI = 1.37-4.92), urinary incontinence (OR = 3.00, 95% CI = 1.02-8.83), depression (OR = 2.67, 95% CI = 1.50-4.77), heavy alcohol use (OR = 2.83, 95% CI = 1.39-5.75) and subjective cognitive concerns (OR = 2.69, 95% CI = 1.31-5.52). High ACB was less common in rural (OR = 0.10, 95% CI = 0.03-0.34) and remote (OR = 0.51, 95% CI = 0.25-1.04) patients and more common in those with kidney disease (OR = 3.07, 95% CI = 1.50-6.30) or depression (OR = 3.32, 95% CI = 1.70-6.47). CONCLUSION: Associations between potentially suboptimal prescribing and depression or cognitive concerns highlight the importance of considering medication review and deprescribing for these patients.
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Nativos de Hawái y Otras Islas del Pacífico , Polifarmacia , Atención Primaria de Salud , Humanos , Femenino , Masculino , Estudios Transversales , Anciano , Persona de Mediana Edad , Factores de Riesgo , Prescripción Inadecuada/estadística & datos numéricos , Australia/epidemiología , Anciano de 80 o más Años , Lista de Medicamentos Potencialmente Inapropiados , PrevalenciaRESUMEN
BACKGROUND: Dementia is the second leading cause of disease burden in Australia. We aimed to calculate the population attributable fractions (PAFs) of dementia attributable to 11 of 12 previously identified potentially modifiable health and social risk factors (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, alcohol excess, air pollution, and traumatic brain injury), for Australians overall and three population groups (First Nations, and those of European and Asian ancestry). METHODS: We calculated the prevalence of dementia risk factors (excluding traumatic brain injury) and PAFs, adjusted for communality, from the cross-sectional National Aboriginal and Torres Strait Islander Health Survey (2018-19), National Aboriginal and Torres Strait Islander Social Survey (2014-15), National Health Survey (2017-18), and General Social Survey (2014) conducted by the Australian Bureau of Statistics. We conducted sensitivity analyses using proxy estimates for traumatic brain injury (12th known risk factor) for which national data were not available. FINDINGS: A large proportion (38·2%, 95% CI 37·2-39·2) of dementia in Australia was theoretically attributable to the 11 risk factors; 44·9% (43·1-46·7) for First Nations Australians, 36·4% (34·8-38·1) for European ancestry, and 33·6% (30·1-37·2) for Asian ancestry. Including traumatic brain injury increased the PAF to 40·6% (39·6-41·6) for all Australians. Physical inactivity (8·3%, 7·5-9·2), hearing loss (7·0%, 6·4-7·6), and obesity (6·6%, 6·0-7·3) accounted for approximately half of the total PAF estimates across Australia, and for all three population groups. INTERPRETATION: Our PAF estimates indicate a substantial proportion of dementia in Australia is potentially preventable, which is broadly consistent with global trends and results from other countries. The highest potential for dementia prevention was among First Nations Australians, reflecting the enduring effect of upstream social, political, environmental, and economic disadvantage, leading to greater life-course exposure to dementia risk factors. Although there were common dementia risk factors across different population groups, prevention strategies should be informed by community consultation and be culturally and linguistically appropriate. FUNDING: Australian National Health and Medical Research Council and University College London Hospitals' National Institute for Health Research (NIHR) Biomedical Research Centre, and North Thames NIHR Applied Research Collaboration.
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Lesiones Traumáticas del Encéfalo , Demencia , Humanos , Estudios Transversales , Grupos de Población , Australia/epidemiología , Factores de Riesgo , Obesidad , Demencia/epidemiologíaRESUMEN
OBJECTIVE: Improving the quality of life (QoL) of older people is a key priority for governments, clinicians, researchers and service providers worldwide. However, the lack of culturally appropriate QoL tools for First Nations people is a major barrier to such efforts. The purpose of this study was to evaluate the psychometric properties of the Good Spirit, Good Life (GSGL) QoL tool for older Aboriginal Australians. METHODS: One hundred and twenty older Aboriginal people living in Perth and Melbourne, Australia, were administered the GSGL tool, along with several other instruments assessing cognition (KICA-Cog), depression (KICA-Dep), anxiety (GAI-SF), health and well-being (EQ-5D-5L and ICECAP-O) and resilience (ARRQ-25). Associations between these instruments and the GSGL tool were explored to determine concurrent and known-groups validity. Internal consistency was assessed with split-half reliability and Cronbach's alpha. Exploratory factor analysis was performed to investigate construct validity. RESULTS: GSGL scores were positively correlated with ICECAP-O and ARRQ-25 scores, and negatively correlated with EQ-5D-5L score. GSGL scores differed significantly between participants with a probable anxiety disorder or depression, but not those with cognitive impairment. The Spearman-Brown prophecy estimate was 0.83 and Cronbach's alpha was 0.75. Principal component analysis identified two factors, which were labelled foundation and external. CONCLUSIONS: The GSGL tool is a valid tool to assess quality of life in older Aboriginal Australians. The tool demonstrates acceptable convergent, concurrent and known-groups validity. It was co-designed at all stages with older Aboriginal people contributing to its strong face and content validity.
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Aborigenas Australianos e Isleños del Estrecho de Torres , Salud Mental , Calidad de Vida , Anciano , Humanos , Australia , Aborigenas Australianos e Isleños del Estrecho de Torres/psicología , Calidad de Vida/psicología , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Psicometría , Competencia Cultural , Salud Mental/etnología , Salud Mental/estadística & datos numéricosRESUMEN
OBJECTIVES: To investigate whether diabetes and obesity are associated with frailty independently, and to determine the proportion of frailty cases attributable to each factor. STUDY DESIGN: Prospective cohort study of 4219 older men assessed in 2001-04 (time-point 1, T1), of whom 1939 were reassessed in 2008-09 (time-point 2, T2). Frailty was defined as positive responses on three or more of the five domains on the FRAIL scale: fatigue, difficulty climbing a flight of stairs (resistance), difficulty walking 100 m (ambulation), >5 illnesses, or >5% weight loss. We explored associations of diabetes and obesity with frailty using binary logistic regression, and estimated population attributable fractions for diabetes and obesity as risk factors for frailty. MAIN OUTCOME MEASURES: Associations of obesity and diabetes with frailty. RESULTS: At T1, 15.5% of participants (n = 652) were frail, 15.4% (n = 651) had diabetes, and 15.1% (n = 636) were obese (BMI ≥ 30 kg/m2). At T2, 22.9% (n = 444) were frail, 19.8% (n = 383) had diabetes and 9.1% (n = 176) were obese. In multivariable models, diabetes was associated with frailty at T1 (odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.7-2.6) and T2 (OR = 2.1, CI = 1.6-2.8). Obesity was associated with frailty at T1 (OR = 1.7, CI = 1.3-2.2) only. Both diabetes (OR = 1.5, CI = 1.1-2.2) and obesity (OR = 1.9, CI = 1.3-2.9) at T1 were independently associated with the development of frailty between T1 and T2. Approximately the same proportion (5%) of new frailty cases were attributable to diabetes or to obesity. CONCLUSIONS: Diabetes and obesity are modifiable risk factors which independently carry equal risk for the development of frailty in older men. Interventions targeting these risk factors may have the potential to reduce frailty risk.
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Diabetes Mellitus , Fragilidad , Anciano , Australia , Índice de Masa Corporal , Diabetes Mellitus/epidemiología , Anciano Frágil , Fragilidad/epidemiología , Humanos , Masculino , Obesidad/complicaciones , Obesidad/epidemiología , Estudios ProspectivosRESUMEN
The epidemiology of coronavirus disease 2019 in children has been challenging to establish, owing to the high prevalence of asymptomatic infection in this population. Lower secondary attack rates in children compared with adults have been observed in household contact studies, but there is evidence that this may reflect lower testing in children and reduced exposure, rather than a genuine difference in biological susceptibility. In addition, children may shed infectious virus for a shorter period than adults and their antibody response may be less broad, with implications for both polymerase chain reaction and serological testing. Improvements in study design, data collection, and data interpretation are required to better understand the epidemiology of coronavirus disease 2019 in children.
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COVID-19 , SARS-CoV-2 , Adulto , Infecciones Asintomáticas , Niño , Pruebas Diagnósticas de Rutina , Humanos , IncidenciaRESUMEN
OBJECTIVE: To offer a quantitative risk-benefit analysis of two doses of SARS-CoV-2 vaccination among adolescents in England. SETTING: England. DESIGN: Following the risk-benefit analysis methodology carried out by the US Centers for Disease Control, we calculated historical rates of hospital admission, Intensive Care Unit admission and death for ascertained SARS-CoV-2 cases in children aged 12-17 in England. We then used these rates alongside a range of estimates for incidence of long COVID, vaccine efficacy and vaccine-induced myocarditis, to estimate hospital and Intensive Care Unit admissions, deaths and cases of long COVID over a period of 16 weeks under assumptions of high and low case incidence. PARTICIPANTS: All 12-17 year olds with a record of confirmed SARS-CoV-2 infection in England between 1 July 2020 and 31 March 2021 using national linked electronic health records, accessed through the British Heart Foundation Data Science Centre. MAIN OUTCOME MEASURES: Hospitalisations, Intensive Care Unit admissions, deaths and cases of long COVID averted by vaccinating all 12-17 year olds in England over a 16-week period under different estimates of future case incidence. RESULTS: At high future case incidence of 1000/100,000 population/week over 16 weeks, vaccination could avert 4430 hospital admissions and 36 deaths over 16 weeks. At the low incidence of 50/100,000/week, vaccination could avert 70 hospital admissions and two deaths over 16 weeks. The benefit of vaccination in terms of hospitalisations in adolescents outweighs risks unless case rates are sustainably very low (below 30/100,000 teenagers/week). Benefit of vaccination exists at any case rate for the outcomes of death and long COVID, since neither have been associated with vaccination to date. CONCLUSIONS: Given the current (as at 15 September 2021) high case rates (680/100,000 population/week in 10-19 year olds) in England, our findings support vaccination of adolescents against SARS-CoV2.
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Vacunas contra la COVID-19 , COVID-19/prevención & control , Hospitalización , Unidades de Cuidados Intensivos , Salud Pública , Índice de Severidad de la Enfermedad , Vacunación , Adolescente , Salud del Adolescente , Factores de Edad , COVID-19/complicaciones , COVID-19/mortalidad , COVID-19/terapia , Vacunas contra la COVID-19/efectos adversos , Niño , Salud Infantil , Inglaterra , Femenino , Humanos , Incidencia , Masculino , Miocarditis/etiología , Riesgo , SARS-CoV-2 , Resultado del Tratamiento , Vacunación/efectos adversos , Síndrome Post Agudo de COVID-19RESUMEN
INTRODUCTION: Unpaid carers have a crucial role in supporting older people with cognitive impairment and disability, but their own health and wellbeing are often impacted. There are limited data on how carer strain, depression and empowerment may be improved for carers. METHODS: This was a cluster randomised controlled trial to compare the effect of a carer support program developed with a community-based participatory action research (PAR) approach to the delivery of information sessions to 100 carers of people aged 45 years or more living in four remote Aboriginal communities in Western Australia. RESULTS: The mean age of carers was 38.3±14.9 years, 76% were female and 77% were children or grandchildren of the care recipient. Carer strain and empowerment measures did not change significantly between baseline and follow-up. A statistically significant decrease in depression scores was observed in the PAR group. However, decreases were observed in both the PAR and control groups, and the change in scores did not differ significantly between groups. Depression scores decreased most in those who had not attended high school. Overall, the proportion of participants meeting criteria for depression decreased from 18.8% at baseline to 8.3% at follow-up. CONCLUSION: A carer support program was of equivocal benefit, although this research demonstrates that the wellbeing of carers in remote Aboriginal communities can potentially be markedly improved by outreach strategies.
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Cuidadores , Grupos de Población , Adulto , Anciano , Niño , Empoderamiento , Familia , Femenino , Humanos , Persona de Mediana Edad , Grupos Raciales , Adulto JovenAsunto(s)
Vacunas contra la COVID-19 , COVID-19 , Transmisión de Enfermedad Infecciosa , Política de Salud , Aceptación de la Atención de Salud , Salud Pública , Niño , Humanos , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19/administración & dosificación , Transmisión de Enfermedad Infecciosa/prevención & control , Pandemias/prevención & control , SARS-CoV-2 , Reino Unido/epidemiologíaAsunto(s)
COVID-19/prevención & control , COVID-19/transmisión , Microbiología del Aire , Australia , HumanosAsunto(s)
COVID-19 , Infecciones del Sistema Respiratorio , Niño , Humanos , SARS-CoV-2 , Instituciones AcadémicasRESUMEN
BACKGROUND: Pain is a growing public health problem associated with significant health and functional implications. Limited data exist for Aboriginal Australians. AIMS: To describe the prevalence, severity and sites of pain, analgesic use and associated factors, including depression and disability, in remote-living Aboriginal Australians. METHODS: Cross-sectional study of 263 Aboriginal Australians aged ≥45 years from six remote Indigenous communities and the town of Derby in the Kimberley region of Western Australia between 2011 and 2013. Pain was assessed using a culturally adapted pain scale. Factors associated with pain were investigated with binary logistic regression. RESULTS: One hundred and seventy (64.6%) participants reported having pain and 53 (20.2%) reported persistent pain. Of those reporting pain, 61 (35.9%) rated it as moderate and 70 (41.2%) as severe. The most common sites of pain were back and knee, and 38 (22.4%) participants with pain indicated three or more sites of pain. Only 70 (41.2%) participants with pain were on some type of analgesic medication. After adjustment, poor vision (odds ratio (OR) = 2.21; 95% confidence interval (CI) 1.22-4.00), hypertension (OR = 1.89; 95% CI 1.03-3.45) and heart problems (OR = 2.05; 95% CI 1.01-4.14) were associated with pain. Higher depression scores were associated with more persistent pain, but pain was not significantly associated with clinically relevant depressive symptoms, or requiring assistance with two or more personal and/or instrumental activities of daily living. CONCLUSION: High levels of pain were reported, although the prevalence of persistent pain was comparable to the general population. Identifying risk factors, improving pain recognition and assessment and evaluating culturally tailored management approaches should be a priority.
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Depresión , Nativos de Hawái y Otras Islas del Pacífico , Actividades Cotidianas , Australia/epidemiología , Estudios Transversales , Depresión/epidemiología , Humanos , Dolor/diagnóstico , Dolor/epidemiología , PrevalenciaRESUMEN
Objective: To describe demographic features and well-being of carers of Aboriginal Australians aged ≥45 years in remote Western Australia. Method: Carer burden, empowerment, and depression were assessed in 124 Aboriginal carers in four remote Aboriginal communities. Results: Carers were aged 38.8 ± 15.0 years, 73.4% were female, and 75.8% were children or grandchildren of the person cared for. The mean Zarit-6 score was 3.7 ± 3.6. Attending high school (odds ratio [OR] = 0.3; 95% confidence interval [CI] = [0.1, 0.7]) and feeling empowered (OR = 0.2; 95% CI = [0.1, 0.8]) were inversely associated with carer burden; female carers were less likely to feel empowered (OR = 0.4; 95% CI = [0.2, 0.9]); and empowerment was inversely associated with depression (OR = 0.3; 95% CI = [0.1, 0.7]). Discussion: Aboriginal carers in remote communities are relatively young and most are children or grandchildren. Carer burden was lower than anticipated. However, existing tools may not adequately measure Aboriginal perspectives. Education and empowerment are key factors which support programs must consider.