The future burden of oesophageal and stomach cancers attributable to modifiable behaviours in Australia: a pooled cohort study.

BACKGROUND: We quantified the individual and joint contribution of contemporaneous causal behavioural exposures on the future burden of oesophageal and stomach cancers and their subtypes and assessed whether these burdens differ between population groups in Australia, as such estimates are currently lacking. METHODS: We combined hazard ratios from seven pooled Australian cohorts (N = 367,058) linked to national cancer and death registries with exposure prevalence from the 2017-2018 National Health Survey to estimate Population Attributable Fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death. RESULTS: Current and past smoking explain 35.2% (95% CI = 11.7-52.4%), current alcohol consumption exceeding three drinks/day 15.7% (95% CI = 0.9-28.4%), and these exposures jointly 41.4% (95% CI = 19.8-57.3%) of oesophageal squamous cell carcinomas in Australia. Current and past smoking contribute 38.2% (95% CI = 9.4-57.9%), obesity 27.0% (95% CI = 0.6-46.4%), and these exposures jointly 54.4% (95% CI = 25.3-72.1%) of oesophageal adenocarcinomas. Overweight and obesity explain 36.1% (95% CI = 9.1-55.1%), current and past smoking 24.2% (95% CI = 4.2-40.0%), and these exposures jointly 51.2% (95% CI = 26.3-67.8%) of stomach cardia cancers. Several population groups had a significantly higher smoking-attributable oesophageal cancer burden, including men and those consuming excessive alcohol. CONCLUSIONS: Smoking is the leading preventable behavioural cause of oesophageal cancers and overweight/obesity of stomach cancers.

A longitudinal analysis of factors associated with age-related cataract among older Australian women: a cohort study of 7851 older Australian women 79-90 years.

BACKGROUND: Age-related cataracts are a significant global health issue due to population ageing. More than 70% of older Australians aged 80 or above have clinically significant age-related cataracts. AIM: The study aimed to identify factors associated with age-related cataracts among older Australian women 79-90 years. METHOD: A 6-year longitudinal analysis of the Australian Longitudinal Study on Women's Health (ALSWH) was conducted on 7117 women from surveys four to six. The women were asked whether they had been diagnosed or treated for cataracts 3 years before each survey. We used generalised estimating equation (GEE) modelling to identify factors independently associated with age-related cataracts. RESULTS: At baseline (79-84 years), 44.8% lived in metropolitan Australia, 67.9% had good general health, 26.5% had private health insurance, 30.6% had cataracts, 28.8% had undergone cataract surgery, 12.0% had diabetes, 24.9% had skin cancer, 56.2% had hypertension, 24.0% had a history of falls, 63.0% had visited general practitioner (GP) frequently, and 48.8% were driving themselves as their main means of transport. In the final model, poor general health [adjusted odds ratio (AOR) = 1.23, 95% CI = 1.14, 1.33)], not driving (AOR = 1.09, 95% CI = 1.01, 1.18), having private health insurance (AOR = 1.13, 95% CI = 1.04, 1.23), frequent GP visits (AOR = 1.16, 95% CI = 1.07, 1.25), skin cancer (AOR = 1.26, 95% CI = 1.16, 1.37), hypertension (AOR = 1.13, 95% CI = 1.05, 1.21), and fall (AOR = 1.12, 95% CI = 1.04, 1.22) were significantly associated with the age-related cataracts. CONCLUSIONS: Systemic diseases, poor quality of life, driving cessation, and health service use were significantly associated with age-related cataracts in older women.

Transitions in health service use among women with poor mental health: a 7-year follow-up.

OBJECTIVE: Women suffering from mental health problems require varied needs of mental health service utilisation. Transition between general practitioner and mental health services use are available through the Better Access Scheme initiative, for those in need of treatment. The study's aim was to identify trajectories of mental health service utilisation by Australian women. DESIGN: The Australian Longitudinal Study on Women's Health data linked to the administrative medical claims dataset were used to identify subgroups of women profiled by their mental health service use from 2006 to 2013. Latent growth mixture model is a statistical method to profile subgroups of individuals based on their responses to a set of observed variables allowing for changes over time. Latent class groups were identified, and used to examine predisposing factors associated with patterns of mental health service use change over time. SETTING: This study was conducted in Australia. PARTICIPANTS: National representative sample of women of born in 1973-1978, who were aged between 28 and 33 years at the start of our study period. RESULTS: Six latent class trajectories of women's mental health service use were identified over the period 2006-2013. Approximately, one-quarter of the sample were classified as the most recent users, while approximate equal proportions were identified as either early users, late/low user or late-high users. Additional, subgroups were defined as the consistent-reduced user and the late-high users, over time. Only 7.2% of the sample was classified as consistent high users who potentially used the services each year. CONCLUSION: These findings suggest that use of the Better Access Scheme mental health services through primary care was varied over time and may be tailored to each individual's needs for the treatment of depressive symptoms.

Onset and progression of chronic disease and disability in a large cohort of older Australian women.

OBJECTIVE: To estimate the probability of onset and progression of disease and disability, length of life with or without disease and/or disability, and incidence of mortality, and to identify factors associated with transitioning to disease and/or disability over time. STUDY DESIGN: A prospective cohort study. Data were provided by 12,432 participants (born 1921-26) of the Australian Longitudinal Study of Women's Health linked with National Death Index data from 1996 (age: 70-75) to 2016 (age: 90-95). MAIN OUTCOME MEASURES: A five-state Markov model was fitted to estimate the transition probability, length of life with or without disease and/or disability, and the association between baseline characteristics and disease/disability/mortality risk. RESULTS: Over two-thirds of women had died by age 90-95, and only 3.8% of these had died with no chronic disease and disability. Those reporting chronic disease were more likely to have experienced disability (Transition Rate Ratio: 2•72, 95%CI= 2•52-2•93) than those who died without disability. At age 70-75, the expected life without chronic disease and disability was 7•68 (95%CI: 7•52-7•80) years, life with chronic disease but no disability was 4•39 (95%CI=4•23-4•49) years, and life with disability was 3.76 (95%CI=3•66-3•92) years. The factors difficulties managing on available income (HR=1•18, 95%CI=1•02-1•38), did not complete secondary school (HR=1•19, 95%CI=1•03-1•37), and overweight/obese (HR=1•36, 95%CI=1•20-1•55) were associated with an increased risk of disability. CONCLUSIONS: Our findings provide important insights on the onset and progression of disease and disability in older women, underscoring the importance of addressing mid-/early old-life risk factors, managing chronic conditions, and delaying disability onset and progression through targeted intervention programs.

Determinants of driving among oldest-old Australian women.

This study examined predictors of driving among oldest-old Australian women in their late 80s in accordance with the World Health Organization's healthy aging framework. The study used data from the 1921-26 cohort of the Australian Longitudinal Study on Women's Health, wave-6 (n = 4025). The result of the multivariable logistic regression showed providing care, living alone, volunteering, living in rural/outer regional Australia, having higher educational attainment, and social interactions were associated with driving. The findings indicate driving should not be dismissed based on age alone. Policymakers need to also consider social roles, driving environment and context with the goals of healthy aging.

Medications use among women with dementia: a cohort study.

BACKGROUND: Older population with dementia use huge range of medications. In this study, we aimed to determine the prevalence of commonly used medications a year before and after first recorded dementia diagnosis among older Australian women. METHODS: The study utilized Australian Longitudinal Study on Women's Health (ALSWH) data from 2090 women with known dementia, linked with administrative health datasets. The Pharmaceutical Benefits Scheme (PBS) data provided detailed information about prescribed medications. We applied latent class analysis (LCA) to the post-dementia data to identify patterns of medication use. Logistic regression model was used to explore the impact of potential predictors for medication utilization. RESULTS: Antipsychotic use increased from 5% before dementia to 19% after dementia, while antidementia medication use increased from < 1 to 28%. There was a modest increase in benzodiazepines and antidepressants. Post-dementia, four distinct groups were identified using LCA (names based on probabilities of medications use) as: "High Psychotropic-Low Cardiovascular" (16% of the sample); "Moderate Psychotropic-High Cardiovascular" (12%); "Low Psychotropic-High Cardiovascular" (27%); and "Low Psychotropic-Low Cardiovascular" (45%). Living in Residential Aged Care (RAC) and frailty were associated with increased odds of being in the higher psychotropic use groups. CONCLUSIONS: Substantial utilization of psychotropic medications by older people with dementia indicates a need for a careful review of the use of these medications. Appropriate alternative approaches to the management of dementia should be practiced with a special focus on RAC residents with frailty.

Validation of a residential aged care consumer experience survey, 2019.

OBJECTIVE: Residential aged care (RAC) quality is often measured as part of regulatory compliance. To inform care delivery and service improvements, we developed a consumer experience survey. METHODS: Validation study incorporating 2018-2019 survey data (n = 1504 individuals, 25 RAC homes) and test-retest reliability evaluation. RESULTS: Most of the respondents were women (67%) with 38% of the surveys completed by residents, 39% with staff support, and 23% by family members. Moderate-to-high correlations (0.46-0.84) between individual items indicate the survey is a coherent measure of satisfaction; good inter-item correlation was found across all sections (0.61-0.70) with high internal consistency (Cronbach's alpha 0.90-0.94); and moderate correlation for test-retest reliability was found on the same individual when providing an overall recommendation score (individual ICC 0.684). CONCLUSIONS: The RAC Consumer Experience Survey is a validated measure of lived experience and satisfaction that aligns closely with the Australian Aged Care Quality Standards, affording providers a standardised tool for benchmarking and informing care quality across the sector.

Thyroid cancers potentially preventable by reducing overweight and obesity in Australia: A pooled cohort study.

Thyroid cancer incidence and the prevalence of overweight and obesity are increasing, but the future thyroid cancer burden attributable to contemporary levels of overweight and obesity has not been evaluated before. We quantified this burden in Australia, and assessed whether the overweight/obesity-attributable burden differed by sex or other population subgroupings. We estimated the strength of the associations of overweight and obesity with thyroid cancer with adjusted proportional hazards models using pooled data from seven Australian cohorts (N = 367 058) with 431 thyroid cancer cases ascertained from linked national cancer registry data during a maximum 22-year follow-up. We combined these estimates with nationally representative 2017 to 2018 estimates of overweight and obesity prevalence to estimate population attributable fractions (PAFs) of future thyroid cancers attributable to overweight and obesity, accounting for competing risk of death, and compared PAFs for population subgroups. Contemporary levels of overweight and obesity explain 18.6% (95% confidence interval [CI] = 5.2%-30.2%), and obesity alone 13.7% (95% CI: 5.2%-21.4%), of the future thyroid cancer burden. The obesity-attributable thyroid cancer burden is 21.4% (95% CI: 2.8%-36.5%) for men and 10.1% (95% CI: 0.8%-18.6%) for women. Were the currently obese overweight instead, 9.9% (95% CI: 1.0%-18.1%) of thyroid cancers could be avoided. The relative overweight/obesity-attributable burden is higher for those consuming on average more than two alcoholic drinks per day (63.4%) and for those who are not married/co-habiting (33.2%). In conclusion, avoiding excess weight, especially obesity, should be a priority for thyroid cancer prevention. Further studies, with findings stratified by tumour size, may reveal the potential role of overdiagnosis in our results.

Housing and Care for Older Women in Australia.

Background: Housing is essential for healthy ageing, being a source of shelter, purpose, and identity. As people age, and with diminishing physical and mental capacity, they become increasingly dependent on external supports from others and from their environment. In this paper we look at changes in housing across later life, with a focus on the relationship between housing and women's care needs. Methods: Data from 12,432 women in the 1921-26 cohort of the Australian Longitudinal Study on Women's Health were used to examine the interaction between housing and aged care service use across later life. Results: We found that there were no differences in access to home and community care according to housing type, but women living in an apartment and those in a retirement village/hostel were more likely to have an aged care assessment and had a faster rate of admission to institutional residential aged care than women living in a house. The odds of having an aged care assessment were also higher if women were older at baseline, required help with daily activities, reported a fall, were admitted to hospital in the last 12 months, had been diagnosed or treated for a stroke in the last 3 years, or had multiple comorbidities. On average, women received few services in the 24 months prior to admission to institutional residential aged care, indicating a potential need to improve the reach of these services. Discussion: We find that coincident with changes in functional capacities and abilities, women make changes to their housing, sometimes moving from a house to an apartment, or to a village. For some, increasing needs in later life are associated with the need to move from the community into institutional residential aged care. However, before moving into care, many women will use community services and these may in turn delay the need to leave their homes and move to an institutional setting. We identify a need to increase the use of community services to delay the admission to institutional residential aged care.

The Future Burden of Head and Neck Cancers Attributable to Modifiable Behaviors in Australia: A Pooled Cohort Study.

BACKGROUND: Estimates of future burden of cancer attributable to current modifiable causal exposures can guide cancer prevention. We quantified future head and neck cancer burden in Australia attributable to individual and joint causal exposures, and assessed whether these burdens differ between population subgroups. METHODS: We estimated the strength of the associations between exposures and head and neck cancer using adjusted proportional hazards models from pooled data from seven Australian cohorts (N = 367,058) linked to national cancer and death registries and estimated exposure prevalence from the 2017 to 2018 Australian National Health Survey. We calculated population attributable fractions (PAF) with 95% confidence intervals (CI), accounting for competing risk of death, and compared PAFs for population subgroups. RESULTS: Contemporary levels of current and former smoking contribute 30.6% (95% CI, 22.7%-37.8%), alcohol consumption exceeding two standard drinks per day 12.9% (95% CI, 7.6%-17.9%), and these exposures jointly 38.5% (95% CI, 31.1%-45.0%) to the future head and neck cancer burden. Alcohol-attributable burden is triple and smoking-attributable burden is double for men compared with women. Smoking-attributable burden is also at least double for those consuming more than two alcoholic drinks daily or doing less than 150 minutes of moderate or 75 minutes of vigorous activity weekly, and for those aged under 65 years, unmarried, with low or intermediate educational attainment or lower socioeconomic status, compared with their counterparts. CONCLUSIONS: Two-fifths of head and neck cancers in Australia are preventable by investment in tobacco and alcohol control. IMPACT: Targeting men and other identified high-burden subgroups can help to reduce head and neck cancer burden disparities.

The Joint Effects of Diet and Dietary Supplements in Relation to Obesity and Cardiovascular Disease over a 10-Year Follow-Up: A Longitudinal Study of 69,990 Participants in Australia.

It is unknown whether a healthy diet or unhealthy diet combined with specific supplements may jointly contribute to incidence of obesity and cardiovascular disease (CVD). We included 69,990 participants from the 45 and Up Study who completed both baseline (2006-2009) and follow-up (2012-2015) surveys. We found that compared to participants with a long-term healthy diet and no supplement consumption, those with a long-term healthy diet combined with multivitamins and minerals (MVM) or fish oil consumption were associated with a lower incidence of CVD (p < 0.001); whilst those with an unhealthy diet and no MVM or fish oil consumption were associated with a higher risk of obesity (p < 0.05). Compared to participants with a long-term healthy diet and no calcium consumption, the combination of a long-term healthy diet and calcium consumption was linked to a lower risk of CVD (IRR = 0.87, 95% CI: 0.78; 0.96). In conclusion, a long-term healthy diet combined with MVM or fish oil was associated with a lower incidence of CVD. Participants who maintained a healthy diet and used calcium supplements were associated with a lower incidence of obesity. However, these associations were not found among those with an unhealthy diet, despite taking similar supplements.

Estimating the effect of health assessments on mortality, physical functioning and health care utilisation for women aged 75 years and older.

Health assessments have potential to improve health of older people. This study compares long-term health care utilisation, physical functioning, and mortality for women aged 75 years or over who have had a health assessment and those who have not. Prospective data on health service use, physical functioning, and deaths among a large cohort of women born 1921-26 were analysed. Propensity score matching was used to produce comparable groups of women according to whether they had a health assessment or not. The study population included 6128 (67.3%) women who had an assessment, and 2971 (32.7%) women who had no assessment. Propensity matching produced 2101 pairs. Women who had an assessment had more use of other health services, longer survival, and were more likely to survive with high physical functioning compared to women with no assessment. Among women who had good baseline physcial functioning scores, women who had an assessment had significantly lower odds of poor outcomes at 1000 days follow-up compared to women who had no assessment (OR: 0.67, 95%CI: 0.52, 0.85). This large observational study shows the real-world potential for assessments to improve health outcomes for older women. However, they also increased health service use. This increased healthcare is likely to be an important mechanism in improving the women's health outcomes.

Utility estimations of health states of older Australian women with atrial fibrillation using SF-6D.

PURPOSE: To estimate SF-6D utility scores for older women with atrial fibrillation (AF); calculate and compare mean utility scores for women with AF with various demographic, health behaviours, and clinical characteristics; and develop a multivariable regression model to determine factors associated with SF-6D utility scores. METHODS: This study evaluated N = 1432 women diagnosed with AF from 2000 to 2015 of the old cohort (born 1921-26) of the Australian Longitudinal Study on Women's Health (ALSWH) who remained alive for at least 12 months post first recorded AF diagnosis. Self-reported data on demographics, health behaviours, health conditions, and SF-36 were obtained from the ALSWH surveys, corresponding to within three years of the date of the first record of AF diagnosis. Linked Pharmaceutical Benefits Scheme (PBS) data determined the use of oral anticoagulants and comorbid conditions, included in CHA2DS2-VA (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, Stroke or TIA, Vascular disease and Age 65-74 years) score calculation, were assessed using state-based hospital admissions data. Utility scores were calculated for every woman from their SF-36 responses using the SF-6D algorithm with Australian population norms. Mean utility scores were then calculated for women with various demographic, health behaviours, and clinical characteristics. Ordinary Least Square (OLS) regression modelling was performed to determine factors associated with these utility scores. Two different scenarios were used for the analysis: (1) complete-case, for women with complete data on all the SF-36 items required to estimate SF-6D (N = 584 women), and (2) Multiple Imputation (MI) for missing data, applied to missing values on SF-36 items (N = 1432 women). MI scenario was included to gauge the potential bias when using complete data only. RESULTS: The mean health utility was estimated to be 0.638 ± 0.119 for the complete dataset and 0.642 ± 0.120 for the dataset where missing values were handled using MI. Using the MI technique, living in regional and remote areas ([Formula: see text]) and the use of oral anticoagulants ([Formula: see text] were positively associated with health utility compared to living in major cities and no use of anticoagulants, respectively. Difficulty to manage on available income [Formula: see text], no/low physical activity [Formula: see text], disability [Formula: see text], history of stroke ([Formula: see text] and history of arthritis [Formula: see text] were negatively associated with health utility. CONCLUSION: This study presents health utility estimates for older women with AF. These estimates can be used in future clinical and economic research. The study also highlights better health utilities for women living in regional and remote areas, which requires further exploration.

BMI trajectory and subsequent risk of type 2 diabetes among middle-aged women.

BACKGROUND AND AIMS: Little is known about how weight trajectories among women during menopausal transition and beyond may be related to risk of type 2 diabetes mellitus (T2DM). The aim of this study was to examine associations between body mass index (BMI) trajectories over 20 years, age of obesity onset, cumulative obese-years and incidence of T2DM among middle-aged women. METHODS AND RESULTS: 12,302 women enrolled in the Australian Longitudinal Study on Women's Health (ALSWH) were surveyed in 1996 (Survey 1, age 45-50), 1998 and then every three years to 2016. Self-reported weight and height were collected for up to eight time points. Incident diabetes was assessed via validated self-report of physician-diagnosed diabetes. Growth mixture models were used to identify distinct BMI trajectories. A total of 1380 (11.2%) women newly developed T2DM over an average 16 years of follow-up. Seven distinct BMI trajectories were identified with differential risk of developing T2DM. Initial BMI was positively associated with T2DM risk. We also observed that risk of T2DM was positively associated with rapid weight increase, early age of obesity onset and greater obese-years. CONCLUSION: Slowing down weight increases, delaying the onset of obesity, or reducing cumulative exposure to obesity may substantially lower the risk of developing T2DM.

Exposure to heavy metals from point pollution sources and risk of incident type 2 diabetes among women: a prospective cohort analysis.

Heavy metal exposures may contribute to diabetes risk but prospective studies are uncommon. We analyzed the Australian Longitudinal Study on Women's Health (three cohorts aged 18-23, 45-50, or 70-75 at baseline in 1996, N = 34,191) merged with emissions data for 10 heavy metals (As, Be, Co, Cr, Cu, Hg, Mn, Ni, Pb, Zn) from the National Pollutant Inventory. Over 20-year follow-up, 2,584 women (7.6%) reported incident diabetes. Cox proportional hazards regression models showed that women aged 45-50 at baseline had higher diabetes risk in association with exposure to total air emissions, total water emissions, all individual metals air emissions, and six individual water emissions. After correction for false discovery rate, nine of 11 air emissions and five water emissions remained significant. Associations were not observed for land-based emissions, or for younger or older cohorts. Emissions were dominated by mining, electricity generation and other metals-related industrial processes.

Polypharmacy trajectories among older women with and without dementia: A longitudinal cohort study.

Background: Although multiple medications are often utilized to achieve optimal treatment outcomes, polypharmacy (use of five or more medications) among older population is associated with several detrimental effects. Trajectories of polypharmacy among older population over time has not been described. Objective: This study estimated polypharmacy prevalence and clusters of individuals with similar patterns of change in polypharmacy among a cohort of older Australian women with and without dementia. Method: Longitudinal prospective cohort data from the oldest birth cohort (1921-1926) of the Australian Longitudinal Study on women's Health (ALSWH) were analysed. Survey data were linked with Pharmaceutical Benefit Schemes (PBS) data to obtain information about the type and number of prescription medications for each year 2003-2015. Group based trajectory modelling was used to identify distinct trajectory groups, based on the presence of polypharmacy for each year of observation. Trajectories were named based on distinctive and meaningful subgroups that followed approximately the same developmental course and probability assignment rule. Generalized estimating equation was used to identify factors associated with polypharmacy. Results: A total of 10,372 women were eligible for the inclusion in the study. Prevalence of polypharmacy increased over time and reached as high as 71.19% and 71.29% in 2014 for women with and without dementia, respectively. Four distinct polypharmacy trajectories were identified: 'Consistent Polypharmacy' (55.88%);'Low Polypharmacy' (24.52%); 'Rapid Increasing Polypharmacy' (12.50%); and 'Moderate Polypharmacy' (7.12%). Dementia, Residential Aged Care (RAC), frailty and comorbid condition were the key drivers of polypharmacy in this cohort. Conclusion: The prevalence of polypharmacy among older women increased over time, with most women have a pattern of consistent polypharmacy or rapidly increasing polypharmacy. Appropriate, sustainable, and effective strategies for reducing medication use should be implemented for women as they age, and particularly for those with dementia and those in residential care.

Impact of Diabetes on Life and Healthy Life Expectancy Among Older Women.

BACKGROUND: Diabetes is a major chronic condition with ever-increasing health and economic burden. This study aimed to measure the impact of diabetes on total life expectancy (TLE) and healthy life expectancy (HLE) at ages 70 and 80 and to assess how educational level, obesity, and comorbidity affected the expectancies. METHODS: The study involved 9849 population-representative women born between 1921 and 1926 from the Australian Longitudinal Study on Women's Health (ALSWH). Self-rated health was obtained from the ALSWH surveys. Diabetes diagnosis was ascertained using survey and health care administrative data. Total life expectancy and HLE were estimated for women with and without diabetes using multistate modeling. RESULTS: Diabetes was associated with an increased risk of poor health (adjusted risk ratio: 1.63, 95% confidence interval: 1.49-1.79). Diabetes was also associated with a reduction of 0.9 years in HLE and 2.6 years in TLE at age 70 and 0.4 years in HLE and 1.3 years in TLE at age 80. If a woman had low education, obesity, and more than 2 comorbidities in addition to diabetes, these reductions increased to 3.0 years in TLE and 7.9 years in HLE at age 70 and 1.5 years in TLE and 3.8 years in HLE at age 80. CONCLUSIONS: Diabetes substantially reduced older women's quantity and quality of life, with further reductions for those with lower education, obesity, and comorbidities. These findings underscore the importance of optimally managing diabetes by maintaining a healthy weight and delaying the onset of comorbidities, to promote healthy aging for older women with diabetes.

Patterns of Medications for Atrial Fibrillation Among Older Women: Results From the Australian Longitudinal Study on Women's Health.

PURPOSE: Examine patterns of medication use, changes in medication patterns over time, and investigate factors associated with medication patterns among older Australian women with Atrial Fibrillation (AF). METHODS: It is a retrospective analysis of the 1921-26 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH), diagnosed with AF between 2000-2015 (N = 1206). Survey data of these women was linked with national registries for medications and death. Latent Transition Analysis (LTA) identified distinct patterns of medication use and transitions among these patterns for 3 consecutive years following AF diagnosis. LTA with co-variates determined the factors associated with latent status membership. RESULTS: One-tenth (9.6%, 11.7%, 11.4%) of the study population did not receive any medication for AF in all 3 years following AF diagnosis and about 60% did not receive any medication for the prevention of thromboembolism. Among those who received medications, almost three-quarters (76.6%, 68.4%, 68.5%) received some kind of combination of medications. LTA indicated at least 6 different patterns of AF medications. These patterns had transition probabilities >85% for most of the latent statuses. All factors but diabetes mellitus among the CHA2DS2-VA scoring scheme were independently associated with latent status membership at the time of AF diagnosis. CONCLUSIONS: Evaluation of pharmacological treatment indicates that prevention of thromboembolism is inadequate among women with AF. There exists wide variations in medication patterns. However, once in a particular pattern, women are likely to continue the same medications long-term. This underscores the importance of initial assessment of patient profile and stroke risk score in determining the treatment for AF. Failure to assess risk makes women susceptible to devastating AF complications.

Use of medication reviews among older women with dementia, 2003-2015: A longitudinal cohort study.

OBJECTIVE: To identify factors associated with incidence of medication reviews (MRs), particularly in women with dementia and in residential aged care (RAC). METHODS: Data from 10 359 women in the 1921-1926 cohort of the Australian Longitudinal Study on Women's Health were linked to Medicare Benefits Schedule data to identify MRs for each year from 2003 to 2015. RESULTS: Incidence of MR increased from 2003 to 2013 (age 87-92 years) when 37.1% of women with dementia had a MR compared to 19.8% of women without dementia. Adjusting for time and other factors, the odds of having a MR were higher for women with dementia (AOR = 1.18, 95% CI: 1.06-1.32) and women in RAC (AOR = 3.61, 95% CI: 3.28-3.98). CONCLUSIONS: Although higher in women with dementia and those in RAC, utilisation of MR was modest. System-level interventions may be required to ensure the use and benefits of MRs.