A Longitudinal Study of the Use and Effects of Fall-Risk-Increasing Drugs in Residential Aged Care.

OBJECTIVES: Fall-risk-increasing drugs (FRIDs)-psychotropics and cardiovascular disease (CVD) drugs-may elevate the risk of falling, with strong evidence observed in psychotropic FRIDs, whereas findings from cardiovascular disease (CVD) FRIDs remain inconclusive. Existing studies on FRIDs and falls are often hampered by methodologic limitations. Leveraging longitudinal observational data, we aimed to determine the long-term patterns of FRID use and their association with falls in residential aged care (RAC) homes. DESIGN: A retrospective longitudinal cohort study. SETTING AND PARTICIPANTS: A total of 4207 permanent residents newly admitted to 27 RAC homes in Sydney, Australia. METHOD: The outcomes were incidence of all and injurious falls. We measured exposure to each FRID over 60 months using the Proportion of Days Covered (PDC) metric. We used group-based multitrajectory modeling to determine concurrent usage patterns of psychotropics and CVD FRIDs and applied negative binomial regression to assess their associations with the outcomes. RESULTS: A total of 83.6% (n = 3516) and 77.3% (n = 3254) residents used psychotropic and CVD FRIDs, respectively. The PDC values ranged from 67.3% (opioids) to 86.9% (antidepressants) for specific psychotropics and 79.0% (α-adrenoceptor antagonists) to 89.6% (ß blockers) for CVD FRIDs. We identified 4 groups: group 1, low psychotropics-low CVDs use (16.7%, n = 701); group 2, low psychotropics-high CVDs (25.0%, n = 1054); group 3, high psychotropics-high CVDs (41.0%, n = 1723); and group 4, high psychotropics-low CVDs (17.3%, n = 729). Group 4 had a significantly higher rate of falls than the other groups for both outcomes, including relative to group 3, in which exposure to both FRID classes was high. CONCLUSIONS AND IMPLICATIONS: Our findings reveal concerningly high FRID use in RAC homes and highlight a critical difference in the impact of the 2 major FRID classes on falls. Psychotropics were strongly associated with falls, whereas the studied CVD FRIDs did not elevate risk of falling.

The relationship between participation in leisure activities and incidence of falls in residential aged care.

BACKGROUND: Active engagement in leisure activities has positive effects on individuals' health outcomes and social functioning; however, there is limited understanding of the link between participation in leisure activities, particularly non-exercise activities, and falls in older adults. This study aimed to determine the relationship between participation in leisure activities and the incidence of falls, and the variation of this relationship by dementia status in residential aged care facilities (RACFs). METHODS: A retrospective longitudinal cohort study utilising routinely collected data (January 2021-August 2022) from 25 RACFs in Sydney, Australia, was conducted. The cohort included 3,024 older permanent residents (1,493 with dementia and 1,531 without) aged ≥65 and with a stay of ≥1 week. The level of participation in leisure activities was measured using the number of leisure activities per 1,000 resident days and divided into quartiles. Outcome measures were the incidence rate of all falls and injurious falls (i.e., number of falls per 1,000 resident days). We used multilevel negative binary regression to examine the relationship between leisure participation and fall incidence. RESULTS: For the whole sample, leisure participation was significantly inversely associated with the incidence rate of all falls and injurious falls. For example, residents in the high leisure participation group were 26% less likely to experience a fall compared to those in the low leisure participation group after controlling for confounders (incidence rate ratio = 0.74, 95% confidence interval = 0.60, 0.91). Such inverse relationship was observed in both exercise and non-exercise activities and was stronger among residents without dementia. CONCLUSIONS: Leisure participation is associated with a lower rate of falls, a key quality indicator by which RACFs are benchmarked and funded in Australia and many other countries. More recognition and attention are needed for the currently underfunded leisure activities in RACFs in future funding arrangement.

Development and internal validation of a dynamic fall risk prediction and monitoring tool in aged care using routinely collected electronic health data: a landmarking approach.

OBJECTIVES: Falls pose a significant challenge in residential aged care facilities (RACFs). Existing falls prediction tools perform poorly and fail to capture evolving risk factors. We aimed to develop and internally validate dynamic fall risk prediction models and create point-based scoring systems for residents with and without dementia. MATERIALS AND METHODS: A longitudinal cohort study using electronic data from 27 RACFs in Sydney, Australia. The study included 5492 permanent residents, with a 70%-30% split for training and validation. The outcome measure was the incidence of falls. We tracked residents for 60 months, using monthly landmarks with 1-month prediction windows. We employed landmarking dynamic prediction for model development, a time-dependent area under receiver operating characteristics curve (AUROCC) for model evaluations, and a regression coefficient approach to create point-based scoring systems. RESULTS: The model identified 15 independent predictors of falls in dementia and 12 in nondementia cohorts. Falls history was the key predictor of subsequent falls in both dementia (HR 4.75, 95% CI, 4.45-5.06) and nondementia cohorts (HR 4.20, 95% CI, 3.87-4.57). The AUROCC across landmarks ranged from 0.67 to 0.87 for dementia and from 0.66 to 0.86 for nondementia cohorts but generally remained between 0.75 and 0.85 in both cohorts. The total point risk score ranged from -2 to 57 for dementia and 0 to 52 for nondementia cohorts. DISCUSSION: Our novel risk prediction models and scoring systems provide timely person-centered information for continuous monitoring of fall risk in RACFs. CONCLUSION: Embedding these tools within electronic health records could facilitate the implementation of targeted proactive interventions to prevent falls.

Hospitalisations before and after entry into a residential aged care facility: An interrupted time series analysis.

OBJECTIVE: Hospitalisations are an important indicator of safety and quality of care in residential aged care facilities (RACFs). This study aimed to investigate changes in hospital use 12 months before and 12 months after RACF entry using routinely collected data from 25 Australian RACFs. METHODS: This was a retrospective longitudinal cohort study using linked aged care provider and hospital record data. The sample comprised 1029 residents living in an aged care facility between July 2014 and December 2019 who had stayed a minimum of 12 months in an RACF. The outcome measures were all-cause hospitalisations and fall-related hospitalisations. We applied an interrupted time series analysis using segmented regression to examine changes in both outcome measures over time. Stratified analyses were conducted by gender and dementia status. RESULTS: The rate of all-cause hospitalisations increased dramatically over the 12 months before RACF entry, from 97 per 1000 residents per month 12 months prior to RACF admission to 303 per 1000 residents at the second month prior to RACF entry. All-cause hospitalisations then decreased considerably to 55 per 1000 residents upon RACF admission and stabilised across the next 12 months. Such trajectories were also observed in fall-related hospitalisations and were consistent for gender and dementia status. CONCLUSIONS: In this study, hospitalisation rates decreased significantly after RACF entry, and such reductions were maintained for residents who stayed for 12 months in RACFs. Multiple hospital admissions are likely to precipitate entry into RACF. Additional investigation of how community-based services can be successful in reducing the escalating hospitalisations is needed.

Changing impact of COVID-19 on life expectancy 2019-2023 and its decomposition: Findings from 27 countries.

Background: The World Health Organization declared COVID-19 no longer a global health emergency on 5th May 2023; however, the impact of COVID-19 on life expectancy throughout the pandemic period is not clear. This study aimed to quantify and decompose the changes in life expectancy during 2019-2023 and corresponding age and gender disparities in 27 countries. Methods: Data were sourced from the Human Mortality Database, the World Population Prospects 2022 and the United Kingdom's Office for National Statistics. Life expectancy was estimated using the abridged life table method, while differentials of life expectancies were decomposed using the age-decomposition algorithm. Results: There was an overall reduction in life expectancy at age 5 among the 27 countries in 2020. Life expectancy rebounded in Western, Northern and Southern Europe in 2021 but further decreased in the United States, Chile and Eastern Europe in the same year. In 2022 and after, lost life expectancy years in the United States, Chile and Eastern Europe were slowly regained; however, as of 7th May 2023, life expectancy in 22 of the 27 countries had not fully recovered to its pre-pandemic level. The reduced life expectancy in 2020 was mainly driven by reduced life expectancy at age 65+, while that in subsequent years was mainly driven by reduced life expectancy at age 45-74. Women experienced a lower reduction in life expectancy at most ages but a greater reduction at age 85+. Conclusions: The pandemic has caused substantial short-term mortality variations during 2019-2023 in the 27 countries studied. Although most of the 27 countries experienced increased life expectancy after 2022, life expectancy in 22 countries still has not entirely regained its pre-pandemic level by May 2023. Threats of COVID-19 are more prominent for older adults and men, but special attention is needed for women aged 85+ years.

Innovative approaches to analysing aged care falls incident data: international classification for patient safety and correspondence analysis.

Falls in residential aged care facilities (RACFs) are common and can have significant health consequences. Understanding how and why falls occur in RACFs is an essential step to design targeted fall prevention and intervention programmes; however, little is known about falls' mechanisms in RACFs. This study aims to use international incident classification systems and novel analysis techniques to describe factors that contribute to falls requiring hospitalization in RACFs. Retrospective data of falls assessed by nurses as requiring hospitalization from 429 residents in 22 Australian RACFs in 2019 were used. Data were reviewed using a modified version of the International Classification for Patient Safety (ICPS), which categorizes patient safety into incident types and contributing factors using a three-tiered structure. The ICPS codes were summarized using the descriptive statistics. The association between assigned ICPS codes were analysed using correspondence analysis. Six hundred and three falls assessed as requiring hospitalization were classified into 659 incident types, with the most common incident type being 'patient incidents' (injury sustained/adverse effect in the health care system) (603, 91.5%) at Level 1, 'falls' (601, 91.2%) at Level 2, and 'falls involving bedrooms' (214, 32.5%) at Level 3. The 603 falls had 1082 contributing factors, with the most common contributing factor being 'patient factors' (events affected by factors associated with the patient) (982, 90.8%) at Level 1, 'patient not elsewhere classified' (characteristics of the patient contributed to the incident not classified elsewhere) (571, 52.8%) at Level 2, and 'loss of balance' (361, 33.4%) at Level 3. In a correspondence analysis, three dimensions were responsible for 81.2% of the variation in falls incidents and environmental and organizational factors were important factors contributing to falls. The application of the ICPS demonstrated that personal factors (e.g. pre-existing physical and psychological health or impairment) were the most common contributing factors to falls assessed as requiring hospitalization, while the correspondence analysis highlighted the role of environmental and organizational factors. The results signal the need for more research into multifactorial falls prevention interventions in RACFs.

Nativity in the healthy migrant effect: Evidence from Australia.

Migrant health constitutes an important public health issue; however, variations in the 'healthy migrant effect' among migrants of different nativity are not adequately understood. To fill this gap, this study examines the life expectancy (LE) and healthy life expectancy (HLE) of the Australian-born population and eight major migrant groups in Australia for 2006, 2011 and 2016. The results show that compared with the Australian-born population, the foreign-born population overall had a higher LE and HLE but a lower HLE/LE ratio. Considerable variations in migrant health status according to nativity were also observed. Specifically, migrants from South Africa, Britain and Germany exhibited a similar or higher LE, HLE and HLE/LE ratio, while those from China, India, Italy and Greece had a higher LE but a significantly lower HLE/LE ratio compared with the Australian-born population. Lebanese migrants were the only group who experienced an unchanging LE and a declining HLE from 2006 to 2016. These notable differences in migrants' health outcomes with respect to nativity may be explained by the sociocultural differences between the origin and host countries and the different extents of migration selectivity of different migrant groups. Targeted countermeasures such as improving the quality of life of migrants from culturally diverse backgrounds or with negative migration experiences are suggested.

The effect of the COVID-19 pandemic on life expectancy in 27 countries.

The expected year-on-year intrinsic mortality variations/changes are largely overlooked in the existing research when estimating the effect of the COVID-19 pandemic on mortality patterns. To fill this gap, this study provides a new assessment of the loss of life expectancy caused by COVID-19 in 27 countries considering both the actual and the expected changes in life expectancy between 2019 and 2020. Life expectancy in 2020 and the expected life expectancy in the absence of COVID-19 are estimated using the Lee-Carter model and data primarily from the Human Mortality Database. The results show that life expectancy in 21 of the 27 countries was expected to increase in 2020 had COVID-19 not occurred. By considering the expected mortality changes between 2019 and 2020, the study shows that, on average, the loss of life expectancy among the 27 countries in 2020 amounted to 1.33 year (95% CI 1.29-1.37) at age 15 and 0.91 years (95% CI 0.88-0.94) at age 65. Our results suggest that if the year-on-year intrinsic variations/changes in mortality were considered, the effects of COVID-19 on mortality are more profound than previously understood. This is particularly prominent for countries experiencing greater life expectancy increase in recent years.

The relationship between fall incidents and place of birth in residential aged care facilities: a retrospective longitudinal cohort study.

BACKGROUND: Older populations in residential aged care facilities (RACFs) in many immigrant-receiving countries are now being increasingly culturally and linguistically diverse (CALD). CALD populations require tailored social and health services to support their needs and improve health outcomes. Falls among the elderly are common and can have significant health and psychosocial consequences. There is some evidence to suggest that country of birth may influence risk of falls among older people, but such evidence has been scarce. This study aimed to determine the association between place of birth and the incidence of falls in RACFs. METHODS: Routinely collected incident data relating to 5,628 residents aged ≥ 65 years in 25 RACFs in Sydney, New South Wales, Australia were used. RACF residents were classified into two groups, Australia-born (N = 4,086) and overseas-born (N = 1,542). Overseas-born RACF residents were further categorised into two subgroups: overseas-English-speaking-country (N = 743) and overseas-non-English-speaking-country (N = 799). Outcomes measures were rate of all falls, injurious falls and falls requiring hospitalisation. Multilevel binary negative regression was used to examine the relationship between fall risk and place of birth. RESULTS: Incidence rates of all falls, injurious falls and falls requiring hospitalisation were 8.62, 3.72 and 1.07 incidents per 1,000 resident days, respectively, among the Australia-born RACF residents, but were higher at 11.02, 4.13 and 1.65, respectively, among the overseas-born RACF residents. Within those born overseas, fall rates were higher among the overseas-non-English-speaking-country-born residents (11.32, 4.29 and 2.22, respectively) than those overseas-English-speaking-country-born (10.70, 3.96 and 1.05, respectively). After controlling for confounders, the overseas-born RACF residents overall experienced a higher risk of all three types of falls (incidence rate ratios: [IRR] = 1.278, 95% confidence interval [CI] = 1.131, 1.443; injurious falls: IRR = 1.164 [95% CI = 1.013, 1.338]; falls requiring hospitalisation: IRR = 1.460 [95% CI = 1.199, 1.777]) than the Australia-born RACF residents. Among the overseas-born RACF residents, males, respite residents and those overseas-non-English-speaking-country-born experienced higher rates of falls. CONCLUSIONS: Fall incidence in RACFs varies significantly by place of birth. With increasingly diverse RACF populations, fall intervention and prevention programs should consider cultural and linguistical backgrounds of RACF residents. Greater attention to understand the mechanisms for the differences by place of birth in risk profiles is warranted.

Measuring the Effect of COVID-19 Pandemic on Mortality: Review and Prospect - China, 2021.

Current progress in measuring the effect of the pandemic on mortality is limited. Few studies have comprehensively and systematically elucidated the mechanism through which the pandemic affects mortality and what indicators are valid to capture such an effect. This paper presents a comprehensive analysis regarding the multifaceted effects of coronavirus disease 2019 (COVID-19) on mortality and its measurements [i.e., confirmed deaths per million people (CDPMP), case fatality rate (CFR), infection fatality risk (IFR), excess mortality P-score (EMPS), and life expectancy (LE)]. It was revealed that both data collection efforts and measurements on mortality due to COVID-19 were far from perfect and discussed the importance of accurate, prompt, and accessible data by any government over the course of fighting against the COVID-19 pandemic. It is believed that the biggest challenge in measuring the effect of the COVID-19 pandemic on mortality lies not in the construction of indicators at the academic level, but in the collection of data at the practical level. Thus, it is suggested to take measures to better monitor the development of the pandemic and mitigate the increasing burdens borne by the public health systems by improving the tracking system of mortality, standardizing the diagnosis of COVID-19's deaths, and disclosing mortality data.

Associations of depressive symptoms with disability-free life expectancy and self-assessed healthy life expectancy in middle-aged and older adults: Results from a longitudinal population-based study in China.

Objectives Although the health consequences of depression have been extensively examined, little attention has been given to its nonfatal conditions. This study aims to investigate the association of depressive symptoms with total life expectancy (TLE), disability-free life expectancy (DFLE) and self-assessed healthy life expectancy (SHLE). Methods Data were sourced from the China Health and Retirement Longitudinal Study 2011-2013. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) short form was used to measure depressive symptoms in 14,982 Chinese middle-aged and older adults. The population-based multistate life table method was used to estimate the differences in TLE, DFLE and SHLE by the status of depressive symptoms. Results At the age of 45 years, depressive symptoms were associated with a reduction of 1.8 (95% CI: 0.4-3.2) additional years of TLE. The estimated depression-induced reduction in TLE was 1.8 (95% CI: 0.1-3.5) in females, and 2.6 (95% CI: 1.0-4.2) in males. For DFLE, a reduction of 3.1 (95% CI: 2.0-4.2) additional years was found in individuals with depressive symptoms. The proportion of DFLE in TLE in participants with depressive symptoms decreased compared with that of the non-depressive symptoms group (depressive symptoms: 87.4% vs non-depressive symptoms: 91.4%). For SHLE, on average, individuals with depressive symptoms suffered a reduction of 7.6 (95% CI: 6.5-8.7) additional years in their SHLE at 45 years old and a reduction in the proportion of SHLE in TLE by 17.7%. Similar patterns were found in groups aged 55, 65, 75 and 85 years. Conclusion This study showed that depressive symptoms were associated with reductions in TLE, DFLE and SHLE among middle-aged and older adults in China, and the depression-induced reduction in proportions of DFLE and SHLE in TLE continued to increase as age increased. This study provides new insight into the nonfatal health consequences of depressive symptoms and their adverse effects on quantity and quality of life. Our findings are useful for policy makers and individuals in mental health management, depression prevention and intervention and informing health policies.

Loss of life expectancy due to respiratory infectious diseases: findings from the global burden of disease study in 195 countries and territories 1990-2017.

Understanding of the patterns of and changes in mortality from respiratory infectious diseases (RID) and its contribution to loss of life expectancy (LE) is inadequate in the existing literature. With rapid sociodemographic changes globally, and the current COVID-19 pandemic, it is timely to revisit the disease burden of RID. Using the approaches of life table and cause-eliminated life table based on data from the Global Burden of Disease Study (GBD), the study analyses loss of LE due to RID in 195 countries/territories and its changes during the period 1990-2017. Results indicate that loss of LE due to RID stood at 1.29 years globally in 2017 globally and varied widely by age, gender, and geographic location, with men, elderly people, and populations in middle/low income countries/territories suffering a disproportionately high loss of LE due to RID. Additionally, loss of LE due to RID decreased remarkably by 0.97 years globally during the period 1990-2017 but increased slightly among populations older than 70 years and in many high income countries/territories. Results suggest that RID still pose a severe threat for population and public health, and that amid dramatic sociodemographic changes globally, the disease burden of RID may resurge. The study presents the first examination of the life-shortening effect of RID at the global and country/territory levels, providing new understanding of the changing disease burden of RID and shedding light on the potential consequences of the current COVID-19 pandemic.

Multidimensional healthy life expectancy of the older population in China.

Research on healthy life expectancy (HLE) that considers cognitive impairment has been inadequate, particularly in the context of less developed countries. Using data from the China Health and Retirement Longitudinal Study, our study fills this research gap by computing active life expectancy (ALE), cognitive-impairment-free life expectancy (CIFLE), and active and cognitive-impairment-free life expectancy (ACIFLE) for China's older population, using multistate life tables. Results show that at age 60, the three life expectancies were 19.4 years (ALE), 9.5 years (CIFLE), and 8.8 years (ACIFLE) during the period 2011-13. HLE exhibits significant differentials by sex, urban/rural residence, educational level, marital status, and health status at age 60. Among China's older people, males and those living in urban areas experience higher CIFLE, and those who live with a spouse, are more educated, and are healthy at age 60 expect more years in good health according to all three HLE measures.Supplementary material for this article is available at: https://doi.org/10.1080/00324728.2021.1914854.

Prevalence and related influencing factors of depression symptoms among empty-nest older adults in China.

BACKGROUND: The phenomenon of empty-nest older adults has raised growing concerns in contemporary Chinese society. In this study, we examined the prevalence and related influencing factors of depression symptoms among empty-nest older adults in China at a national level. METHODS: The database of the 2015 China Health and Retirement Longitudinal Study (N = 8549, aged ≥ 60) was used. The 10-item version of the Centre for Epidemiologic Studies Depression Scale was employed to measure depression symptoms. RESULTS: The prevalence of depression symptoms was 34.7 % for empty-nest respondents, 32.2 % for respondents living with a spouse only and 43.4 % for those living alone. Multivariable logistic regression indicated that, compared with the non-empty-nest respondents, older adults living alone were more susceptible to depression symptoms (OR 1.194, 95 %CI 1.016-1.405) whereas older adults living with a spouse only were not exposed to an elevated probability of being depressed (OR 0.945, 95 %CI 0.847-1.055). Multivariable logistic regression also suggested that empty nesters who were female, lived in rural areas, had a lower frequency of children's visits, had lower socioeconomic status and had worse physical health conditions were more vulnerable to depression symptoms. CONCLUSIONS: The association between empty-nest status and later-life depression is mixed. More concerns should be raised about the mental health of empty nesters living alone. Increased attention should also be paid to empty nesters who are female, rural residents and have low contact frequency with their children, disadvantaged socioeconomic status and poor physical health conditions.