Heterogeneity in the Health and Functional Capacity of Adults Aged 85+ as Risk for Mortality.

OBJECTIVES: To examine whether older adults aged 85+, with different health and functional capacities, cluster in different ways and to demonstrate whether individuals within particular clusters report differential mortality risk. DESIGN: Retrospective cohort study. SETTING: The Dynamic Analyses to Optimize Aging (DYNOPTA) project is a harmonization project of nine Australian longitudinal surveys of health and well-being in adults aged 50+ between 1991 and 2006. PARTICIPANTS: Participants were 685 older adults (female = 52%) living in the community and aged 85 to 103 at baseline who were followed until death or December 31, 2006, for survivors. MEASUREMENT: Latent class analysis (LCA) analyzed self-reported information on physical health, mental health, and functional capacity to define homogeneous classes based on probable cognitive impairment and depression status, medical conditions, and number of activities of daily living and instrumental activities of daily living. RESULTS: LCA discriminated four classes reflecting two main survival patterns. Two classes reported half the median survival days; differences between these classes were related to high vs moderate depression and extent of functional limitations. Two classes reported better survival; differences between these classes were related to functional limitations, but both had low proportions with depression and dementia. The classes with shorter survival were associated with substantively higher rates of depression and dementia. CONCLUSION: Higher rates of baseline depression and dementia were unique characteristics of those individuals in the clusters that reported shorter survival. However, a substantial proportion of very old adults experience good mental health with better survival outcomes. J Am Geriatr Soc 67:1036-1042, 2019.

Gender differences in alcohol consumption among middle-aged and older adults in Australia, the United States and Korea.

OBJECTIVES: To compare gender differences in alcohol use and the socioeconomic correlates of at-risk drinking among middle-aged and older adults in Australia, the United States (US) and South Korea. METHOD: Data were drawn from large nationally representative surveys of people aged 45 years and older, collected in 2006. RESULTS: Rates of any drinking and at-risk drinking (>14 US standard drinks/week) were higher for males than females in all countries and these gender differences were largest in Korea. Socioeconomic differentials for at-risk drinking varied by country and gender. In the US, at-risk drinking was associated with lower educational levels among men, but higher educational levels among women; in Korea, it was associated with being unpartnered, particularly for women; and in Australia, at-risk drinking was associated with higher income. CONCLUSIONS: Gender-role expectations differ between countries and may influence both the levels at which older adults consume alcohol and the ways in which at-risk drinking is associated with socioeconomic factors. IMPLICATIONS: Heavy alcohol use in middle-aged and older adults is a cause for concern. Health promotion strategies should target older age groups and consider the ways in which gender, marital status and education influence norms and opportunities for risky alcohol use.

Rumination, substance use, and self-harm in a representative Australian adult sample.

BACKGROUND: There are few data on self-harm in the general population, especially examining the roles of rumination and substance use. OBJECTIVES: To evaluate the inter-relationships of rumination, self-harm, and potential mediating variables. METHOD: A cohort with follow-up every 4 years involving a random sample of adults aged 20-24 and 40-44 years (at baseline) living in Australia. The survey included items on three common forms of self-harm. Other measures included rumination, Goldberg Anxiety and Depression scales, substance use, coping style (Brief COPE), and demographic risk factors. RESULTS: The sample comprised 2,184 women and 1,942 men with 287 self-harm cases (7.0%). Depression and coping style were significant mediators of rumination on self-harm for men, with depression being the only robust mediator for women. For males, age and education were also significantly associated, while for women, age, smoking, trauma, and sexual abuse were significant. CONCLUSIONS: Men and women differ on mediators of self-harm.

Alcohol, hospital admissions, and falls in older adults: a longitudinal evaluation.

BACKGROUND: There are limited data on the impacts of alcohol use in older adults. We aimed to evaluate self-reported hospital admissions and falls against current Australian alcohol consumption guidelines. METHODS: We conducted a longitudinal analysis of data from five Australian cohort studies. The study comprised 16,785 people aged 65 years or older at baseline. Alcohol consumption was categorized using Australian guidelines in standard (10 g) drinks per day as "abstinent," "low-risk" (>0 ≤2), "long-term risk" (>2 ≤4), or "short-term risk" (>4). Separate generalized estimating equations for men and women, controlling for key demographic, and health variables (depression, diabetes, circulatory and musculoskeletal conditions) were used to examine the relationship of alcohol consumption with hospitalization and falls against a reference category of low-risk consumption. RESULTS: Most participants were in the low (10,369, 62%) or abstinent (5,488, 33%) categories. Among women, all alcohol groups had greater odds of admission than low-risk users; among men, only the abstinent group had increased odds. For both genders, depression, diabetes, circulatory and musculoskeletal conditions all increased the odds of admission. For both genders, the unadjusted model showed that abstainers had increased odds of falling, with depression, diabetes, and for women, musculoskeletal conditions also associated with falls in the adjusted model. CONCLUSION: These outcomes suggest that older women in particular could benefit from targeted alcohol consumption messages or interventions. In relation to falls, other health conditions appear better targets for intervention than alcohol use.

Cross-national gender differences in the socioeconomic factors associated with smoking in Australia, the United States of America and South Korea.

OBJECTIVES: We compared rates of smoking among those aged 45 years and older in Australia, the United States of America and South Korea, and examined cross-national gender differences in key socioeconomic differentials in smoking. METHODS: We conducted weighted analyses on cross-sectional data from nationally representative surveys conducted in 2006. RESULTS: Current smoking was more prevalent for males than females in all countries; the gender difference was largest in Korea. Being unpartnered increased the likelihood of smoking in all countries, while greater wealth reduced it. In Korea, these effects interacted with gender; both indicators showed larger differentials among women than men. Lower educational attainment increased the likelihood of smoking for all groups except Korean women, among whom high school educated women were less likely to smoke than the tertiary educated. CONCLUSIONS: Our findings support a cultural interpretation of gender differences in smoking: in countries with low gender empowerment, gender differences in smoking are greater. With increasing divorce and female tertiary education rates in nations like Korea, we highlight the need for health promotion messages targeted towards older and more educated women.

Correlates of subjective health across the aging lifespan: understanding self-rated health in the oldest old.

OBJECTIVES: To examine the determinants of self-rated health (SRH) in different age groups of older adults, including the oldest old. METHODS: Variables assessing physical health, difficulty with self-care, depressive symptoms, and cognitive impairment were pooled and harmonized from three Australian longitudinal studies of ageing (N = 5,222). The association of these with SRH was examined in older adults aged 60 to 64 years, 65 to 74 years, 75 to 84 years, and 85 years and older. RESULTS: SRH was not associated with cognitive impairment or difficulty with self-care in the oldest old, and its association with physical health was diminished compared with younger groups. Depression showed a significant relationship in all age groups, conferring an approximately fourfold increase in the likelihood of poorer SRH. DISCUSSION: As old age progresses, self-reports of poor health become most closely related to psychological symptoms. This explains some of the paradoxes of past literature and offers important insights for health professionals working with the oldest old.

A simple measure with complex determinants: investigation of the correlates of self-rated health in older men and women from three continents.

BACKGROUND: Self-rated health is commonly employed in research studies that seek to assess the health status of older individuals. Perceptions of health are, however, influenced by individual and societal level factors that may differ within and between countries. This study investigates levels of self-rated health (SRH) and correlates of SRH among older adults in Australia, United States of America (USA), Japan and South Korea. METHODS: Cross-sectional data were drawn from large surveys of older respondents (≥ 65 years) in Australia (n = 7,355), USA (n = 10,358), Japan (n = 3,541) and South Korea (n = 3,971), collected between 2000 and 2006. Harmonized variables were developed to represent socioeconomic, lifestyle and health indicators. We then assessed whether these variables, and their potentially different impact in different countries, could account for cross-national differences in levels of SRH. RESULTS: SRH differed significantly between countries, with older Koreans reporting much poorer health than those in the other three nations. This was not the result of biases in response patterns (for example central versus extreme tendency). Health-related correlates of SRH were similar across countries; those with more medical conditions, functional limitations or poor mental health gave poorer ratings. After accounting for the differential impact of determinants in different national contexts, Australians reported better SRH than other nations. CONCLUSIONS: We conclude that when examining correlates of SRH, the similarities are greater than the differences between countries. There are however differences in levels of SRH which are not fully accounted for by the health correlates. Broad generalizations about styles of responding are not helpful for understanding these differences, which appear to be country, and possibly cohort specific. When using SRH to characterize the health status of older people, it is important to consider earlier life experiences of cohorts as well as national and individual factors in later life. Further research is required to understand the complex societal influences on perceptions of health.

Alcohol use and depression from middle age to the oldest old: gender is more important than age.

BACKGROUND: Alcohol use disorders are associated with other mental health disorders in young adults, but there are few data on alcohol use and mental health outcomes in older adults, particularly the oldest old. This study examines the relationship between alcohol consumption and depressive symptoms. METHODS: Data were collected from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project, which has pooled nine Australian longitudinal studies. Alcohol consumption was classified using standard drinks (10 g alcohol)/day as: abstinent, low risk (<0-≤ 2 standard drinks), long-term risk (>2-≤ 4) and short-term risk (>4). Probable depression was classified from harmonized scores on various standard instruments (e.g. Centre for Epidemiological Studies Depression scale). RESULTS: Overall, 39,104 (86%) participants contributed data. Alcohol classification at baseline showed 7,526 abstinent, 28,112 low risk, 2,271 long-term risk, and 1,195 short-term risk participants. Age ranged from 45 to 103 year (median 60). Using generalized estimating equations (GEE), there were significant gender by alcohol and gender by age interactions, so the analysis was split by gender. Among males, the abstinent and short-term risk groups had increased likelihood of depression: in females the abstinent, long- and short-term risk groups had increased odds of depression. Increased odds of depression was also associated with former and current smoking, younger age-group, not being partnered, leaving school before age 15 and increasing levels of health-impaired walking, dressing, or bathing. CONCLUSION: The impact of alcohol use differs by gender, nevertheless those using higher levels of alcohol or who smoke should be screened for depression and may benefit from interventions.

Oral health and access to dental care: a qualitative investigation among older people in the community.

OBJECTIVE: The aim of this study was to explore older persons' beliefs and attitudes towards oral health and access to and use of dental care services. BACKGROUND: As the proportion of dentate older people increases, the need and demand for dental services will rise (J Public Health Dent, 60, 2000, 276). DESIGN: Focus groups and semi-structured interviews were used for data collection. SETTING AND SUBJECTS: The study participants included 63 older people in Perth, WA. RESULTS: Five major themes emerged from the interviews - the need for information and knowledge; accessibility of services; cost and affordability of oral care; fear and anxiety regarding dental visits and relationships with dentists. Attitudes and behaviours were slow to change in this group. CONCLUSION: This investigation provided important perspectives regarding oral health and dental access for older people residing in the community and demonstrated the importance of understanding this group when considering provision and use of services.

Can parents accurately screen children at risk of developmental delay?

AIM: To evaluate the validity and potential value of the parent-completed Infant/Child Monitoring Questionnaire (IMQ) as a screening measure for developmental delay in high-risk infants. METHODS: One hundred and forty-one term infants born with moderate or severe newborn encephalopathy (NE) and 374 randomly selected comparison infants were administered a Griffiths Mental Development Scales (GMDS) assessment and an IMQ concurrently. Concordance of classifications between measures was compared for agreement, sensitivity, specificity, positive predictive value, negative predictive value, false positives and false negatives. RESULTS: Overall, sensitivity and specificity of the IMQ for infants with NE averaged across all age groups was 87%, positive predictive value 57% and negative predictive value 97%. The IMQ did not perform as well for comparison infants with a sensitivity of 50%, specificity 94%, positive predictive value 15% and negative predictive value 99% averaged across all age groups. Overall under-referral for infants with NE was 13%, compared with 50% for comparison infants. CONCLUSIONS: Use of the IMQ as an accurate screening measure in infants 'at risk' of developmental delay is supported. The low sensitivity of the IMQ for the comparison infants indicates a need for caution when considering its application for general population screening.

Coping with the challenges of recovery from stroke: long term perspectives of stroke support group members.

Recovery from stroke poses significant physical and psychological challenge. To develop appropriate psychological support interventions, increased understanding of the challenge and coping behaviours that promote adjustment is critical. This study presents results from a series of focus groups with stroke support group members. The evolution of challenges faced during hospitalization, rehabilitation and into the longer term is described. The active, social and cognitive coping strategies reported as helpful are explored. In the long term, acceptance of life changes, engagement in new roles and activities and the presence of social support appear to be key factors in post-stroke adjustment.

Treatment burden and health-related quality of life of children with diabetes, cystic fibrosis and asthma.

AIM: To identify the time required by children with cystic fibrosis (CF), diabetes or asthma to complete daily treatment tasks and the hassle they experienced when completing these tasks. To compare parent and child reports of daily treatment time and hassle. To investigate the relationship between treatment time and hassle, and (i) children's health-related quality of life (HRQL); and (ii) disease severity. METHODS: 160 children aged 10-16 years with CF, type 1 diabetes, or asthma were followed over a 2-year period. Information about children's treatment time and hassle, and their HRQL was obtained from parents and children at baseline, 1-year and 2-year follow-up assessments. RESULTS: On average, children with CF reported spending 74.6 +/- 57.0 min completing treatment tasks, children with diabetes spent 56.9 +/- 27.8 min and children with asthma spent 6.4 +/- 9.3 min. Parents reported that children spent less time that was reported by their children. Over the two years, parent and child reports describing treatment time for children with CF did not vary significantly (P = 0.3). Treatment time for children with diabetes increased (P = 0.02) whereas that for children with asthma reduced (P = 0.001). The level of hassle experienced by children when completing individual treatment tasks was low for all three conditions. There was no significant relationship between treatment time and children's HRQL. CONCLUSION: Children with CF or diabetes spent a substantial amount of time each day completing the treatment tasks. Although this was not related to HRQL, it could impact the ability to comply with complex and all home-based-therapies for some children.

Health-related quality of life of children and adolescents with chronic illness--a two year prospective study.

The aim of this study was to compare the self-reported health-related quality of life (HRQL) of children and adolescents with diabetes, asthma or cystic fibrosis (CF) with the HRQL of a large community sample, to assess the extent to which the HRQL of the children and adolescents with chronic illness changes over time, and to examine the consistency of changes in different HRQL domains. One hundred and twenty three young people aged 10-16 years with asthma, diabetes, or CF were recruited from specialist paediatric clinics. Children rated their HRQL using the Child Health Questionnaire (CHQ) and three disease-specific measures at baseline, 6, 12, 18 and 24 months post-baseline. In several areas, the HRQL of children with chronic illness was significantly worse than that of children in the community sample. Over the 2 years of the study, although children with asthma and diabetes did not report significant changes in CHQ scores rating their physical health, they reported significant improvements in scores rating the extent to which health problems interfered with physical and family activities. CHQ scores describing their physical health reported by children with CF declined significantly but there was no significant change in scores rating interference with physical and family activities.

Comparison of three models of alcohol craving in young adults: a cross-validation.

AIMS: The aim of study 1 was to develop a three-factor Approach and Avoidance of Alcohol Questionnaire (AAAQ), designed to assess mild and intense inclinations to drink, as well as inclinations to avoid drinking. The aims of study 2 were to cross-validate the AAAQ with an independent sample and to test the goodness-of-fit of three models of craving for alcohol: (a) the traditional unidimensional model; (b) a two-dimensional, approach-avoidance ambivalence model; and (c) an expanded two-dimensional neuroanatomical model that retains avoidance, while positing a threshold that partitions approach into two distinct levels and relates all three factors involved in craving to brain pathways associated with inhibitory processes, reward and obsessive-compulsive behaviour, respectively. DESIGN, SETTING AND PARTICIPANTS: The survey was administered to 589 Australian university students (69% women) in study 1 and to 523 American university students (64% women) in study 2. MEASUREMENTS: Inclinations to drink and to not drink (AAAQ), drinking behaviour (quantity and frequency), drinking problems (Young Adult Alcohol Problems Screening Test; YAAPST) and readiness for change (Stages of Change Readiness and Treatment Eagerness Scale; SOCRATES). FINDINGS: The expanded two-dimensional neuroanatomical model provided the best fit to the data. The AAAQ explained a substantial proportion of the variance in drinking frequency (41-53%), drinking quantity (49-60%) and drinking problems (43%). AAAQ profiles differed as a function of drinking-related risk, and the three AAAQ scales differentially predicted readiness for change. CONCLUSIONS: Approach and avoidance inclinations toward alcohol are separable constructs, and their activation may not be invariably reciprocal. Craving can be defined as the relative activation of substance-related response inclinations along these two primary dimensions. There may be a threshold of intensity that separates mild from intense approach inclinations.

Measurement invariance in the General Health Questionnaire-12 in young Australian adolescents.

The General Health Questionnaire-12 (GHQ-12) has been extensively validated with adults, but its validity with young adolescents is questionable. Further, the dimensionality of the survey remains in doubt. Confirmatory factor analysis was used to compare five competing models for the GHQ-12 using an adult sample (n = 235). The best model was then applied to a young adolescent dataset (n = 236, aged 11-15): all fit indices were "adequate" or "good" (i. e. Comparative Fit Index 0.97). Measurement invariance for the combined data was demonstrated for item loadings and factor covariance but not for error variance. These data provide support for the validity of the survey with young adolescents and suggest that adolescents interpret the GHQ-12 in a similar manner to adults.

Validity and psychometric properties of the General Health Questionnaire-12 in young Australian adolescents.

BACKGROUND: The General Health Questionnaire (GHQ) is a measure of current mental wellbeing that has been extensively validated with adults. The instrument has also been used with adolescents. OBJECTIVE: (i) To assess the psychometric properties of the GHQ-12 among school students in grades 7-10; (ii) to validate it against other psychological tests; and (iii) to suggest a threshold score. METHOD: The survey was conducted in single sex and mixed schools from the state and private system in Perth, Western Australia. The survey contained the GHQ-12 and measures of anxiety, depression, self-esteem, stress, generalized self-efficacy, social desirability and negative affectivity. RESULTS: There were 336 students (female 55%) with an age range of 11-15 years (median 13). The GHQ showed good internal consistency (alpha 0.88). Girls had higher mean GHQ-12 scores than boys (F (1,326) 15.0, p < 0.001) and scores for both genders increased with school grade (F (3,326) 4.2, p < 0.01). Multiple linear regression showed that depression, anxiety, self-esteem and stress were significant independent predictors of GHQ scores. The model accounted for 68% of the variance (adjusted R 2). Screening indices were calculated by comparison with a combined depression and/or anxiety category. Threshold scores of 13/14 for males and 18/19 for females appeared optimal. General Health Questionnaire scores were compared with two criterion groups: adolescents in hospital with alcohol or drug (AOD) related problems and those with problems not related to AOD use. Only the former group had significantly higher total scores. CONCLUSIONS: The GHQ-12 showed good structural characteristics and was appropriately correlated with other measures of related traits. Overall, the GHQ-12 appears to be a valid index of psychological wellbeing in this population and was considerably shorter than some of the other instruments.