007 The impact of demographic changes on the presentation and outcome of stroke: experiences of the oldest old in the murrumbidgee region

IntroductionDemographic changes are leading to an ageing population with a disproportionate increase in the oldest old. Stroke is a leading cause of death and disability in Australia and is particularly prevalent in the elderly. The Murrumbidgee region has a population profile that is 14 years ahead of national Australia and therefore data from this population portends how stroke may present nationally in the future. Existing research suggests that stroke risk factors, subtype, treatment provided and outcomes differ between younger and older demographic groups. This study seeks to build a profile of the experiences of stroke in the oldest old and compare variables with two younger cohorts to test a number of hypotheses about background, treatment and outcomes.MethodsData was collected retrospectively from the electronic medical records of 100 stroke patients consecutively admitted to the Wagga Wagga Rural Referral Hospital Acute Stroke Unit. They were split into three demographic groups; young old, 65–74 old (75 to 84) and oldest old (85 and older) and comparisons were made of baseline functional status and risk factor profile, stroke type, stroke treatment and outcomes.ResultsOlder people admitted with stroke were more likely to be female with poorer premorbid functional status and higher numbers living in residential care. Atrial fibrillation (p=0.008) and hypertension (p=0.01) were significantly more common with advancing age while rates of smoking (p=0.006) were higher in younger patients. Stroke mechanism was predominantly cardioembolic in older patients and embolic stroke of undetermined source (ESUS) in the youngest group. Stroke severity and stroke treatment did not vary according to age. However, outcomes were poorer with rates of dependency (p=0.03) and residential aged care facility placement (p=0.06) increased among older patients post stroke.ConclusionThese data provide an indication of how stroke may manifest in our ageing population in the future.

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The effect of ageing on presentation, management and outcomes in degenerative cervical myelopathy: a systematic review

Age and Ageing ◽

10.1093/ageing/afaa236 ◽

2020 ◽

Author(s):

Ben Grodzinski ◽

Rory Durham ◽

Oliver Mowforth ◽

Daniel Stubbs ◽

Mark R N Kotter ◽

...

Keyword(s):

Systematic Review ◽

Functional Status ◽

Cervical Myelopathy ◽

Older Patients ◽

Meta Analysis ◽

Current Evidence ◽

Clinical Aspects ◽

Similar Amount ◽

Degenerative Cervical Myelopathy ◽

The Impact

Abstract Objective Degenerative cervical myelopathy (DCM) is a disabling neurological condition. The underlying degenerative changes are known to be more common with age, but the impact of age on clinical aspects of DCM has never been synthesised. The objective of this study is to determine whether age is a significant predictor in three domains—clinical presentation, surgical management and post-operative outcomes of DCM. Methods a systematic review of the Medline and Embase databases (inception to 12 December 2019), registered with PROSPERO (CRD42019162077) and reported in accordance with preferred reporting items of systematic reviews and meta-analysis (PRISMA) guidelines, was conducted. The inclusion criteria were full text articles in English, evaluating the impact of age on clinical aspects of DCM. Results the initial search yielded 2,420 citations, of which 206 articles were eventually included. Age was found to be a significant predictor in a variety of measures. Within the presentation domain, older patients have a worse pre-operative functional status. Within the management domain, older patients are more likely to undergo posterior surgery, with more levels decompressed. Within the outcomes domain, older patients have a worse post-operative functional status, but a similar amount of improvement in functional status. Because of heterogenous data reporting, meta-analysis was not possible. Conclusion the current evidence demonstrates that age significantly influences the presentation, management and outcomes of DCM. Although older patients have worse health at all individual timepoints, they experience the same absolute benefit from surgery as younger patients. This finding is of particular relevance when considering the eligibility of older patients for surgery.

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The Effect of Demographic Change on Financial Stability

Jurnal Intelek ◽

10.24191/ji.v14i2.222 ◽

2019 ◽

Vol 14 (2) ◽

pp. 80-93

Author(s):

Asma' Rashidah Idris ◽

Muzafar Shah Habibullah ◽

Ranjanee Kaliappan

Keyword(s):

Old Age ◽

Demographic Change ◽

Financial Stability ◽

Labour Force ◽

Developed Countries ◽

Low Fertility ◽

Ageing Population ◽

Fertility Level ◽

Demographic Changes ◽

The Impact

This study investigates the effect of fertility on financial stability and its determinant particularly therelevance of demographic changes. This is motivated by the huge impact of demographic changes(increasing ageing population and low fertility level). Population ageing and low fertility tend to lowerboth labour- force participation and saving rates (change bank business model), thereby raising concernson a future slowing economic growth and financial instability. The system GMM results show that thefertility level somehow acts as a buffer and reflects to the degree of stability to the financial system. Anincrease in fertility and old-age population will contribute to lowering the financial stability. As a matterof policy implication, the nations, financial sectors, and economies should take pro-active active stepsand enhance policies in handling the inter-related issue of the ageing population, decreasing fertility, andfinancial stability especially in developed countries, but not necessarily to overlook the impact of theissues in developing countries. Keywords: Demographic change, old-age population, fertility, financial stability

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Corrigendum to: Who uses residential aged care now, how has it changed and what does it mean for the future?

Australian Health Review ◽

10.1071/ah20040_co ◽

2020 ◽

Vol 44 (6) ◽

pp. 983

Author(s):

Diane Gibson

Keyword(s):

Residential Care ◽

Average Length ◽

Age Groups ◽

Aged Care ◽

Residential Aged Care ◽

Ageing Population ◽

The Past ◽

The Future ◽

Australian Bureau Of Statistics ◽

Care System

ObjectiveThis paper presents past trends in resident characteristics and usage patterns in residential aged care and explores implications for the future.MethodsTime series analyses were undertaken of national aged care administrative datasets and the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers.ResultsAlthough the number of people in residential care has continued to increase, resident profiles have changed as a result of higher growth rates in the number of men and of people aged 65–74 years and 90 years and over, and a decline in the number of women aged 75–89 years. Relative to population size, usage rates are declining across all age groups, the average length of stay is shortening, and dependency levels appear to be rising.ConclusionChanging trends in residential aged care use, when combined with key trends in the broader population of older Australians, offer useful insights in planning for the future.What is known about the topic?Trends in the changing characteristics of permanent aged care residents and patterns of use of Australian residential aged care have received sparse attention in scholarly journals. Government reports and databases contain useful statistics, but they do not provide a coherent analysis and interpretation of the implications of these trends or situate them in broader population patterns.What does this paper add?The analyses in this paper demonstrate patterns of change and continuity in the use of residential care over the past decade, and locate those changes in the context of broader trends in the ageing population. Together, this provides useful insights into current and likely future trends, as well as a basis for imagining an improved residential aged care system in the future.What are the implications for practitioners?These analyses illustrate how data on aged care services, demographic trends and disease patterns can be used to consider the challenges that have affected our residential aged care system in the past and how that may be addressed in the future.

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Who uses residential aged care now, how has it changed and what does it mean for the future?

Australian Health Review ◽

10.1071/ah20040 ◽

2020 ◽

Vol 44 (6) ◽

pp. 820

Author(s):

Diane Gibson

Keyword(s):

Residential Care ◽

Average Length ◽

Age Groups ◽

Aged Care ◽

Residential Aged Care ◽

Ageing Population ◽

The Past ◽

The Future ◽

Australian Bureau Of Statistics ◽

Care System

ObjectiveThis paper presents past trends in resident characteristics and usage patterns in residential aged care and explores implications for the future. MethodsTime series analyses were undertaken of national aged care administrative datasets and the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers. ResultsAlthough the number of people in residential care has continued to increase, resident profiles have changed as a result of higher growth rates in the number of men and of people aged 65–74 years and 90 years and over, and a decline in the number of women aged 75–89 years. Relative to population size, usage rates are declining across all age groups, the average length of stay is shortening, and dependency levels appear to be rising. ConclusionChanging trends in residential aged care use, when combined with key trends in the broader population of older Australians, offer useful insights in planning for the future. What is known about the topic?Trends in the changing characteristics of permanent aged care residents and patterns of use of Australian residential aged care have received sparse attention in scholarly journals. Government reports and databases contain useful statistics, but they do not provide a coherent analysis and interpretation of the implications of these trends or situate them in broader population patterns. What does this paper add?The analyses in this paper demonstrate patterns of change and continuity in the use of residential care over the past decade, and locate those changes in the context of broader trends in the ageing population. Together, this provides useful insights into current and likely future trends, as well as a basis for imagining an improved residential aged care system in the future. What are the implications for practitioners?These analyses illustrate how data on aged care services, demographic trends and disease patterns can be used to consider the challenges that have affected our residential aged care system in the past and how that may be addressed in the future.

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Hospital nurses’ knowledge regarding older patients: a multicenter study

BMC Nursing ◽

10.1186/s12912-021-00604-4 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Christel T. A. J. Derks ◽

Marjo M. G. M. Hutten - van den Elsen ◽

Lysette J. Hakvoort ◽

Mariëlle P. J. van Mersbergen ◽

Marieke J. Schuurmans ◽

...

Keyword(s):

Nursing Students ◽

The Netherlands ◽

Multicenter Study ◽

Older Patients ◽

Hospital Nurses ◽

Ageing Population ◽

Knowledge And Attitudes ◽

Knowledge Levels ◽

The Impact ◽

Nurses Knowledge

Abstract Background Nursing care in hospitals increasingly involves older adults. A nursing workforce able to care for the ageing population is therefore critical for ensuring quality older adult care. Gaining insight in the knowledge and attitudes of nurses regarding older patients in the Netherlands is needed to develop and increase the impact of education- and quality improvement programs which can positively influence nurses’ knowledge and attitudes regarding older patients. Methods A cross-sectional multicenter study was performed. Data was collected in ten tertiary medical teaching hospitals well spread across the Netherlands (89 wards, 2902 nurses). Knowledge levels were measured using the Knowledge about Older Patient-Quiz (KOP-Q), consisting of 30 true-false questions. Knowledge levels of registered nurses are compared with knowledge levels known from literature of first year nursing students; last year nursing students; nurses; and nurse specialist. Potential associated factors considered were: age; sex; education; experience; opinions and preferences. Opinion and preferences regarding working with older patients were measured by three questions: 1) which patient group nurses preferred to work with; 2) how nurses feel about the increase of older patients in the hospital; and 3) whether nurses find it difficult to care for older patients. Results From all wards, a representative sample of 1743 registered hospital nurses working on all 89 wards participated. On all wards, a large range in knowledge levels is observed between nurses, with 37% of nurses presenting knowledge levels comparable with nursing student and 31% of nurses presenting knowledge levels comparable with nurse specialists. Knowledge is related to age (p < .001), work experiences (p < .001), preparatory secondary education (p < .001) and nurses education level (p = .012). A minority (12.5%) prefers working with older patients and most nurses do not find it difficult. Conclusions This study shows that there is a large diversity in knowledge levels of Dutch hospital nurses in every hospital, on every ward. A majority of nurses demonstrate negative opinions and preferences. This implies that older patients admitted can receive different levels of quality of care on the same day as nurses with different knowledge levels provide care during the various shifts. Findings demonstrate an urgent need for education programs with themes regarding essential care for older patients in the Netherlands.

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The global challenge of ageing population – Part II: the impact on health services, and the optimum healthcare strategy for older patients

Caribbean Medical Journal ◽

10.48107/cmj.2019.04.007 ◽

2019 ◽

Author(s):

Ian Sammy ◽

Joanne Paul ◽

Arvind Ramnarine ◽

Joseph Ramdhanie

Keyword(s):

Health Services ◽

Acute Care ◽

Older Patients ◽

Population Ageing ◽

World Health ◽

Ageing Population ◽

Electronic Search ◽

Study Results ◽

The World ◽

The Impact

Objectives: Analysis of data from the World Health Organization over the past 50 years, has demonstrated a transition towards population ageing globally. This has a significant impact on acute care services as well as on the approach to patient care in the acute setting. Methods: A narrative review of the literature was undertaken using Medline, CINAHL and the Cochrane Database, supplemented by manual searches of the literature, and further guided by the reference lists of relevant papers identified in the electronic search. No restriction was placed on the type of paper to be included in the study. Results: The initial electronic search of the three databases included 239 papers, of which 87 were found to be relevant and included in this review. Among the papers included were those which described the unique challenges posed by the ageing population, proposed modifications to the delivery of health services and recommended adaptations in the approach to older patients in the acute care setting. Conclusion: Population ageing is a significant global phenomenon, affecting both developed and developing regions of the world. More work is needed, particularly in the developing world, to better understand the impact of ageing on our population.

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62 Geriatric Surgical Liaison Staff Perspectives of Geriatric Care Before and After Introduction of An Embedded Service

Age and Ageing ◽

10.1093/ageing/afz187.03 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i18-i20

Author(s):

K Shah ◽

R Kyzy ◽

H Pittaway

Keyword(s):

Older Patients ◽

Discharge Planning ◽

Adverse Outcomes ◽

Ageing Population ◽

Emergency Setting ◽

Complication Rates ◽

Before And After ◽

Key Indicators ◽

The Impact ◽

Multi Disciplinary Team

Abstract Introduction National evidence demonstrates that older people having surgery, both in the elective and emergency setting, have more adverse outcomes postoperatively when compared with their younger counterparts (1). National reports have recommended daily input from a geriatric team for older patients having surgery (2). At our hospital we have introduced a geriatric surgical liaison consultant as a formal post to ensure daily geriatric input or review for patients over the age of 70 or comorbid younger patients as requested. The aim of this study was to review perspectives across the multi-disciplinary team on care provided to these patients before and after introduction of the surgical liaison team. Methods We created a 10 part questionnaire, which was distributed amongst all members of the multi-disciplinary team, asking them to rate confidence out of 10 in management of comorbidity, polypharmacy, discharge planning, pain assessments and nutrition. These data were then analysed to produce median scores for each category before and after the introduction of the service. We compared the change in scores between the foundation year 1 (FY1) doctors and the remainder of the respondents. Results The below table demonstrates the median scores across all 36 respondents in their confidence with the assessment and management of the 10 key domains before and after the liaison service was introduced: Conclusions Universally within our survey, staff reported improvement in all 10 key indicators of care of older patients on surgery with the introduction of a geriatric surgical liaison team. Greatest benefit was seen within the FY1 group. References 1. McVeigh TP, Al-Azawi D, O'Donoghue GT, Kerin MJ. Assessing the impact of an ageing population on complication rates and in-patient length of stay, Int J Surg, 2013, vol. 11 (pg. 872–5). 2. Wilkinson K. An age old Problem: A Review of the Care Received by Elderly Patients Undergoing Surgery: A Report by the National Confidential Enquiry Into Patient Outcome and Death. London, 2010.

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The Impact of Ageing Population on Malaysian Economic Growth

ASM Science Journal ◽

10.32802/asmscj.2020.sm26(1.24) ◽

2020 ◽

pp. 1-6

Author(s):

Mazlynda Md Yusuf ◽

Sarina Mohamed ◽

Mohamad Yazis Ali Basah

Keyword(s):

Economic Growth ◽

Life Expectancy ◽

Labour Force ◽

Labour Force Participation ◽

Ageing Population ◽

Dependency Ratio ◽

Fertility Rates ◽

The Past ◽

The Future ◽

The Impact

An ageing population is a worldwide phenomenon, as the results of improvement in mortality rates and drops in fertility rate over the past century. Previously, this trend was focused among the developed countries of Europe and North America but over the past 20 years, the ageing population has started to grow in the developing countries, especially countries of Southeast Asia such as Malaysia. Given changes in fertility and improving life expectancy, the figure is expected to increase significantly. According to the Department of Statistics Malaysia, it is estimated that 6.5% of the total population is aged 65 and above in 2018 and this figure is expected to increase to 14.5% in 2040. With the current changes in the demographic trend, it is expected that there will be changes in the amount of savings and this could also lead to changes in the economic performances in the future. Thus, the main objective of this study is to examine the impact of the ageing population on economic growth in Malaysia by using annual data from the year 1985 to 2016. Total fertility rates, life expectancy, labour force participation rate and old-dependency ratio are variables that are used in the study. These data were analysed using Multiple Linear Regression Model and the results indicate that Malaysia is expected to experience the ageing population in the future and that it gives effect towards Malaysian's economic growth. Keywords: ageing population; economic growth; life expectancy; labour force participation; old-dependency ratio; fertility rates

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Relative Survival of Older Patients with Indolent Lymphoma–Analysis From the SEER Database

Blood ◽

10.1182/blood.v118.21.5214.5214 ◽

2011 ◽

Vol 118 (21) ◽

pp. 5214-5214

Author(s):

Mamatha Prabhakar ◽

Bindu Kanapuru ◽

Ahmedin Jemal ◽

Charles Hesdorffer ◽

William Ershler ◽

...

Keyword(s):

Older Patients ◽

Conflicts Of Interest ◽

Oldest Old ◽

Survival Rates ◽

Age Groups ◽

Indolent Lymphoma ◽

Men And Women ◽

Indolent Lymphomas ◽

Hodgkin's Lymphomas ◽

The Impact

Abstract Abstract 5214 Background: Indolent lymphomas account for 35–40% of Non-Hodgkin's lymphomas (NHL). The treatment choices, and as a result, the overall outcome of these indolent lymphomas seem to be changing with the introduction of chemoimmunotherapy. However, the impact of these new treatment approaches on the survival in older patients has not been specifically studied. Methods: We used data from the Surveillance, Epidemiology and End Results database to determine survival for older patients diagnosed with indolent lymphomas. We compared trends in survival between 1977–86, 1987–96 and 1997–2006 in men and women, for three age groups 65–74, 75–84 and 85+ years. Survival rates were calculated up to 9 years post-diagnosis. Results: Between 1977 and 2006, survival rates increased for both men and women in all three age groups. The greatest improvement in survival was seen at 5 years. Between 1977–86 and 1997–2006, 5-year survival rates increased in men/women by 21%/22%, 23%/29% and 16%/24% in the 65–74, 75–84 and 85+ age groups respectively. Survival gains increased with each decade in all age groups for both sexes with the most marked improvements between 1987–1996 & 1997–2006. Women in the first two groups consistently demonstrated a better survival than men. The oldest old men (85+) had the lowest survival rate with the majority of the deaths occurring in the first year of diagnosis. Conclusions: Survival for older patients has increased considerably in the interval between 1977–2006 with the largest improvement seen in the 75–84 year old age group. Larger increases in the survival rates between 1987–1996 and 1997–2006 might be accounted for by the benefits of immunotherapy with the introduction of rituximab in 1998. The increased early deaths noted in men 85+, could be related to treatment toxicity. While earlier treatment is being advocated for patients diagnosed with indolent lymphoma, the data we present imply that more careful consideration should be given to the selection of patients above the age of 85 for such treatment. Male-female differences in survival are interesting and further study would seem important to elucidate the causes. Disclosures: No relevant conflicts of interest to declare.

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