%0 Journal Article %~ PubMed %A Hairi, Noran N %A Cumming, Robert G %A Blyth, Fiona M %A Naganathan, Vasi %T Chronic pain, impact of pain and pain severity with physical disability in older people-Is there a gender difference? %B Maturitas %D 2013 %C Ireland %I Elsevier Ireland Ltd %V 74 %N 1 %P 68-73 %@ 1873-4111 %X %Z FOR Codes: 111702 110308 %0 Journal Article %~ PubMed %A Crisp, Alice %A Dixon, Tracy %A Jones, Graeme %A Cumming, Robert G %A Laslett, Laura L %A Bhatia, Kuldeep %A Webster, Adrian %A Ebeling, Peter R %T Declining incidence of osteoporotic hip fracture in Australia. %B Archives of Osteoporosis %D 2012 %C United Kingdom %I Springer UK %V 7 %N 1-2 %P 179-185 %@ 1862-3514 %X %Z FOR Codes: 110321 %0 Journal Article %~ PubMed %A Sambrook, P N %A Cameron, I D %A Chen, J S %A Cumming, R G %A Durvasula, S %A Herrmann, M %A Kok, C %A Lord, S R %A Macara, M %A March, L M %A Mason, R S %A Seibel, M J %A Wilson, N %A Simpson, J M %T Does increased sunlight exposure work as a strategy to improve vitamin D status in the elderly: a cluster randomised controlled trial. %B Osteoporosis International %D 2012 %C United Kingdom %I Springer UK %V 23 %N 2 %P 615-624 %@ 1433-2965 %X Sunlight exposure by improving vitamin D status could be a simple public health strategy in reducing falls among frail elder people. In a randomised controlled trial, adherence to sunlight exposure was low (median adherence, 26%) and no effect of increased UV exposure on falls risk was observed (incidence rate ratio (IRR) 1.06, P???=???0.73). INTRODUCTION: This study aimed to determine whether increased sunlight exposure was effective to improve vitamin D status and reduce falls in the elderly. METHODS: In a cluster randomised controlled trial (NCT00322166 at ClinicalTrials.gov), 602 residents aged 70 or more (mean age, 86.4??years; 71% female) were recruited from 51 aged care facilities in Northern Sydney, Australia. Participants were randomised by facility to receive either increased sunlight exposure (additional 30-40??min/day in the early morning) with (UV+) or without (UV) calcium supplementation (600??mg/day) or neither (control) for a year. The co-primary endpoints were change in serum 25 hydroxy vitamin D (25OHD) and falls incidence after 12??months. RESULTS: Adherence to sunlight exposure was low (median adherence, 26%; IQR, 7%-45%). Serum 25OHD levels were low at baseline (median, 32.9??nmol/L) and increased only slightly depending on the number of sunlight sessions attended over 12??months (P???=???0.04). During the study, 327 falls occurred in 111 (54%) subjects in the control group, 326 falls in 111 (58%) subjects in the UV only group and 335 falls in 108 (52%) subjects in the UV+ group. By intention-to-treat analysis, there was no significant effect of increased UV exposure on falls risk (IRR, 1.06; 95% CI, 0.76-1.48; P???=???0.73). However, in 66 participants who attended ???130 sessions per year (adherence, ???50% of 260 sessions-five per week), falls were significantly reduced (IRR, 0.52; 95% CI, 0.31-0.88; P???=???0.01) compared with the control group. CONCLUSIONS: Increased sunlight exposure did not reduce vitamin D deficiency or falls risk in frail older people. This public health strategy was not effective most likely due to poor adherence to the intervention. %Z FOR Codes: 110308 111716 %0 Journal Article %~ PubMed %A Gnjidic, Danijela %A Le Couteur, David G %A Naganathan, Vasi %A Cumming, Robert G %A Creasey, Helen %A Waite, Louise M %A Sharma, Anita %A Blyth, Fiona M %A Hilmer, Sarah N %T Effects of drug burden index on cognitive function in older men. %B Journal of Clinical Psychopharmacology %D 2012 %C United States %I Lippincott Williams & Wilkins %V 32 %N 2 %P 273-277 %@ 1533-712X %X We aimed to assess the relationship between Drug Burden Index (DBI), a risk assessment tool that measures anticholinergic and sedative medication exposure and cognitive performance, and cognitive impairment in older people. The study population consisted of community-dwelling older men, 70 years or older, living in Sydney, Australia. The Addenbrooke''s Cognitive Examination (ACE) and the Trail Making Task (TMT) cognitive tests were performed, and participants were categorized as having intact cognition, mild cognitive impairment, or dementia using clinical diagnostic criteria. The analyses were restricted to participants with English-speaking background (n = 987) and to the subgroup whose cognition was intact (n = 887). In the study group, DBI exposure was not associated with poorer performance on the ACE (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.66-1.47) or the TMT (OR, 0.71; 95% CI, 0.40-1.24) tests, after controlling for covariates. Similarly, DBI exposure was not associated with cognitive impairment (OR, 1.34; 95% CI, 0.83-2.16). There was no association between increasing DBI scores and poorer performance on any of the outcomes. On subgroup analysis of cognitively intact subgroup, DBI exposure or increasing DBI scores were not associated with poorer performance on the ACE or the TMT tests. In this study of community-dwelling older men, DBI was not associated with limitations on objective cognitive performance measures or with a clinical diagnosis of mild cognitive impairment or dementia. %Z FOR Codes: 111502 110308 %0 Journal Article %~ PubMed %A Dean, Catherine M %A Rissel, Chris %A Sherrington, Catherine %A Sharkey, Michelle %A Cumming, Robert G %A Lord, Stephen R %A Barker, Ruth N %A Kirkham, Catherine %A O'Rourke, Sandra %T Exercise to enhance mobility and prevent falls after stroke: the community stroke club randomized trial. %B Neurorehabilitation and Neural Repair %D 2012 %C United States %I Sage Publications, Inc. %V 26 %N 9 %P 1046-1057 %@ 1552-6844 %X %Z FOR Codes: 111712 %0 Journal Article %~ PubMed %A Jagnoor, Jagnoor %A Keay, Lisa %A Ganguli, Atreyi %A Dandona, Rakhi %A Thakur, J S %A Boufous, Soufiane %A Cumming, Robert %A Ivers, Rebecca Q %T Fall related injuries: A retrospective medical review study in North India. %B Injury %D 2012 %C United Kingdom %I Elsevier Ltd %V 43 %N 12 %P 1996-2000 %@ 0020-1383 %X INTRODUCTION: Falls have been identified as a leading cause of injury-related morbidity and mortality in India. However, very little is known about the context and characteristics of such falls. The aim of this study was to describe the context and characteristics of fall related injuries in patients admitted to hospital for fall injury. METHODS: Medical records of patients presenting at the Emergency Department of the Nehru Hospital, Chandigarh, India between March 2008 and February 2009, were reviewed by trained investigators. All injury cases were identified and fall related injury cases were assigned an ICD 10, Chapter XX, External causes of morbidity and mortality code. A review of medical records was conducted to determine the context, nature and site of injury associated with a fall event. RESULTS: Ten percent (7049) of hospital emergency presentations were due to injuries, and falls were the second leading cause (20%, 1407). Seventy-six percent of the fall related presentations were in males. More than one third (36%) of the fall related presentations occurred in those aged 0-14 years old. Falls from building or structures (35%, 499) were the leading cause for all ages except for those older than 60 years, where same level falls due to slipping, tripping and stumbling (40%, 57) were predominant. Half of all the falls resulted in head injury. Nearly 10% of patients presenting for fall related injury died. CONCLUSION: Fall related injuries are an important contributor to hospital emergency presentations, particularly falls from buildings in children, and slips and trips in older people. Given the high proportion of falls that resulted in head injury and death, there is a significant need to develop appropriate interventions to prevent such falls. %Z FOR Codes: 111702 111706 %0 Journal Article %~ PubMed %A Negin, Joel %A Nemser, Bennett %A Cumming, Robert %A Lelerai, Eliud %A Ben Amor, Yanis %A Pronyk, Paul %T HIV Attitudes, Awareness and Testing Among Older Adults in Africa. %B AIDS & Behavior %D 2012 %C United States %I Springer New York LLC %V 16 %N 1 %P 63-68 %@ 1573-3254 %X In Africa, older adults aged 50 and older are still sexually active and play a critical role as caregivers, yet little is known about their attitudes towards HIV and awareness of services. In this study, surveys were conducted in nine African sites. A multilevel model was fitted to evaluate the relationship between age and outcome variables. The study reveals that people aged 50??years and older have lower levels of HIV-related knowledge and awareness than those aged 25-49. Older adults were less likely to have been tested for HIV and women aged 50 and older showed particularly low levels of awareness. %Z FOR Codes: 111702 %0 Journal Article %~ PubMed %A Cumming, Robert G %T HIV and AIDS in Africa: good news and bad news. %B Medical Journal of Australia %D 2012 %C Australia %I Australasian Medical Publishing Company Pty. Ltd. %V 196 %N 5 %P 309 %@ 1326-5377 %X %Z FOR Codes: 1103 %0 Journal Article %~ PubMed %A Gnjidic, D %A Hilmer, S N %A Blyth, F M %A Naganathan, V %A Cumming, R G %A Handelsman, D J %A McLachlan, A J %A Abernethy, D R %A Banks, E %A Le Couteur, D G %T High-risk prescribing and incidence of frailty among older community-dwelling men. %B Clinical pharmacology and therapeutics %D 2012 %C United States %I Nature Publishing Group %V 91 %N 3 %P 521-528 %@ 1532-6535 %X Evidence about the association between treatment with high-risk medicines and frailty in older individuals is limited. We investigated the relationship between high-risk prescribing and frailty at baseline, as well as 2-year incident frailty, in 1,662 men ?70 years of age. High-risk prescribing was defined as polypharmacy (?5 medicines), hyperpolypharmacy (?10 medicines), and by the Drug Burden Index (DBI), a dose-normalized measure of anticholinergic and sedative medicines. At baseline, frail participants had adjusted odds ratios (ORs) of 2.55 (95% confidence interval, CI: 1.69-3.84) for polypharmacy, 5.80 (95% CI: 2.90-11.61) for hyperpolypharmacy, and 2.33 (95% CI: 1.58-3.45) for DBI exposure, as compared with robust participants. Of the 1,242 men who were robust at baseline, 6.2% developed frailty over two years. Adjusted ORs of incident frailty were 2.45 (95% CI: 1.42-4.23) for polypharmacy, 2.50 (95% CI: 0.76-8.26) for hyperpolypharmacy, and 2.14 (95% CI: 1.25-3.64) for DBI exposure. High-risk prescribing may contribute to frailty in community-dwelling older men. %Z FOR Codes: 111702 111503 %0 Journal Article %~ PubMed %A Clemson, Lindy %A Fiatarone Singh, Maria A %A Bundy, Anita %A Cumming, Robert G %A Manollaras, Kate %A O'Loughlin, Patricia %A Black, Deborah %T Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. %B BMJ %D 2012 %C United Kingdom %I BMJ Group %V 345 %N %P e4547 %@ 1756-1833 %X To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls in older, high risk people living at home. %Z FOR Codes: 111702 %0 Journal Article %~ PubMed %A Cameron, Ian D %A Gillespie, Lesley D %A Robertson, M Clare %A Murray, Geoff R %A Hill, Keith D %A Cumming, Robert G %A Kerse, Ngaire %T Interventions for preventing falls in older people in care facilities and hospitals. %B Cochrane Database of Systematic Reviews %D 2012 %C United Kingdom %I John Wiley & Sons Ltd. %V 12 %N %P CD005465 %@ 1469-493X %X %Z FOR Codes: 110308 %0 Journal Article %~ PubMed %A Tan, A G %A Mitchell, P %A Rochtchina, E %A Hong, T %A Cumming, R G %A Wang, J J %T Lens retrodots and vacuoles and their associations with the prevalence and incidence of age-related cataract. %B Eye %D 2012 %C United Kingdom %I Nature Publishing Group %V 26 %N 4 %P 568-575 %@ 1476-5454 %X AimTo assess the prevalence of retrodots and vacuoles and their associations with the prevalence and long-term incidence of age-related cataract in an older Australian cohort.MethodsOf 3654 baseline participants of the Blue Mountains Eye Study aged 49+ years (1992-1994), 2335 and 1952 were re-examined after 5 and 10 years, respectively. Lens photographs were graded for cataract, retrodots, and vacuoles. Eye-specific data were used to assess the associations between retrodots or vacuoles at baseline and the prevalence and 10-year incidence of nuclear, cortical, and posterior subcapsular (PSC) cataract and cataract surgery.ResultsAt baseline, retrodots were present in 142 persons (4%) and vacuoles in 1333 persons (40%). Prevalence of both lens features increased with increasing age (Pfor trend <0.0001). After adjusting for age and gender, vacuoles were associated with prevalent PSC cataract at baseline (odds ratio (OR), 1.60, 95% confidence interval (CI), 1.25-2.05). After adjusting for age, gender, smoking, hypertension, diabetes, education, and use of inhaled/oral steroids, baseline retrodots were associated with an increased incidence of cataract surgery (OR 2.90, 95% CI 1.71-4.91), while 3+ vacuoles at baseline were associated with an increased risk of PSC cataract (OR 3.56, 95% CI 2.13-5.95) and cataract surgery (OR 1.84, 95% CI 1.22-2.77).DiscussionLens retrodots and vacuoles were found to be positively associated with 10-year incidence of cataract surgery, and vacuoles associated with PSC cataract, a finding suggestive of shared risk factors or pathogenesis between these two lens features and the development of PSC cataract.Eye advance online publication, 23 December 2011; doi:10.1038/eye.2011.349. %Z FOR Codes: 111706 111301 %0 Journal Article %~ PubMed %A Gnjidic, Danijela %A Stanaway, Fiona F %A Cumming, Robert %A Waite, Louise %A Blyth, Fiona %A Naganathan, Vasi %A Handelsman, David J %A Le Couteur, David G %T Mild Cognitive Impairment Predicts Institutionalization among Older Men: A Population-Based Cohort Study. %B PLoS One %D 2012 %C United States %I Public Library of Science %V 7 %N 9 %P e46061 %@ 1932-6203 %X %Z FOR Codes: 110308 %0 Journal Article %A Kuteesa, Monica O %A Seeley, Janet %A Cumming, Robert %A Negin, Joel %T Older people living with HIV in Uganda: understanding their experience and needs %B African Journal of AIDS Research %D 2012 %C South Africa %I National Inquiry Services Centre %V 11 %N 4 %P 295-305 %@ 1608-5906 %X %Z FOR Codes: 111706 %0 Journal Article %~ PubMed %A Gnjidic, Danijela %A Hilmer, Sarah N %A Blyth, Fiona M %A Naganathan, Vasi %A Waite, Louise %A Seibel, Markus J %A McLachlan, Andrew J %A Cumming, Robert G %A Handelsman, David J %A Le Couteur, David G %T Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. %B Journal of Clinical Epidemiology %D 2012 %C United States %I Elsevier Inc. %V 65 %N 9 %P 989-995 %@ 0895-4356 %X OBJECTIVE: This study aimed to determine an optimal discriminating number of concomitant medications associated with geriatric syndromes, functional outcomes, and mortality in community-dwelling older men. STUDY DESIGN AND SETTING: Older men aged ???70 years (n=1,705), enrolled in the Concord Health and Aging in Men Project were studied. Receiver operating characteristic curve analysis using the Youden Index and the area under the curve was performed to determine discriminating number of medications in relation to each outcome. RESULTS: The highest value of the Youden Index for frailty was obtained for a cutoff point of 6.5 medications compared with a cutoff of 5.5 for disability and 3.5 for cognitive impairment. For mortality and incident falls, the highest value of Youden Index was obtained for a cutoff of 4.5 medications. For every one increase in number of medications, the adjusted odds ratios were 1.13 (95% confidence interval [CI]=1.06-1.21) for frailty, 1.08 (95% CI=1.00-1.15) for disability, 1.09 (95% CI=1.04-1.15) for mortality, and 1.07 (95% CI=1.03-1.12) for incident falls. There was no association between increasing number of medications and cognitive impairment. CONCLUSION: The study supports the use of five or more medications in the current definition of polypharmacy to estimate the medication-related adverse effects for frailty, disability, mortality, and falls. %Z FOR Codes: 110308 %0 Journal Article %~ PubMed %A Negin, Joel %A Martiniuk, Alexandra %A Cumming, Robert G %A Naidoo, Nirmala %A Phaswana-Mafuya, Nancy %A Madurai, Lorna %A Williams, Sharon %A Kowal, Paul %T Prevalence of HIV and chronic comorbidities among older adults. %B AIDS %D 2012 %C United States %I Lippincott Williams & Wilkins %V 26 %N Suppl 1 %P S55-S63 %@ 1473-5571 %X %Z FOR Codes: 111706 %0 Journal Article %~ PubMed %A Litchfield, Melisa J %A Cumming, Robert G %A Smith, David P %A Naganathan, Vasi %A Le Couteur, David G %A Waite, Louise M %A Blyth, Fiona M %A Handelsman, David J %T Prostate-specific antigen levels in men aged 70 years and over: findings from the CHAMP study. %B Medical Journal of Australia %D 2012 %C Australia %I Australasian Medical Publishing Company Pty. Ltd. %V 196 %N 6 %P 395-398 %@ 1326-5377 %X To describe values of serum prostate-specific antigen (PSA) in older men without diagnosed prostate cancer, categorised by age and country of birth, and to describe self-reported prostate cancer screening. %Z FOR Codes: 111404 110308 %0 Journal Article %~ PubMed %A Steinbeck, Katharine %A Hazell, Philip %A Cumming, Robert G %A Skinner, S Rachel %A Ivers, Rebecca %A Booy, Robert %A Fulcher, Greg %A Handelsman, David J %A Martin, Andrew J %A Morgan, Geoff %A Starling, Jean %A Bauman, Adrian %A Rawsthorne, Margot L %A Bennett, David L %A Chow, Chin Moi %A Lam, Mary K %A Kelly, Patrick %A Brown, Ngiare J %A Paxton, Karen %A Hawke, Catherine %T The study design and methodology for the ARCHER study - adolescent rural cohort study of hormones, health, education, environments and relationships. %B BMC Pediatrics %D 2012 %C United Kingdom %I BioMed Central Ltd. %V 12 %N 1 %P 143 %@ 1471-2431 %X %Z FOR Codes: 111403 111706 %0 Journal Article %~ PubMed %A Sherrington, Catherine %A Lord, Stephen R %A Close, Jacqueline C T %A Barraclough, Elizabeth %A Taylor, Morag %A O'Rourke, Sandra %A Kurrle, Susan %A Tiedemann, Anne %A Cumming, Robert G %A Herbert, Robert D %T A simple tool predicted probability of falling after aged care inpatient rehabilitation. %B Journal of Clinical Epidemiology %D 2011 %C United States %I Elsevier Inc. %V 64 %N 7 %P 779-786 %@ 0895-4356 %X To develop and internally validate a falls prediction tool for people being discharged from inpatient aged care rehabilitation. %Z FOR Codes: 111702 110321 %0 Journal Article %~ PubMed %A Negin, Joel %A van Lettow, Monique %A Semba, Medson %A Martiniuk, Alexandra %A Chan, Adrienne %A Cumming, Robert G %T Anti-Retroviral Treatment Outcomes among Older Adults in Zomba District, Malawi. %B PLoS One %D 2011 %C United States %I Public Library of Science %V 6 %N 10 %P e26546 %@ 1932-6203 %X There are approximately 3 million people aged 50 and older in sub-Saharan Africa who are HIV-positive. Despite this, little is known about the characteristics of older adults who are on treatment and their treatment outcomes. %Z FOR Codes: 111702 110799 %0 Journal Article %~ PubMed %A Wilson, Nicholas M %A Hilmer, Sarah N %A March, Lyn M %A Cameron, Ian D %A Lord, Stephen R %A Seibel, Markus J %A Mason, Rebecca S %A Chen, Jian Shen %A Cumming, Robert G %A Sambrook, Philip N %T Associations Between Drug Burden Index and Falls in Older People in Residential Aged Care. %B Journal of the American Geriatrics Society %D 2011 %C United States %I Wiley-Blackwell Publishing, Inc. %V 59 %N 5 %P 875-880 %@ 0002-8614 %X To evaluate the association between the Drug Burden Index (DBI), a measure of a person''s total exposure to anticholinergic and sedative medications that includes principles of dose-response and maximal effect and is associated with impaired physical function in community-dwelling older people, and falls in residents of residential aged care facilities (RACFs). %Z FOR Codes: 1103 1115 %0 Journal Article %~ PubMed %A Kanjanarach, Tipaporn %A Krass, Ines %A Cumming, Robert G %T Australian community pharmacists' practice in complementary medicines: a structural equation modeling approach. %B Patient Education and Counseling %D 2011 %C Ireland %I Elsevier %V 83 %N 3 %P 352-359 %@ 1873-5134 %X This survey tested a model of factors influencing pharmacists'' practice in relation to complementary medicines (CMs). %Z FOR Codes: 111503 %0 Journal Article %~ PubMed %A Stanaway, Fiona F %A Blyth, Fiona M %A Cumming, Robert G %A Naganathan, Vasi %A Handelsman, David J %A Waite, Louise M %A Sambrook, Philip N %A Creasey, Helen M %A Seibel, Markus J %A Le Couteur, David G %T Back pain in older male Italian-born immigrants in Australia: The importance of socioeconomic factors. %B European Journal of Pain %D 2011 %C United Kingdom, Belg %I Elsevier Ltd %V 15 %N 1 %P 70-76 %@ 1532-2149 %X Back pain is common in older people and is associated with functional disability and poor self-rated health. Older persons are under-represented in back pain research, and research on back pain in older persons from ethnic minorities is particularly sparse. We investigated differences in back pain characteristics, effects and medication use in a population-based sample of 335 Italian-born immigrants and 849 Australian-born men aged 70 years and over. There were 189 (62%) Italian-born men and 507 (63%) Australian-born men who reported experiencing back pain in the past 12 months. Despite no difference in the reported prevalence of back pain between the two groups of men, Italian-born men were more likely to report that their pain was frequent, severe and chronic. Italian-born men were also more likely to report having other sites of pain and that they had limited their activities in the past 12 months due to back pain. Despite these differences, the use of analgesic medication was the same in both groups. Multivariate analyses showed that differences in pain characteristics and effects between the two groups of men were explained by socioeconomic factors such as years of education and occupation history. %Z FOR Codes: 111702 %0 Journal Article %~ PubMed %A Travison, Thomas G %A Nguyen, Anh-Hoa %A Naganathan, Vasi %A Stanaway, Fiona F %A Blyth, Fiona M %A Cumming, Robert G %A Le Couteur, David G %A Sambrook, Philip N %A Handelsman, David J %T Changes in Reproductive Hormone Concentrations Predict the Prevalence and Progression of the Frailty Syndrome in Older Men: The Concord Health and Ageing in Men Project. %B Journal of Clinical Endocrinology and Metabolism %D 2011 %C United States %I The Endocrine Society %V 96 %N 8 %P 2464-2474 %@ 1945-7197 %X Frailty, a syndrome of multiple morbidity, weakness, and immobility in aging, is an increasingly urgent threat to public health. Single measures of low serum androgen have been associated with frailty in men, but the contributory role of hormonal changes with time is unassessed. %Z FOR Codes: 110306 %0 Journal Article %~ PubMed %A Hosseini, S R %A Cumming, R G %A Sajjadi, P %A Bijani, A %T Chronic diseases among older people in Amirkola, northern Islamic Republic of Iran. %B Eastern Mediterranean Health Journal %D 2011 %C Egypt %I World Health Organization %V 17 %N 11 %P 843-849 %@ 1020-3397 %X This descriptive cross-sectional study was undertaken to describe the prevalence of noncommunicable diseases and their risk factors in elderly people in Amirkola, Islamic Republic of Iran. A total of 1019 people aged 60+ years were assessed using a standard questionnaire and a review of medical records. The most common chronic diseases were cardiovascular disease (29.5%), digestive disorders (28.5%), hypertension (23.6%) and diabetes mellitus (23.5%), while 44.4% of subjects were overweight or obese. Overall, 83.0% of the sample reported at least 1 chronic disease and 64% had 2 or more diseases. In age-adjusted logistic regression analysis, hypertension (OR 3.94, 95% CI: 2.87-5.40) and diabetes mellitus (OR 1.83, 95% CI: 1.32-2.55) were associated with cardiovascular disease, but sex, smoking, overweight and lack of walking were not. The study provides valuable data for planning appropriate health services for elderly people in this area of the Islamic Republic of Iran. %Z FOR Codes: 111706 111702 %0 Journal Article %~ PubMed %A Clifton-Bligh, Roderick J %A Nguyen, Tuan V %A Au, Amy %A Bullock, Martyn %A Cameron, Ian %A Cumming, Robert %A Chen, Jian Sheng %A March, Lyn M %A Seibel, Markus J %A Sambrook, Philip N %T Contribution of a Common Variant in the Promoter of the 1-α-Hydroxylase Gene (CYP27B1) to Fracture Risk in the Elderly. %B Calcified Tissue International %D 2011 %C United States %I Springer New York LLC %V 88 %N 2 %P 109-116 %@ 1432-0827 %X CYP27B1 encodes mitochondrial 1??-hydroxylase, which converts 25-hydroxyvitamin D to its active 1,25-dihydroxylated metabolite. We tested the hypothesis that common variants in the CYP27B1 promoter are associated with fracture risk. The study was designed as a population-based genetic association study, which involved 153 men and 596 women aged 65-101 years, who had been followed for 2.2 years (range 0.1-5.5) between 1999 and 2006. During the follow-up period, the incidence of fragility fractures was ascertained. Bone ultrasound attenuation (BUA) was measured in all individuals, as were serum 25-hydroxyvitamin D and PTH concentrations; 86% subjects had vitamin D insufficiency. Genotypes were determined for the -1260C>A (rs10877012) and +2838T>C (rs4646536) CYP27B1 polymorphisms. A reporter gene assay was used to assess functional expression of the -1260C>A CYP27B1 variants. The association between genotypes and fracture risk was analyzed by Cox''s proportional hazards model. We found that genotypic distribution of CYP27B1 -1260 and CYP27B1 +2838 polymorphisms was consistent with the Hardy-Weinberg equilibrium law. The two polymorphisms were in high linkage disequilibrium, with D'' = 0.96 and r?? = 0.94. Each C allele of the CYP27B1 -1260 polymorphism was associated with increased risk of fracture (hazard ratio = 1.34, 95% CI 1.03-1.73), after adjustment for age, sex, number of falls, and BUA. In transient transfection studies, a reporter gene downstream of the -1260(A)-containing promoter was more highly expressed than that containing the C allele. These data suggest that a common but functional variation within the CYP27B1 promoter gene is associated with fracture risk in the elderly. %Z FOR Codes: 111702 60412 %0 Journal Article %~ PubMed %A Le Couteur, David G %A Benson, Vicky L %A McMahon, Aisling C %A Blyth, Fiona %A Handelsman, David J %A Seibel, Markus J %A Kennerson, Marina %A Naganathan, Vasi %A Cumming, Robert G %A de Cabo, Rafael %T Determinants of Serum-Induced SIRT1 Expression in Older Men: The CHAMP Study. %B Journals of Gerontology. Series A: Biological Sciences & Medical Sciences %D 2011 %C United States %I Oxford University Press %V 66 %N 1 %P 3-8 %@ 1758-535X %X Circulating factors that have an effect on SIRT1 expression are influenced by caloric restriction. To determine the association between frailty and such circulating factors, we measured serum-induced SIRT1 expression from a nested cohort of frail (n = 77) and robust (n = 82) participants from Concord Health and Ageing in Men Project, a population-based study of community-dwelling men older than 70 years. Serum-induced SIRT1 expression was not different between frail and robust men (103.1 ?? 17.0 versus 100.4 ?? 19.3 ??g/L). However, subsequent analyses showed that men with the lowest values (first quartile) were less likely to be frail (odds ratio = 0.5, 95% confidence interval = 0.2-1.0, p = .04) and had higher total body lean mass (p = .001) than the other participants. Serum-induced SIRT1 expression did not correlate with age, diseases, medications, albumin, fasting glucose, or lipids. Overall, there was no association between frailty and serum-induced SIRT1 expression; however, post hoc analysis suggested that there might be a paradoxical association between low serum-induced SIRT1 expression and robustness. %Z FOR Codes: 110308 %0 Journal Article %~ PubMed %A Stanaway, Fiona F %A Cumming, Robert G %A Naganathan, Vasi %A Blyth, Fiona M %A Handelsman, David J %A Le Couteur, David G %A Waite, Louise M %A Creasey, Helen M %A Seibel, Markus J %A Sambrook, Philip N %T Ethnicity and falls in older men: low rate of falls in Italian-born men in Australia. %B Age and Ageing %D 2011 %C United Kingdom %I Oxford University Press %V 40 %N 5 %P 595-601 %@ 0002-0729 %X past research suggests that fall rates in older persons may differ by ethnicity. The aim of this study was to compare the incidence of falls between older male Italian-born immigrants and their Australian-born counterparts. %Z FOR Codes: 111706 %0 Journal Article %~ PubMed %A Stanaway, Fiona F %A Gnjidic, Danijela %A Blyth, Fiona M %A Le Couteur, David G %A Naganathan, Vasi %A Waite, Louise %A Seibel, Markus J %A Handelsman, David J %A Sambrook, Philip N %A Cumming, Robert G %T How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over. %B BMJ %D 2011 %C United Kingdom %I BMJ Publishing Group %V 343 %N %P d7679 %@ 1468-5833 %X To determine the speed at which the Grim Reaper (or Death) walks. %Z FOR Codes: 110308 %0 Journal Article %~ PubMed %A Blyth, F M %A Cumming, R G %A Nicholas, M K %A Creasey, H %A Handelsman, D J %A Le Couteur, D G %A Naganathan, V %A Sambrook, P N %A Seibel, M J %A Waite, L M %T Intrusive pain and worry about health in older men: The CHAMP study. %B Pain %D 2011 %C Netherlands, United States %I Elsevier BV %V 152 %N 2 %P 447-52 %@ 0304-3959 %X The role of anxiety in pain is less well understood than the role of depression. Based on recent conceptual thinking about worry and pain, we explored the relationship between pain status and worry about health and anxiety in 1217 community-dwelling men aged 70 years or older who participated in the baseline phase of the Concord Health and Ageing in Men Project study, a large population-based epidemiological study of healthy ageing based in Sydney, Australia. We hypothesised that worry about health would be associated with having persistent pain, and that the association would be stronger in the presence of co-existing pain-related interference with activities (intrusive pain). Of men in the study, 12.5% had persistent and intrusive pain, 22.4% were worried about their health, and 6.3% had anxiety. We found a strong association between worry about health and pain that was both persistent and intrusive, and that remained after accounting for age, number of comorbidities, depression, self-rated health status, arthritis, and gait speed (adjusted odds ratio 2.9; 95% confidence interval 1.8-4.7), P<0.0001). The corresponding adjusted odds ratio for the association between anxiety and pain was 2.3 (95% confidence interval 1.0-4.8; P=0.0363). These findings suggest that at a population level, subthreshold anxiety and pain are strongly related, and worry about health occurs much more commonly than anxiety itself. To our knowledge, this is the first study to explore, specifically, the relationship between pain status and worry about health in older men. In older community-dwelling men, pain was robustly associated with worry about health, highlighting the potential importance of subthreshold anxiety-related psychological factors. %Z FOR Codes: 111706 170106 %0 Journal Article %~ PubMed %A Chen, Js %A Cameron, Id %A Simpson, Jm %A Seibel, Mj %A March, Lm %A Cumming, Rg %A Lord, Sr %A Sambrook, Pn %T Low-trauma fractures indicate increased risk of hip fracture in frail older people. %B Journal of Bone and Mineral Research %D 2011 %C United States %I Wiley-Blackwell Publishing, Inc %V 26 %N 2 %P 428-433 %@ 1523-4681 %X This study aims to investigate the risk of subsequent fractures after low-trauma fracture in frail older people. A total of 1412 elderly residents (mean age 86.2 years, SD 7.0 years, female 77%) were recruited from aged care facilities in Australia. Residents were assessed and then followed for any fracture for 2 years and hip fractures for at least 5 years. Residents with and without a newly acquired fracture in the first 2 years were compared for risk of subsequent hip fracture. Residents with a nonhip fracture in the first 2 years had an increased risk of subsequent hip fracture for about 2.5 years, whereas those with a hip fracture had a similar risk over the whole period compared with those with no fracture. During these 2.5 years, 60, 28, and 6 subsequent hip fractures occurred in the nonfracture group (n = 953), the nonhip fracture group (n = 194), and the hip fracture group (n = 101), respectively, resulting in the probability of subsequent hip fracture of 8.0%, 19.9%, and 10.4%, respectively. Compared with the nonfracture group, the hazard ratio (HR) was 2.82 [95% confidence interval (CI) 1.73-4.59; p or =65 years. WHAT THIS STUDY ADDS * This study has shown that lean body weight can be estimated using three different equations from easily obtainable participant characteristics with results comparable to DXA-derived estimates. * These equations may be useful tools to estimate lean body weight in situations where DXA is not practical. AIMS Lean body weight (LBW) decreases with age while total body fat increases, altering drug pharmacokinetics. The aim of this study was to evaluate the ability of the LBW equation to predict dual-energy X-ray absorptiometry (DXA)-derived fat free mass (FFM(DXA)) in older community-dwelling males compared with that of two existing FFM equations: the Heitmann and Deurenberg equations. METHODS Data were obtained from 1655 older men enrolled in the Concord Health and Ageing in Men Project. The predictive performance of the LBW and FFM equations to predict FFM(DXA) accurately was assessed graphically using Bland-Altman plots and quantitatively for precision and bias using the method of Sheiner and Beal in all participants and in frailty and body mass index (BMI) subgroups. RESULTS The LBW and Heitmann equations consistently overestimated FFM(DXA) for all frailty and BMI subgroups with a mean difference [95% confidence interval (CI)] of 5.5 kg (-0.65, 11.63 kg) and 3.34 kg (-2.84, 9.64 kg), respectively. The Deurenberg equation overestimated FFM(DXA) for overweight participants but underestimated FFM(DXA) for not-frail participants, with a mean difference (95% CI) of 1 kg (-7.23, 5.25 kg) for all participants. CONCLUSION LBW and FFM estimated using these equations give results comparable to DXA-derived FFM. The LBW and Heitmann equations provide a more consistent estimate of FFM(DXA) in all frailty and BMI groups despite the Deurenberg equation having the smallest mean difference. Further studies to determine whether the LBW equation is a clinically useful substitute for weight when determining drug dose in older people appear warranted. %Z FOR Codes: 111502 110308 %0 Journal Article %~ PubMed %A Rochat, Stephane %A Cumming, Robert G %A Blyth, Fiona %A Creasey, Helen %A Handelsman, David %A Le Couteur, David G %A Naganathan, Vasi %A Sambrook, Philip N %A Seibel, Markus J %A Waite, Louise %T Frailty and use of health and community services by community-dwelling older men: the Concord Health and Ageing in Men Project. %B Age and Ageing %D 2010 %C United Kingdom %I Oxford University Press %V 39 %N 2 %P 228-233 %@ 0002-0729 %X BACKGROUND: frailty is a concept used to describe older people at high risk of adverse outcomes, including falls, functional decline, hospital or nursing home admission and death. The associations between frailty and use of specific health and community services have not been investigated. METHODS: the cross-sectional relationship between frailty and use of several health and community services in the last 12 months was investigated in 1,674 community-dwelling men aged 70 or older in the Concord Health and Ageing in Men study, a population-based study conducted in Sydney, Australia. Frailty was assessed using a modified version of the Cardiovascular Health Study criteria. RESULTS: overall, 158 (9.4%) subjects were frail, 679 (40.6%) were intermediate (pre-frail) and 837 (50.0%) were robust. Frailty was associated with use of health and community services in the last 12 months, including consulting a doctor, visiting or being visited by a nurse or a physiotherapist, using help with meals or household duties and spending at least one night in a hospital or nursing home. Frail men without disability in activities of daily living were twice more likely to have seen a doctor in the previous 2 weeks than robust men (adjusted odds ratio 2.04, 95% confidence interval 1.21-3.44), independent of age, comorbidity and socio-economic status. CONCLUSION: frailty is strongly associated with use of health and community services in community-dwelling older men. The high level of use of medical services suggests that doctors and nurses could play a key role in implementation of preventive interventions. %Z FOR Codes: 110308 %0 Journal Article %~ PubMed %A Negin, Joel %A Cumming, Robert G %T HIV infection in older adults in sub-Saharan Africa: extrapolating prevalence from existing data. %B Bulletin of the World Health Organization %D 2010 %C Switzerland %I World Health Organization %V 88 %N 11 %P 847-853 %@ 1564-0604 %X OBJECTIVE: To quantify the number of cases and prevalence of human immunodeficiency virus (HIV) infection among older adults in sub-Saharan Africa. METHODS: We reviewed data from Demographic and Health Surveys (DHS). Although in these surveys all female respondents are ???49??years of age. Little is known about comorbidity and sexual behaviour among HIV+ older adults or about the biological and cultural factors that increase the risk of transmission. HIV services need to be better targeted to respond to the growing needs of older adults living with HIV. %Z FOR Codes: 111702 111799 %0 Journal Article %~ PubMed %A Negin, Joel %A Wariero, James %A Cumming, Robert G %A Mutuo, Patrick %A Pronyk, Paul M %T High Rates of AIDS-Related Mortality Among Older Adults in Rural Kenya. %B Journal of acquired immune deficiency syndromes (1999) %D 2010 %C United States %I Lippincott Williams & Wilkins %V 55 %N 2 %P 239-44 %@ 1944-7884 %X Health challenges faced by older people in developing countries are often neglected amidst a wide range of competing priorities. This is evident in the HIV field where the upper age limit for reporting HIV prevalence remains 49 years. However, the long latency period for HIV infection, and the fact that older people continue to be sexually active, suggests that HIV and AIDS are likely to affect older people. To better understand this, we studied mortality due to AIDS in people aged 50 and older in an area of rural Kenya with high rates of HIV infection. %Z FOR Codes: 111799 %0 Journal Article %~ PubMed %A Cameron, Ian D %A Chen, Jian Sheng %A March, Lyn M %A Simpson, Judy M %A Cumming, Robert G %A Seibel, Markus J %A Sambrook, Philip N %T Hip fracture causes excess mortality owing to cardiovascular and infectious disease in institutionalized older people: A prospective 5-year study. %B Journal of Bone and Mineral Research %D 2010 %C United States %I Wiley-Blackwell Publishing, Inc. %V 25 %N 4 %P 866-872 %@ 1523-4681 %X An increasing risk of death after hip fracture has been well documented, but the duration and causes remain unclear, especially in very frail older people. This is a nested case-control study of 229 hip fracture cases and 229 controls matched by age, gender, institution type, and follow-up period from a cohort of 2005 institutionalized older people. The residents were assessed at baseline and followed up for hip fracture and death for at least 5 years. Time to death was measured from the same time for each case (time of the hip fracture) and the matched control. The study sample consisted of 90 males and 368 females with a mean age of 86 years (range 67 to 102 years). The hazard ratio (HR) of death for the cases compared with the controls was 3.09 [95% confidence interval (CI) 1.83-5.22, p < .001] for the first 3 months, 1.99 (95% CI 1.13-3.51, p = .02) for the period of 3 to 9 months, and 0.88 (95% CI 0.64-1.22, p = .46) for the period beyond 9 months following a fracture, after adjusting for age, gender, institution type, weight, immobility, cognitive function, comorbidities, and number of medications. The main causes of the excess mortality in the first 9 months were infections (HR = 6.66, 95% CI 1.95-22.77, p = .002) for females and cardiac disease (HR = 2.68, 95% CI 1.39-5.15, p = .003) for both males and females. Bisphosphonate use was associated with a reduction in mortality after hip fracture (p = .002). Intensive medical supervision to reduce cardiovascular and infective complications should be provided for frail older people with recent hip fracture to reduce mortality. (c) 2010 American Society for Bone and Mineral Research. %Z FOR Codes: 110308 %0 Book Section %A Mohamed, Alana %A Lal, Sean %A Ho, Joshua WK %A Brown, Angus %A Lui, Rodney %A Nguyen, Lisa %A Yong, Andy %A Su, YingYing %A Braet, Philip %A Dyer, Wayne %A Junius, Frank %A Cumming, Robert %A Freedman, Saul %A Kritharides, Leonard %A dos Remedios, Cristobal %T How to interrogate the cellular immune system in patients with ischemic heart disease %B Myocardial ischemia: Causes, symptoms and treatment %D 2010 %C United States %I Nova Publishers %V %N %P 195-216 %@ 9781608766109 %E Vukovic, Dmitry %E Kiyan, Vladimir %X %Z FOR Codes: 110201 110704 %0 Journal Article %~ PubMed %A Cameron, Ian D %A Murray, Geoff R %A Gillespie, Lesley D %A Robertson, M Clare %A Hill, Keith D %A Cumming, Robert G %A Kerse, Ngaire %T Interventions for preventing falls in older people in nursing care facilities and hospitals. %B Cochrane Database of Systematic Reviews %D 2010 %C United Kingdom %I John Wiley & Sons Ltd. %V 1 %N 1 %P CD005465 %@ 1469-493X %X BACKGROUND: Falls in nursing care facilities and hospitals are common events that cause considerable morbidity and mortality for older people. OBJECTIVES: To assess the effectiveness of interventions designed to reduce falls by older people in nursing care facilities and hospitals. SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2009); the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 2); MEDLINE, EMBASE, and CINAHL (all to November 2008); trial registers and reference lists of articles. SELECTION CRITERIA: Randomised controlled trials of interventions to reduce falls in older people in nursing care facilities or hospitals. Primary outcomes were rate of falls and risk of falling. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. Data were pooled where appropriate. MAIN RESULTS: We included 41 trials (25,422 participants).In nursing care facilities, the results from seven trials testing supervised exercise interventions were inconsistent. This was the case too for multifactorial interventions, which overall did not significantly reduce the rate of falls (rate ratio (RaR) 0.82, 95% CI 0.62 to 1.08; 7 trials, 2997 participants) or risk of falling (risk ratio (RR) 0.93, 95% CI 0.86 to 1.01; 8 trials, 3271 participants). A post hoc subgroup analysis, however, indicated that where provided by a multidisciplinary team, multifactorial interventions reduced the rate of falls (RaR 0.60, 95% CI 0.51 to 0.72; 4 trials, 1651 participants) and risk of falling (RR 0.85, 95% CI 0.77 to 0.95; 5 trials, 1925 participants). Vitamin D supplementation reduced the rate of falls (RaR 0.72, 95% CI 0.55 to 0.95; 4 trials, 4512 participants), but not risk of falling (RR 0.98, 95% CI 0.89 to 1.09; 5 trials, 5095 participants).In hospitals, multifactorial interventions reduced the rate of falls (RaR 0.69, 95% CI 0.49 to 0.96; 4 trials, 6478 participants) and risk of falling (RR 0.73, 95% CI 0.56 to 0.96; 3 trials, 4824 participants). Supervised exercise interventions showed a significant reduction in risk of falling (RR 0.44, 95% CI 0.20 to 0.97; 3 trials, 131 participants). AUTHORS'' CONCLUSIONS: There is evidence that multifactorial interventions reduce falls and risk of falling in hospitals and may do so in nursing care facilities. Vitamin D supplementation is effective in reducing the rate of falls in nursing care facilities. Exercise in subacute hospital settings appears effective but its effectiveness in nursing care facilities remains uncertain. %Z FOR Codes: 110308 %0 Journal Article %~ PubMed %A Clemson, Lindy %A Singh, Maria Fiatarone %A Bundy, Anita %A Cumming, Robert G %A Weissel, Elvina %A Munro, Jo %A Manollaras, Kate %A Black, Deborah %T LiFE Pilot Study: A randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults. %B Australian Occupational Therapy Journal %D 2010 %C Australia %I Wiley-Blackwell Publishing Asia %V 57 %N 1 %P 42-50 %@ 1440-1630 %X Background:??? Exercise as a falls prevention strategy is more complex with people at risk than with the general population. The Lifestyle approach to reducing Falls through Exercise (LiFE) involves embedding balance and lower limb strength training in habitual daily routines. Methods:??? A total of 34 community-residing people aged ???70???years were randomised either into the LiFE programme or into a no-intervention control group and followed up for six months. Inclusion criteria were two or more falls or an injurious fall in the past year. Results:??? There were 12 falls in the intervention group and 35 in the control group. Therelative risk (RR) analysis demonstrated a significant reduction in falls (RR???=???0.23; 0.07-0.83). There were indications that dynamic balance (P???=???0.04 at three???months) and efficacy beliefs (P???=???0.04 at six???months) improved for the LiFE programme participants. In general, secondary physical and health status outcomes, which were hypothesised as potential mediators of fall risk, improved minimally and inconsistently. Conclusions:??? LiFE was effective in reducing recurrent falls in this at-risk sample. However, there were minimal changes in secondary measures. The study was feasible in terms of recruitment, randomisation, blinding and data collection. A larger randomised trial is needed to investigate long-term efficacy, mechanisms of benefit and clinical significance of this new intervention. %Z FOR Codes: 110317 110317 %0 Journal Article %~ PubMed %A Bleicher, K %A Cumming, R G %A Naganathan, V %A Seibel, M J %A Sambrook, P N %A Blyth, F M %A Le Couteur, D G %A Handelsman, D J %A Creasey, H M %A Waite, L M %T Lifestyle factors, medications, and disease influence bone mineral density in older men: findings from the CHAMP study. %B Osteoporosis International %D 2010 %C United Kingdom %I Springer UK %V 22 %N 9 %P 2421-2437 %@ 1433-2965 %X Aging alone is not the only factor accounting for poor bone health in older men. There are modifiable factors and lifestyle choices that may influence bone health and result in higher bone density and lower fracture risk even in very old men. %Z FOR Codes: 110306 %0 Journal Article %~ PubMed %A Hairi, Noran N %A Cumming, Robert G %A Naganathan, Vasi %A Handelsman, David J %A Le Couteur, David G %A Creasey, Helen %A Waite, Louise M %A Seibel, Markus J %A Sambrook, Philip N %T Loss of Muscle Strength, Mass (Sarcopenia), and Quality (Specific Force) and Its Relationship with Functional Limitation and Physical Disability: The Concord Health and Ageing in Men Project. %B Journal of the American Geriatrics Society %D 2010 %C United States %I Wiley-Blackwell Publishing, Inc. %V 58 %N 11 %P 2055-2062 %@ 0002-8614 %X OBJECTIVES: To determine the association between loss of muscle strength, mass, and quality and functional limitation and physical disability in older men. DESIGN: Cross-sectional study of older men participating in the Concord Health and Ageing in Men Project (CHAMP). SETTING: Elderly men living in a defined geographical region in Sydney, Australia. PARTICIPANTS: One thousand seven hundred five community-dwelling men aged 70 and older who participated in the baseline assessments of CHAMP. MEASUREMENTS: Upper and lower extremity strength were measured using dynamometers for grip and quadriceps strength. Appendicular skeletal lean mass was assessed using dual X-ray absorptiometry. Muscle quality was defined as the ratio of strength to mass in upper and lower extremities. For each parameter, subjects in the lowest 20% of the distribution were defined as below normal. Functional limitation was assessed according to self-report and objective lower extremity performance measures. Physical disability was measured according to self-report questionnaire. RESULTS: After adjusting for important confounders, the prevalence ratio (PR) for poor quadriceps strength and self-reported functional limitation was 1.91 (95% confidence interval (CI)=1.10-2.40); for performance-based functional limitation the PR was 1.81 (95% CI=1.45-2.24). The adjusted PR for poor grip strength and physical disability in instrumental activities of daily living (IADLs) was 1.37 (95% CI=1.20-1.56). The adjusted PR for low skeletal lean mass (adjusted for fat mass) and physical disability in basic activities of daily living was 2.08 (95% CI=1.37-3.15). For muscle quality, the PR for lower extremity specific force and functional limitation and physical disability was stronger than upper extremity specific force. CONCLUSION: Muscle strength is the single best measure of age-related muscle change and is associated with physical disability in IADLs and functional limitation. %Z FOR Codes: 111702 %0 Journal Article %~ PubMed %A Boyle, Nichola %A Naganathan, Vasi %A Cumming, Robert G %T Medication and falls: risk and optimization. %B Clinics in Geriatric Medicine %D 2010 %C United States %I WB Saunders Co. %V 26 %N 4 %P 583-605 %@ 1557-8623 %X The association between drugs and falls has been widely studied in the past 3 decades, with increasingly robust evidence of a causal link. Both specific classes of drugs and the total number of drugs taken are associated with falls. This review examines some of the reasons why older people are at greater risk of drug-related adverse events such as falls. We discuss the role of drugs in general and polypharmacy (the concurrent use of multiple drugs) on the risk of falling, with a focus on community-dwelling older people. We critically appraise the evidence that specific classes of drugs, such as benzodiazepines and antidepressants, increase the risk of falling and that falls can be prevented through interventions that target medications. %Z FOR Codes: 110308 110399 %0 Journal Article %~ PubMed %A Sherrington, Catherine %A Lord, Stephen R %A Close, Jacqueline Ct %A Barraclough, Elizabeth %A Taylor, Morag %A Cumming, Robert G %A Herbert, Robert D %T Mobility-related disability three months after aged care rehabilitation can be predicted with a simple tool: an observational study. %B Journal of Physiotherapy %D 2010 %C Australia %I Australian Physiotherapy Association %V 56 %N 2 %P 121-127 %@ 1836-9553 %X Questions: What is the prevalence of mobility-related disability 3 months after discharge from inpatient aged care rehabilitation? Can a clinical tool predict which individuals will experience mobility-related disability 3 months after discharge? Design: Prospective cohort study. Participants: 442 patients newly admitted to two large inpatient rehabilitation units. Outcome measures: Predictors were co-morbidities; pre-admission mobility; and discharge cognition, pain, vision, muscle strength, and mobility. The outcome of interest was inability to climb a flight of stairs and walk 800 m without assistance. Results: 157 participants (36%) were unable to climb a flight of stairs and walk 800 m without assistance prior to hospital admission. Three months after discharge, 254 participants (59%) were unable to complete both tasks. A simple clinical prediction tool based on pre-admission ability to complete the two tasks, co-morbidity on admission, and pre-discharge measurement of: leaning while standing (Maximal Balance Range test), low-contrast visual acuity, and knee extension strength, had good discrimination (area under the receiver-operating characteristic curve [AUC] = 0.77, 95% CI 0.72 to 0.81, bootstrap adjusted AUC = 0.77) and was well calibrated. This tool provided substantially better (p < 0-001) discrimination than pre-admission ability alone (AUC = 0.64, 95% CI 0.60 to 0.68, bootstrap adjusted AUC = 0.64). The observed risk of persisting disability ranged from 13% in those with no predictors to 93% in those with 5 predictors. Conclusion: Mobility-related disability 3 months after discharge from inpatient rehabilitation is common and can be predicted easily with a clinical tool. %Z FOR Codes: 110321 %0 Journal Article %~ PubMed %A Lusk, M J %A Konecny, P %A Naing, Z W %A Garden, F L %A Cumming, R G %A Rawlinson, W D %T Mycoplasma genitalium is associated with cervicitis and HIV infection in an urban Australian STI clinic population. %B Sexually Transmitted Infections %D 2010 %C United Kingdom %I BMJ Group %V 87 %N 2 %P 107-109 %@ 1368-4973 %X To investigate the prevalence of the genital mollicutes, Mycoplasma genitalium (MG), Mycoplasma hominis (MH), Ureaplasma urealyticum (UU) and Ureaplasma parvum (UP), and their associations with cervicitis in a sexually transmitted infection (STI) clinic population. Clinical correlates of MG infection were also assessed. %Z FOR Codes: 110899 %0 Journal Article %~ PubMed %A Sambrook, P N %A Cameron, I D %A Chen, J S %A March, L M %A Simpson, J M %A Cumming, R G %A Seibel, M J %T Oral bisphosphonates are associated with reduced mortality in frail older people: a prospective five-year study. %B Osteoporosis International %D 2010 %C United Kingdom %I Springer UK %V 22 %N 9 %P 2551-2556 %@ 1433-2965 %X In a study of 2005 institutionalized older people, use of oral bisphosphonates was associated with a 27% reduction in risk of death compared to non-users after adjusting for potential confounders. %Z FOR Codes: 110308 %0 Journal Article %~ PubMed %A Hairi, Noran N %A Bulgiba, Awang %A Cumming, Robert G %A Naganathan, Vasi %A Mudla, Izzuna %T Prevalence and correlates of physical disability and functional limitation among community dwelling older people in rural Malaysia, a middle income country. %B BMC Public Health %D 2010 %C United Kingdom %I BioMed Central Ltd. %V 10 %N %P 492 %@ 1471-2458 %X BACKGROUND: The prevalence and correlates of physical disability and functional limitation among older people have been studied in many developed countries but not in a middle income country such as Malaysia. The present study investigated the epidemiology of physical disability and functional limitation among older people in Malaysia and compares findings to other countries. METHODS: A population-based cross sectional study was conducted in Alor Gajah, Malacca. Seven hundred and sixty five older people aged 60 years and above underwent tests of functional limitation (Tinetti Performance Oriented Mobility Assessment Tool). Data were also collected for self reported activities of daily living (ADL) using the Barthel Index (ten items). To compare prevalence with other studies, ADL disability was also defined using six basic ADL''s (eating, bathing, dressing, transferring, toileting and walking) and five basic ADL''s (eating, bathing, dressing, transferring and toileting). RESULTS: Ten, six and five basic ADL disability was reported by 24.7% (95% CI 21.6-27.9), 14.4% (95% CI 11.9-17.2) and 10.6% (95% CI 8.5-13.1), respectively. Functional limitation was found in 19.5% (95% CI 16.8-22.5) of participants. Variables independently associated with 10 item ADL disability physical disability, were advanced age (> or = 75 years: prevalence ratio (PR) 7.9; 95% CI 4.8-12.9), presence of diabetes (PR 1.8; 95% CI 1.4-2.3), stroke (PR 1.5; 95% CI 1.1-2.2), depressive symptomology (PR 1.3; 95% CI 1.1-1.8) and visual impairment (blind: PR 2.0; 95% CI 1.1-3.6). Advancing age (> or = 75 years: PR 3.0; 95% CI 1.7-5.2) being female (PR 2.7; 95% CI 1.2-6.1), presence of arthritis (PR 1.6; 95% CI 1.2-2.1) and depressive symptomology (PR 2.0; 95% CI 1.5-2.7) were significantly associated with functional limitation. CONCLUSIONS: The prevalence of physical disability and functional limitation among older Malaysians appears to be much higher than in developed countries but is comparable to developing countries. Associations with socio-demographic and other health related variables were consistent with other studies. %Z FOR Codes: 111799 %0 Journal Article %~ PubMed %A Karpa, Michael J %A Gopinath, Bamini %A Rochtchina, Elena %A Jie Jin Wang, Z %A Cumming, Robert G %A Sue, Carolyn M %A Mitchell, Paul %T Prevalence and neurodegenerative or other associations with olfactory impairment in an older community. %B Journal of Aging and Health %D 2010 %C United States %I Sage Publications, Inc. %V 22 %N 2 %P 154-168 %@ 0898-2643 %X OBJECTIVE: To determine the prevalence of olfactory impairment and its associations with neurodegenerative and other conditions in older adults. METHOD: 1,636 participants (>/=60 years) enrolled in the Blue Mountains Eye Study (2002-2004) were analyzed. Olfaction was assessed by the San Diego Odor Identification Test and used to classify mild impairment (4 or 5), moderate impairment (or=70 years participating in the Concord Health and Ageing in Men Project, a population-based study of urban older Australian men. METHODS: data were collected between January 2005 and June 2007, and the participation rate was 47%. Data on demographics, medical history and from the 12-item Short Form Health Survey (SF-12) and International Consultation on Incontinence Questionnaire were collected. Urinary incontinence was defined as urinary leakage at least two times a week over the past 4 weeks. RESULTS: the prevalence of urinary incontinence was 14.8%, increasing from 12.0% for men aged 70-74 years old to 16.3% for those aged >or=90 years, with urgency incontinence being the most frequent type of urinary incontinence. Daily urine leakage was reported by 3% of men. Men with incontinence had lower overall SF-12 scores with greater impact on the physical (PCS) than the mental (MCS) components of that scale. After adjusting for age, number of co-morbidities, enlarged prostate and prostate cancer, men with incontinence had worse PCS (43.6 vs 45.9) and MCS scores (52.2 vs 54.6) compared with continent men. CONCLUSION: urinary incontinence is common among older community-dwelling men and is associated with worse quality of life with greater impact on physical than mental factors. As the population ages, urinary incontinence prevalence will increase and increased resources will be needed to address this growing problem. %Z FOR Codes: 111702 110312 110308 %0 Journal Article %~ PubMed %A Sureshkumar, Premala %A Jones, Mike %A Cumming, Robert %A Craig, Jonathan %T A Population Based Study of 2,856 School-Age Children With Urinary Incontinence. %B The Journal of urology %D 2009 %C United States %I Elsevier %V 181 %N 2 %P 808-15; discussion 815-6 %@ 0022-5347 %X We estimated the spectrum and risk factors for daytime urinary incontinence in school-age children. %Z FOR Codes: 1114 %0 Journal Article %~ PubMed %A Miller, Michelle D %A Thomas, Jolene M %A Cameron, Ian D %A Chen, Jian Sheng %A Sambrook, Philip N %A March, Lyn M %A Cumming, Robert G %A Lord, Stephen R %T BMI: a simple, rapid and clinically meaningful index of under-nutrition in the oldest old? %B The British Journal of Nutrition %D 2009 %C United Kingdom %I Cambridge University Press %V 101 %N 9 %P 1300-1305 %@ 0007-1145 %X BMI is commonly used as a sole indicator for the assessment of nutritional status. While it is a good predictor of morbidity and mortality among young and middle-aged adults, its predictive ability among the oldest old remains unclear. The objective of the present study was to investigate the relationship between BMI and risk of falls, fractures and all-cause mortality among older Australians in residential aged care facilities. One thousand eight hundred and forty-six residents of fifty-two nursing homes and thirty hostels in northern Sydney, Australia, participated in the present study. Baseline weight and height were measured and BMI (kg/m2) calculated. For 2 years following the baseline measurements, incidence and date of all falls and fractures were recorded by research nurses who visited the facilities regularly and date of death was documented based on the participants'' records at each facility. Cox proportional hazards regression models were calculated to determine the relationship between baseline BMI and time to fall, fracture or death, within 2 years following the baseline measures taken to be the censoring date. After adjustments were made for age, sex and level of care, low BMI (,22 kg/m2) increased the risk of fracture by 38% (hazard ratio = 1.38, 95% CI 1.11, 1.73) and all-cause mortality by 52% (hazard ratio = 1.52, 95% CI 1.30, 1.79). The magnitude of this effect was only slightly reduced when adjustments were further made to incorporate cognition, number of medications, falls and fracture in the subsequent 2-year period. In conclusion, BMI has predictive ability in the area of fracture and all-cause mortality for residents of aged care facilities. It is a simple and rapid indicator of nutritional status rendering it a useful nutrition screen and goal for nutrition intervention. %Z FOR Codes: 111199 %0 Journal Article %~ PubMed %A Henschke, Nicholas %A Maher, Christopher G %A Refshauge, Kathryn M %A Herbert, Robert D %A Cumming, Robert G %A Bleasel, Jane %A York, John %A Das, Anurina %A McAuley, James H %T Characteristics of patients with acute low back pain presenting to primary care in Australia. %B The Clinical Journal of Pain %D 2009 %C United States %I Lippincott Williams & Wilkins %V 25 %N 1 %P 5-11 %@ 1536-5409 %X OBJECTIVES: This study aimed to provide a comprehensive profile of a representative sample of patients with acute low back pain drawn from the primary care setting. A secondary aim was to determine whether patient characteristics are associated with pain intensity or disability at the initial consultation. METHODS: A total of 1172 consecutive patients with acute low back pain presenting to clinics of primary care practitioners (general practitioners, physiotherapists, and chiropractors) in Australia were recruited. Pain intensity and level of disability were measured at the first consultation, and a range of other variables were measured to describe the patient''s characteristics. The characteristics were then grouped into 7 distinct factors: demographic, social, cultural, general health, psychologic, past low back pain history, and current low back pain history. Hierarchical linear regression models were used to determine each factor''s independent relationship with pain intensity and disability. RESULTS: The majority of patients reported having had a previous episode of low back pain (75.7%), and that the current episode was of sudden onset (76.7%). Only a small proportion (14.3%) had compensable back pain. Pain intensity and disability were associated with each other (P<0.01), current low back pain history (P<0.01), and psychologic (P<0.01) characteristics. DISCUSSION: In a representative sample of acute low back pain patients in primary care, we found that the profile included only a small proportion of patients with compensable low back pain. Those without compensation were more likely to remain at work despite low back pain. Psychologic and other patient characteristics were associated with pain intensity and level of disability at the initial consultation. %Z FOR Codes: 111717 %0 Journal Article %~ PubMed %A Anstey, Kaarin J %A Byles, Julie E %A Luszcz, Mary A %A Mitchell, Paul %A Steel, David %A Booth, Heather %A Browning, Colette %A Butterworth, Peter %A Cumming, Robert G %A Healy, Judith %A Windsor, Timothy D %A Ross, Lesley %A Bartsch, Lauren %A Burns, Richard A %A Kiely, Kim %A Birrell, Carole L %A Broe, Gerald A %A Shaw, Jonathan %A Kendig, Hal %T Cohort profile: The Dynamic Analyses to Optimize Ageing (DYNOPTA) project. %B International journal of epidemiology %D 2009 %C United Kingdom, Egypt %I Oxford University Press %V 39 %N 1 %P 44-51 %@ 0300-5771 %X %Z FOR Codes: 111706 %0 Journal Article %~ PubMed %A Karpa, Michael J %A Mitchell, Paul %A Beath, Ken %A Rochtchina, Elena %A Cumming, Robert G %A Wang, Jie Jin %A , Blue Mountains Eye Study %T Direct and indirect effects of visual impairment on mortality risk in older persons. %B Archives of Ophthalmology %D 2009 %C United States %I American Medical Association %V 127 %N 10 %P 1347-1353 %@ 0093-0326 %X OBJECTIVE: To investigate pathways from visual impairment to increased all-cause mortality in older persons. METHODS: The Blue Mountains Eye Study examined 3654 persons 49 years and older (82.4% response) during 1992-1994 and after 5 and 10 years. Australian National Death Index data confirmed deaths until 2005. Visual impairment was defined as presenting, correctable, and noncorrectable, using better-eye visual acuity. Associations between visual impairment and mortality risk were estimated using Cox regression and structural equation modeling. RESULTS: After 13 years, 1273 participants had died. Adjusting for mortality risk markers, higher mortality was associated with noncorrectable visual impairment (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.04-1.75). This association was stronger for ages younger than 75 years (HR, 2.58; 95% CI, 1.42-4.69). Structural equation modeling revealed greater effects of noncorrectable visual impairment on mortality risk (HR, 5.25; 95% CI, 1.97-14.01 for baseline ages <75 years), with both direct (HR, 2.16; 95% CI, 1.11-4.23) and indirect (HR, 2.43; 95% CI, 1.17-5.03) effects. Of mortality risk markers examined, only disability in walking demonstrated a significant indirect pathway for the link between visual impairment and mortality. CONCLUSIONS: Visual impairment predicted mortality by both direct and indirect pathways, particularly for persons younger than 75 years with noncorrectable visual impairment. Disability in walking, which can substantially influence general health, represented a major indirect pathway. %Z FOR Codes: 111301 111706 111702 %0 Journal Article %~ PubMed %A Gnjidic, Danijela %A Cumming, Robert G %A Le Couteur, David G %A Handelsman, David J %A Naganathan, Vasi %A Abernethy, Darrell R %A Hilmer, Sarah N %T Drug Burden Index and physical function in older Australian men. %B British Journal of Clinical Pharmacology %D 2009 %C United Kingdom %I Wiley-Blackwell Publishing Ltd. %V 68 %N 1 %P 97-105 %@ 0306-5251 %X AIMS: This study evaluated the associations of physical performance and functional status measures with the Drug Burden Index in older Australian men. The Drug Burden Index is a measure of total exposure to anticholinergic and sedative medications that incorporates the principles of dose-response and maximal effect. METHODS: A cross-sectional survey was performed on community-dwelling older men enrolled in The Concord Health and Ageing in Men Project, Sydney, Australia. Outcomes included chair stands, walking speed over 6 m, 20-cm narrow walk speed, balance, grip strength and Instrumental Activities of Daily Living score (IADLs). RESULTS: The study population consisted of 1705 men (age 76.9 +/- 5.5 years). Of the 1527 (90%) participants who reported taking medications, 21% were exposed to anticholinergic and 13% to sedative drugs. The average Drug Burden Index in the study population was 0.18 +/- 0.35. After adjusting for confounders (sociodemographics, comorbidities, cognitive impairment, depression), Drug Burden Index was associated with slower walking speed (P < 0.05), slower narrow walk speed (P < 0.05), balance difficulty (P < 0.01), grip weakness (P < 0.01) and poorer performance on IADLs (P < 0.05). Associations with physical performance and function were stronger for the sedative than for the anticholinergic component of the Drug Burden Index. CONCLUSIONS: Higher Drug Burden Index is associated with poorer physical performance and functional status in community-dwelling older Australian men. The Drug Burden Index has broad applicability as a tool for assessing the impact of medications on functions that determine independence in older people. %Z FOR Codes: 111503 110308 %0 Journal Article %~ PubMed %A Dean, Catherine M %A Rissel, Chris %A Sharkey, Michelle %A Sherrington, Catherine %A Cumming, Robert G %A Barker, Ruth N %A Lord, Stephen R %A O'Rourke, Sandra D %A Kirkham, Catherine %T Exercise intervention to prevent falls and enhance mobility in community dwellers after stroke: a protocol for a randomised controlled trial. %B BMC Neurology %D 2009 %C United Kingdom %I BioMed Central Ltd. %V 9 %N 0 %P 38 %@ 1471-2377 %X BACKGROUND: Stroke is the most common disabling neurological condition in adults. Falls and poor mobility are major contributors to stroke-related disability. Falls are more frequent and more likely to result in injury among stroke survivors than among the general older population. Currently there is good evidence that exercise can enhance mobility after stroke, yet ongoing exercise programs for general community-based stroke survivors are not routinely available. This randomised controlled trial will investigate whether exercise can reduce fall rates and increase mobility and physical activity levels in stroke survivors. METHODS AND DESIGN: Three hundred and fifty community dwelling stroke survivors will be recruited. Participants will have no medical contradictions to exercise and be cognitively and physically able to complete the assessments and exercise program. After the completion of the pre-test assessment, participants will be randomly allocated to one of two intervention groups. Both intervention groups will participate in weekly group-based exercises and a home program for twelve months. In the lower limb intervention group, individualised programs of weight-bearing balance and strengthening exercises will be prescribed. The upper limb/cognition group will receive exercises aimed at management and improvement of function of the affected upper limb and cognition carried out in the seated position. The primary outcome measures will be falls (measured with 12 month calendars) and mobility. Secondary outcome measures will be risk of falling, physical activity levels, community participation, quality of life, health service utilisation, upper limb function and cognition. DISCUSSION: This study aims to establish and evaluate community-based sustainable exercise programs for stroke survivors. We will determine the effects of the exercise programs in preventing falls and enhancing mobility among people following stroke. This program, if found to be effective, has the potential to be implemented within existing community services. TRIAL REGISTRATION: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12606000479505). %Z FOR Codes: 111714 %0 Journal Article %~ PubMed %A Kanthan, Gowri L %A Wang, Jie Jin %A Burlutsky, George %A Rochtchina, Elena %A Cumming, Robert G %A Mitchell, Paul %T Exogenous oestrogen exposure, female reproductive factors and the long-term incidence of cataract: the Blue Mountains Eye Study. %B Acta ophthalmologica %D 2009 %C Denmark, United King %I Wiley-Blackwell Munksgaard %V 88 %N 0 %P 773-8 %@ 1755-3768 %X To assess the association between exogenous oestrogen exposure, female reproductive factors and the long-term incidence of cataract. %Z FOR Codes: 111706 111301 %0 Journal Article %~ PubMed %A Gillespie, Lesley D %A Robertson, M Clare %A Gillespie, William J %A Lamb, Sarah E %A Gates, Simon %A Cumming, Robert G %A Rowe, Brian H %T Interventions for preventing falls in older people living in the community. %B Cochrane Database of Systematic Reviews %D 2009 %C United Kingdom %I John Wiley & Sons Ltd. %V 0 %N 2 %P CD007146 %@ 1469-493X %X Approximately 30% of people over 65 years of age living in the community fall each year. %Z FOR Codes: 111702 %0 Journal Article %~ Isi %A Williams, P. C. M. %A Martina, A. %A Cumming, R. G. %A Hall, J. %T Malaria Prevention in Sub-Saharan Africa: A Field Study in Rural Uganda %B Journal of Community Health %D 2009 %C United States %I Springer New York LLC %V 34 %N %P 288-294 %@ 0094-5145 %X %Z FOR Codes: 60506 %0 Journal Article %~ PubMed %A Sherrington, Catherine %A Lord, Stephen R %A Vogler, Constance M %A Close, Jacqueline C T %A Howard, Kirsten %A Dean, Catherine M %A Clemson, Lindy %A Barraclough, Elizabeth %A Ramsay, Elisabeth %A O'Rourke, Sandra D %A Cumming, Robert G %T Minimising disability and falls in older people through a post-hospital exercise program: a protocol for a randomised controlled trial and economic evaluation. %B BMC Geriatrics %D 2009 %C United Kingdom %I BioMed Central Ltd. %V 9 %N %P 8 %@ 1471-2318 %X BACKGROUND: Disability and falls are particularly common among older people who have recently been hospitalised. There is evidence that disability severity and fall rates can be reduced by well-designed exercise interventions. However, the potential for exercise to have these benefits in older people who have spent time in hospital has not been established.This randomised controlled trial will investigate the effects of a home-based exercise program on disability and falls among people who have had recent hospital stays. The cost-effectiveness of the exercise program from the health and community service provider''s perspective will be established. In addition, predictors for adherence with the exercise program will be determined. METHODS AND DESIGN: Three hundred and fifty older people who have recently had hospital stays will participate in the study. Participants will have no medical contraindications to exercise and will be cognitively and physically able to complete the assessments and exercise program.The primary outcome measures will be mobility-related disability (measured with 12 monthly questionnaires and the Short Physical Performance Battery) and falls (measured with 12 monthly calendars). Secondary measures will be tests of risk of falling, additional measures of mobility, strength and flexibility, quality of life, fall-related self efficacy, health-system and community-service contact, assistance from others, difficulty with daily tasks, physical activity levels and adverse events.After discharge from hospital and completion of all hospital-related treatments, participants will be randomly allocated to an intervention group or usual-care control group. For the intervention group, an individualised home exercise program will be established and progressed during ten home visits from a physiotherapist. Participants will be asked to exercise at home up to 6 times per week for the 12-month study period. DISCUSSION: The study will determine the impact of this exercise intervention on mobility-related disability and falls in older people who have been in hospital as well as cost-effectiveness and predictors of adherence to the program. Thus, the results will have direct implications for the design and implementation of interventions for this high-risk group of older people. TRIAL REGISTRATION: The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry ACTRN12607000563460. %Z FOR Codes: 110308 %0 Journal Article %~ PubMed %A Henschke, Nicholas %A Maher, Christopher G %A Refshauge, Kathryn M %A Herbert, Robert D %A Cumming, Robert G %A Bleasel, Jane %A York, John %A Das, Anurina %A McAuley, James H %T Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. %B Arthritis and rheumatism %D 2009 %C United States %I John Wiley & Sons, Inc. %V 60 %N 10 %P 3072-3080 %@ 0004-3591 %X OBJECTIVE: To determine the prevalence of serious pathology in patients presenting to primary care settings with acute low back pain, and to evaluate the diagnostic accuracy of recommended "red flag" screening questions. METHODS: An inception cohort of 1,172 consecutive patients receiving primary care for acute low back pain was recruited from primary care clinics in Sydney, Australia. At the initial consultation, clinicians recorded responses to 25 red flag questions and then provided an initial diagnosis. The reference standard was a 12-month followup supplemented with a specialist review of a random subsample of participants. RESULTS: There were 11 cases (0.9%) of serious pathology, including 8 cases of fracture. Despite the low prevalence of serious pathology, most patients (80.4%) had at least 1 red flag (median 2, interquartile range 1-3). Only 3 of the red flags for fracture recommended for use in clinical guidelines were informative: prolonged use of corticosteroids, age >70 years, and significant trauma. Clinicians identified 5 of the 11 cases of serious pathology at the initial consultation and made 6 false-positive diagnoses. The status of a diagnostic prediction rule containing 4 features (female sex, age >70 years, significant trauma, and prolonged use of corticosteroids) was moderately associated with the presence of fracture (the area under the curve for the rule score was 0.834 [95% confidence interval 0.654-1.014]; P = 0.001). CONCLUSION: In patients presenting to a primary care provider with back pain, previously undiagnosed serious pathology is rare. The most common serious pathology observed was vertebral fracture. Approximately half of the cases of serious pathology were identified at the initial consultation. Some red flags have very high false-positive rates, indicating that, when used in isolation, they have little diagnostic value in the primary care setting. %Z FOR Codes: 110399 %0 Journal Article %~ PubMed %A Chen, Jian Sheng %A Sambrook, Philip N %A Simpson, Judy M %A Cameron, Ian D %A Cumming, Robert G %A Seibel, Markus J %A Lord, Stephen R %A March, Lyn M %T Risk factors for hip fracture among institutionalised older people. %B Age and Ageing %D 2009 %C United Kingdom %I Oxford University Press %V 38 %N 4 %P 429-434 %@ 0002-0729 %X BACKGROUND: risk factors for hip fracture in community-dwelling individuals have been extensively studied, but there have been fewer studies of institutionalised older people. METHODS: a total of 1,894 older people (1,433 females, 461 males; mean age 86 years, SD 7.1 years) were recruited from 52 nursing homes and 30 intermediate-care nursing care facilities in Australia during March 1999 and February 2003. We assessed clinical risk factors for hip fracture and skeletal fragility by calcaneus broadband ultrasound attenuation (BUA) at baseline and then followed up for fracture for 4 years. Hip fractures were validated by x-ray reports. Survival analysis with age as a time-dependent covariate was used to analyse the data. RESULTS: during a mean follow-up period of 2.65 years (SD 1.38), 201 hip fractures in 191 residents were recorded, giving an overall hip fracture incidence rate of 4.0% per person year (males 3.6% and females 4.1%). Residents living in intermediate-care hostels had a higher crude hip fracture rate (4.6% vs. 3.0%) than those living in high-care nursing homes. In multivariate analysis, an increased risk of hip fracture was significantly associated with older age, cognitive impairment, a history of fracture since age 50, lower body weight, longer lower leg length and poorer balance in intermediate-care hostel residents, but not with lower BUA. CONCLUSIONS: institutionalised older people, who are at a higher risk of hip fracture than community-dwelling individuals, have differences in some risk factors for hip fracture that should be considered in targeting intervention programs. %Z FOR Codes: 110306 110322 110308 %0 Journal Article %~ PubMed %A Sureshkumar, Premala %A Jones, Mike %A Cumming, Robert G %A Craig, Jonathan C %T Risk factors for urinary tract infection in children: a population-based study of 2856 children. %B Journal of Paediatrics and Child Health %D 2009 %C United Kingdom %I Wiley-Blackwell Publishing Ltd. %V 45 %N 3 %P 87-97 %@ 1440-1754 %X AIM: To identify risk factors for urinary tract infection (UTI) in children to inform the development of preventative strategies. METHOD: A validated questionnaire covering demographic factors, perinatal, developmental, bowel and urinary history was sent to a cross-sectional sample of parents of elementary school children randomly selected from the first 4 years of school. UTI was ascertained by parental report, verified by cross-referencing with microbiological reports for all positive cases and 50 randomly selected negative cases. RESULTS: Parents of 2856 children (mean age 7.3 years, range 4.8-12.8 years) responded. A total of 3.6% of children had a bacteriologically verified UTI, compared with 12.6% by parental report alone. Multivariate polychotomous logistic regression showed that a history of structural kidney abnormalities (odds ratio (OR) 15.7, 95% confidence interval 8.1-30.4), daytime incontinence (OR 2.6, 1.6-4.5), female gender (OR 2.4, 1.5-3.8), and encopresis (OR 1.9, 1.1-3.4) were independently associated with UTI. Daytime incontinence increased risk more in boys (8.3% vs. 1.2%) than girls (8.1% vs. 4.6%), and kidney problems increased risk in older compared with younger children (29% vs. 2% in > or =8 year olds, 0% vs. 4% in 4-6 year olds). CONCLUSIONS: Parents over-report UTI by about threefold. Effective treatment of daytime urinary incontinence and encopresis may prevent UTI in children, especially boys. %Z FOR Codes: 1114 %0 Journal Article %~ PubMed %A Chen, J %A March, L %A Cumming, R %A Cameron, I %A Simpson, J %A Lord, S %A Sambrook, P %T Role of quantitative ultrasound to predict fracture among institutionalised older people with a history of fracture. %B Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA %D 2009 %C United Kingdom %I Springer-Verlag %V 20 %N 0 %P 105-12 %@ 0937-941X %X The fracture predictive value of quantitative ultrasound (QUS) may be modified by previous fracture status. Non-significant associations between QUS parameters and fracture risk were observed among frail older people with a history of fracture. These findings suggest that QUS measurements for frail older people might be more useful in those without a fracture history. %Z FOR Codes: 110308 %0 Journal Article %~ PubMed %A Shanley, Christopher %A Whitmore, Elizabeth %A Khoo, Angela %A Cartwright, Colleen %A Walker, Amanda %A Cumming, Robert G %T Understanding how advance care planning is approached in the residential aged care setting: A continuum model of practice as an explanatory device. %B Australasian Journal on Ageing %D 2009 %C Australia %I Wiley-Blackwell Publishing Asia %V 28 %N 4 %P 211-215 %@ 1741-6612 %X Objective: To gain an understanding of how advance care planning (ACP) is understood and approached by managers of residential aged care facilities. Methods: Qualitative interviews with managers from 41 residential aged care facilities from South Western Sydney, Australia. Content and thematic analysis of interview transcripts. Results: The majority of facilities do not have a systematic approach to ACP, but tend to initiate discussions about end-of-life treatments late in a resident''s illness. There are varying degrees to which these discussions are used in ongoing care planning or made explicit if the resident is transferred to hospital. A number of factors are identified that support the implementation of ACP. Conclusion: A continuum model of practice is proposed that describes four broad approaches to practice under the domains of initiation, scope, follow-up and documentation of ACP as well as the organisational leadership adopted around ACP. %Z FOR Codes: 111718 %0 Journal Article %~ PubMed %A Wang, Jie Jin %A Rochtchina, Elena %A Tan, Ava Grace %A Cumming, Robert G %A Leeder, Stephen R %A Mitchell, Paul %T Use of inhaled and oral corticosteroids and the long-term risk of cataract. %B Ophthalmology %D 2009 %C United States %I Elsevier Inc. %V 116 %N 4 %P 652-657 %@ 0161-6420 %X OBJECTIVE: Longitudinal associations between inhaled and oral corticosteroid use and 10-year incident cataract were examined. DESIGN: Population-based cohort study. PARTICIPANTS: The Blue Mountains Eye Study examined 3654 Australians aged 49 years or older (1992-1994); 2335 were re-examined after 5 years and 1952 were re-examined after 10 years (75.1%, 75.6% of survivors, respectively). METHODS: Questionnaires were used to assess inhaled and oral corticosteroid use at baseline. Past users were participants who had used these medications for at least 1 month in the past but were not using them at baseline. Current users were those who were using these medications at baseline and had been doing so for at least 1 month. Ever users combined past and current users. MAIN OUTCOME MEASURES: Lens photographs were obtained at each examination and graded for nuclear, cortical, and posterior subcapsular (PSC) cataracts following the Wisconsin Cataract Grading System. Participants without a specific subtype of cataract in either eye at baseline were considered to be at risk of that type of cataract developing over the 10-year follow-up. Incidence of each cataract subtype in this report refers to person-specific, first-eye incidence. RESULTS: At baseline, 103 participants were current and 120 past users of inhaled corticosteroids, and 31 were current and 147 were past users of oral corticosteroids. Current users had a greater risk of developing PSC cataract after adjustment for age and gender (inhaled: odds ratio [OR] 2.50, 95% confidence interval [CI] 1.33-4.69; oral: OR 4.11; 95% CI 1.67-10.08) and nuclear cataract (inhaled: OR 2.04, 95% CI 1.21-3.43; oral: OR 3.45, 95% CI 1.26-9.43) but not cortical cataract. Interaction between inhaled and oral corticosteroid use was significant for PSC (P = 0.01) and nuclear (P = 0.02) cataract incidence. In subgroup analyses, only individuals who used both inhaled and oral steroids were at increased risk of PSC cataract (after adjusting for age, sex, smoking, hypertension, diabetes, and education levels; OR 4.76, 95% CI 2.59-8.74), comparing ever users of both with users of neither. CONCLUSIONS: High long-term risks of PSC and nuclear cataract development were found for users of combined inhaled and oral corticosteroids. %Z FOR Codes: 111706 111301 %0 Journal Article %~ PubMed %A Swamy, Brighu Narayan %A Cumming, Robert G %A Ivers, Rebecca %A Clemson, Lindy %A Cullen, John %A Hayes, Maggie F %A Tanzer, Michael %A Mitchell, Paul R %T Vision screening for frail older people: a randomized trial. %B The British journal of ophthalmology %D 2009 %C United Kingdom %I BMJ Publishing Group %V 93 %N 0 %P 736-41 %@ 1468-2079 %X To assess the effects of vision screening, and subsequent management of visual impairment, on visual acuity and vision-related quality of life among frail older people. %Z FOR Codes: 111301 111706 %0 Journal Article %~ PubMed %A Tan, Ava Grace %A Mitchell, Paul %A Flood, Victoria M %A Burlutsky, George %A Rochtchina, Elena %A Cumming, Robert G %A Wang, Jie Jin %T Antioxidant nutrient intake and the long-term incidence of age-related cataract: the Blue Mountains Eye Study. %B The American journal of clinical nutrition %D 2008 %C United States %I American Society for Clinical Nutrition, Inc %V 87 %N 6 %P 1899-905 %@ 0002-9165 %X BACKGROUND: Oxidative stress has been implicated in cataractogenesis. Long-term intake of antioxidants may offer protection against cataract. OBJECTIVE: We investigated relations between antioxidant nutrient intakes measured at baseline and the 10-y incidence of age-related cataract. DESIGN: During 1992-1994, 3654 persons aged >or=49 y attended baseline examinations of the Blue Mountains Eye Study (82.4% response). Of these persons, 2464 (67.4%) participants were followed >or=1 time after the baseline examinations (at either 5 or 10 y). At each examination, lens photography was performed and questionnaires were administered, including a 145-item semiquantitative food-frequency questionnaire. Antioxidants, including beta-carotene, zinc, and vitamins A, C, and E, were assessed. Cataract was assessed at each examination from lens photographs with the use of the Wisconsin Cataract Grading System. Nuclear cataract was defined for opacity greater than standard 3. Cortical cataract was defined as cortical opacity >or= 5% of the total lens area, and posterior subcapsular (PSC) cataract was defined as the presence of any such opacity. RESULTS: Participants with the highest quintile of total intake (diet + supplements) of vitamin C had a reduced risk of incident nuclear cataract [adjusted odds ratio (OR): 0.55; 95% CI: 0.36, 0.86]. An above-median intake of combined antioxidants (vitamins C and E, beta-carotene, and zinc) was associated with a reduced risk of incident nuclear cataract (OR: 0.51; 95% CI: 0.34, 0.76). Antioxidant intake was not associated with incident cortical or PSC cataract. CONCLUSION: Higher intakes of vitamin C or the combined intake of antioxidants had long-term protective associations against development of nuclear cataract in this older population. %Z FOR Codes: 111301 111706 %0 Journal Article %~ PubMed %A Blyth, Fiona M %A Cumming, Robert G %A Brnabic, Alan J M %A Cousins, Michael J %T Caregiving in the presence of chronic pain. %B The journals of gerontology. Series A, Biological sciences and medical sciences %D 2008 %C United States %I Oxford University Press %V 63 %N 4 %P 399-407 %@ 1079-5006 %X BACKGROUND: Chronic pain sufferers and caregivers share the risk of higher levels of psychological distress and adverse effects on well-being. This study examined the joint impact of chronic pain and primary caregiving on older people. METHODS: Data came from the New South Wales (NSW) Older People''s Health Survey 1999, a state-wide general health survey of over 9000 NSW residents 65 years old or older. Using survey logistic regression modeling, we examined the relationship between chronic pain with different levels of disability, caregiving status, self-reported physical functioning, and two dependent variables--poor/fair self-rated health and psychological distress. RESULTS: Caregivers with chronic pain reported more psychological distress and poorer self-rated health than caregivers without pain, when both were compared to noncaregivers without pain (age-adjusted and sex-adjusted odds ratios [ORs] for caregivers with pain were 3.4 and 2.8, respectively, both p <.001). Caregivers with pain and noncaregivers with pain had similar patterns of results. Physical function significantly declined for both caregivers and noncaregivers with pain when compared with noncaregivers without pain. CONCLUSIONS: Older people coping with caregiving and chronic pain are a potentially vulnerable group. Chronic pain status should be ascertained in older people who are caregivers, with particular attention to the issue of caregiver psychological distress and physical well-being. %Z FOR Codes: 110308 1117 %0 Journal Article %~ PubMed %A Cumming, Robert G %A Sherrington, Catherine %A Lord, Stephen R %A Simpson, Judy M %A Vogler, Constance %A Cameron, Ian D %A Naganathan, Vasi %A , Prevention of Older People's Injury Falls Prevention in Hospitals Research Group %T Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital. %B BMJ (Clinical research ed.) %D 2008 %C United Kingdom %I BMJ Publishing Group %V 336 %N 7647 %P 758-760 %@ 1468-5833 %X OBJECTIVE: To determine the efficacy of a targeted multifactorial falls prevention programme in elderly care wards with relatively short lengths of stay. DESIGN: Cluster randomised trial. SETTING: 24 elderly care wards in 12 hospitals in Sydney, Australia. PARTICIPANTS: 3999 patients, mean age 79 years, with a median hospital stay of seven days. INTERVENTIONS: A nurse and physiotherapist each worked for 25 hours a week for three months in all intervention wards. They provided a targeted multifactorial intervention that included a risk assessment of falls, staff and patient education, drug review, modification of bedside and ward environments, an exercise programme, and alarms for selected patients. MAIN OUTCOME MEASURE: Falls during hospital stay. RESULTS: Intervention and control wards were similar at baseline for previous rates of falls and individual patient characteristics. Overall, 381 falls occurred during the study. No difference was found in fall rates during follow-up between intervention and control wards: respectively, 9.26 falls per 1000 bed days and 9.20 falls per 1000 bed days (P=0.96). The incidence rate ratio adjusted for individual lengths of stay and previous fall rates in the ward was 0.96 (95% confidence interval 0.72 to 1.28). CONCLUSION: A targeted multifactorial falls prevention programme was not effective among older people in hospital wards with relatively short lengths of stay. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRNO 12605000467639. %Z FOR Codes: 111702 %0 Journal Article %~ PubMed %A Cumming, Robert G %A Handelsman, David %A Seibel, Markus J %A Creasey, Helen %A Sambrook, Philip %A Waite, Louise %A Naganathan, Vasi %A Couteur, David Le %A Litchfield, Melisa %T Cohort profile: The Concord Health and Ageing in Men Project (CHAMP). %B International journal of epidemiology %D 2008 %C GREAT CLARENDON ST, OXFORD, ENGLAND, OX2 6D %I Oxford Univ Press %V 38 %N 0 %P 374-8 %@ 0300-5771 %X %Z FOR Codes: 111706 111404 %0 Journal Article %~ PubMed %A Delbaere, Kim %A Close, Jacqueline C T %A Menz, Hylton B %A Cumming, Robert G %A Cameron, Ian D %A Sambrook, Philip N %A March, Lyn M %A Lord, Stephen R %T Development and validation of fall risk screening tools for use in residential aged care facilities. %B The Medical Journal of Australia %D 2008 %C Australia %I Australasian Medical Publishing Company Pty. Ltd. %V 189 %N 4 %P 193-196 %@ 1326-5377 %X OBJECTIVE: To develop screening tools for predicting falls in nursing home and intermediate-care hostel residents who can and cannot stand unaided. DESIGN AND SETTING: Prospective cohort study in residential aged care facilities in northern Sydney, New South Wales, June 1999 - June 2003. PARTICIPANTS: 2005 people aged 65-104 years (mean +/- SD, 85.7 +/- 7.1 years). MAIN OUTCOME MEASURES: Demographic, health, and physical function assessment measures; number of falls over a 6-month period; validity of the screening models. RESULTS: Ability to stand unaided was identified as a significant event modifier for falls. In people who could stand unaided, having either poor balance or two of three other risk factors (previous falls, nursing home residence, and urinary incontinence) increased the risk of falling in the next 6 months threefold (sensitivity, 73%; specificity, 55%). In people who could not stand unaided, having any one of three risk factors (previous falls, hostel residence, and using nine or more medications) increased the risk of falling twofold (sensitivity, 87%; specificity, 29%). CONCLUSIONS: These two screening models are useful for identifying older people living in residential aged care facilities who are at increased risk of falls. The screens are easy to administer and contain items that are routinely collected in residential aged care facilities in Australia. %Z FOR Codes: 111702 %0 Journal Article %~ PubMed %A Sherrington, Catherine %A Whitney, Julie C %A Lord, Stephen R %A Herbert, Robert D %A Cumming, Robert G %A Close, Jacqueline C T %T Effective exercise for the prevention of falls: a systematic review and meta-analysis. %B Journal of the American Geriatrics Society %D 2008 %C United States %I Blackwell Publishing, Inc. %V 56 %N 12 %P 2234-2243 %@ 1532-5415 %X OBJECTIVES: To determine the effects of exercise on falls prevention in older people and establish whether particular trial characteristics or components of exercise programs are associated with larger reductions in falls. DESIGN: Systematic review with meta-analysis. Randomized controlled trials that compared fall rates in older people who undertook exercise programs with fall rates in those who did not exercise were included. SETTING: Older people. PARTICIPANTS: General community and residential care. MEASUREMENTS: Fall rates. RESULTS: The pooled estimate of the effect of exercise was that it reduced the rate of falling by 17% (44 trials with 9,603 participants, rate ratio (RR)=0.83, 95% confidence interval (CI)=0.75-0.91, P<.001, I(2)=62%). The greatest relative effects of exercise on fall rates (RR=0.58, 95% CI=0.48-0.69, 68% of between-study variability explained) were seen in programs that included a combination of a higher total dose of exercise (>50 hours over the trial period) and challenging balance exercises (exercises conducted while standing in which people aimed to stand with their feet closer together or on one leg, minimize use of their hands to assist, and practice controlled movements of the center of mass) and did not include a walking program. CONCLUSION: Exercise can prevent falls in older people. Greater relative effects are seen in programs that include exercises that challenge balance, use a higher dose of exercise, and do not include a walking program. Service providers can use these findings to design and implement exercise programs for falls prevention. %Z FOR Codes: 110308 %0 Journal Article %~ PubMed %A Clemson, Lindy %A Mackenzie, Lynette %A Ballinger, Claire %A Close, Jacqueline C T %A Cumming, Robert G %T Environmental interventions to prevent falls in community-dwelling older people: a meta-analysis of randomized trials. %B Journal of aging and health %D 2008 %C United States %I Sage Publications Inc %V 20 %N 8 %P 954-971 %@ 0898-2643 %X Objective. This study seeks to determine the efficacy of environmental interventions in reducing falls in community-dwelling older people. Method. A systematic review and meta-analysis of randomized trials was performed. Results. Pooled analysis of six trials (N = 3,298) demonstrated a 21% reduction in falls risk (relative risk [RR] = 0.79; 0.65 to 0.97). Heterogeneity was attributable to the large treatment effect of one trial. Analysis of a subgroup of studies with participants at high risk of falls (four trials, n = 570) demonstrated a clinically significant 39% reduction of falls (RR = 0.61; 0.47 to 0.79), an absolute risk difference of 26% for a number needed to treat four people. Discussion. Home assessment interventions that are comprehensive, are well focused, and incorporate an environmental-fit perspective with adequate follow-up can be successful in reducing falls with significant effects. The highest effects are associated with interventions that are conducted with high-risk groups. %Z FOR Codes: 111716 %0 Journal Article %~ PubMed %A Chen, Jian Sheng %A Simpson, Judy M %A March, Lyn M %A Cameron, Ian D %A Cumming, Robert G %A Lord, Stephen R %A Seibel, Markus J %A Sambrook, Philip N %T Fracture risk assessment in frail older people using clinical risk factors. %B Age and ageing %D 2008 %C UK %I Oxford University Press %V 37 %N 5 %P 536-41 %@ 0002-0729 %X this study aims to develop and evaluate a simple fracture risk index for use in frail older people. %Z FOR Codes: 111718 %0 Book Section %A Barratt, Alexandra %A Irwig, Les %A Glasziou, Paul %A Cumming, Robert %A Raffle, Angela %A Hicks, Nicholas %A Gray, J.A. Muir %A Guyatt, Gordon %T Moving from evidence to action: Recommendations about screening %B Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice %D 2008 %C United States %I McGraw-Hill %V %N %P 663-678 %@ 9780071590341 %E Guyatt, Gordon %E Rennie, Drummond %E Meade, Maureen %E Cook, Deborah %X %Z FOR Codes: 111799 %0 Journal Article %~ PubMed %A Blyth, Fiona M %A Rochat, Stephane %A Cumming, Robert G %A Creasey, Helen %A Handelsman, David J %A Couteur, David G Le %A Naganathan, Vasi %A Sambrook, Philip N %A Seibel, Markus J %A Waite, Louise M %T Pain, frailty and comorbidity on older men: The CHAMP study. %B Pain %D 2008 %C Netherlands %I Elsevier BV %V 140 %N 0 %P 224-30 %@ 0304-3959 %X Intrusive pain is likely to have a serious impact on older people with limited ability to respond to additional stressors. Frailty is conceptualised as a functional and biological pattern of decline accumulating across multiple physiological systems, resulting in a decreased capacity to respond to additional stressors. We explored the relationship between intrusive pain, frailty and comorbid burden in 1705 community-dwelling men aged 70 or more who participated in the baseline phase of the CHAMP study, a large epidemiological study of healthy ageing based in Sydney, Australia. 9.4% of men in the study were frail (according to the commonly-used Cardiovascular Health Study frailty criteria).Using a combination of self-report and clinical measures, we found an association between frailty and intrusive pain that remained after accounting for demographic characteristics, number of comorbidities, self-reported depressed mood and arthritis (adjusted odds ratio 1.7 (95% confidence interval (CI) 1.1-2.7), p=0.0149). The finding that adjusting for depressed mood, but not a history of arthritis, attenuated the relationship between frailty and intrusive pain points to a key role for central mechanisms. Additionally, men with the highest overall health burden (frail plus high comorbid burden) were most likely to report intrusive pain (adjusted odds ratio 3.0 (95% CI 1.6-5.5), p=0.0004). These findings provide support for the concept that intrusive pain is an important challenge for older men with limited capacity to respond to additional physical stressors. To our knowledge, this is the first study to explore specifically the relationship between pain and frailty. %Z FOR Codes: 111706 111404 %0 Journal Article %~ PubMed %A Henschke, Nicholas %A Maher, Christopher G %A Refshauge, Kathryn M %A Herbert, Robert D %A Cumming, Robert G %A Bleasel, Jane %A York, John %A Das, Anurina %A McAuley, James H %T Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. %B BMJ %D 2008 %C United Kingdom %I BMJ Publishing Group %V 337 %N 7662 %P 154-157 %@ 1468-5833 %X OBJECTIVE: To estimate the one year prognosis and identify prognostic factors in cases of recent onset low back pain managed in primary care. DESIGN: Cohort study with one year follow-up. SETTING: Primary care clinics in Sydney, Australia. PARTICIPANTS: An inception cohort of 973 consecutive primary care patients (mean age 43.3, 54.8% men) with non-specific low back pain of less than two weeks'' duration recruited from the clinics of 170 general practitioners, physiotherapists, and chiropractors. MAIN OUTCOME MEASURES: Participants completed a baseline questionnaire and were contacted six weeks, three months, and 12 months after the initial consultation. Recovery was assessed in terms of return to work, return to function, and resolution of pain. The association between potential prognostic factors and time to recovery was modelled with Cox regression. RESULTS: The follow-up rate over the 12 months was more than 97%. Half of those who reduced their work status at baseline had returned to previous work status within 14 days (95% confidence interval 11 to 17 days) and 83% had returned to previous work status by three months. Disability (median recovery time 31 days, 25 to 37 days) and pain (median 58 days, 52 to 63 days) took much longer to resolve. Only 72% of participants had completely recovered 12 months after the baseline consultation. Older age, compensation cases, higher pain intensity, longer duration of low back pain before consultation, more days of reduced activity because of lower back pain before consultation, feelings of depression, and a perceived risk of persistence were each associated with a longer time to recovery. CONCLUSIONS: In this cohort of patients with acute low back pain in primary care, prognosis was not as favourable as claimed in clinical practice guidelines. Recovery was slow for most patients. Nearly a third of patients did not recover from the presenting episode within a year. %Z FOR Codes: 110314 %0 Journal Article %~ PubMed %A Chen, Jian Sheng %A Simpson, Judy M %A March, Lyn M %A Cameron, Ian D %A Cumming, Robert G %A Lord, Stephen R %A Seibel, Markus J %A Sambrook, Philip N %T Risk Factors for Fracture Following a Fall Among Older People in Residential Care Facilities in Australia. %B Journal of the American Geriatrics Society %D 2008 %C United States %I Blackwell Publishing, Inc. %V 56 %N 0 %P 2020-6 %@ 1532-5415 %X To investigate which factors best predict whether a fall will result in a fracture. %Z FOR Codes: 111702 %0 Journal Article %~ PubMed %A Tan, Jennifer S L %A Wang, Jie Jin %A Younan, Christine %A Cumming, Robert G %A Rochtchina, Elena %A Mitchell, Paul %T Smoking and the long-term incidence of cataract: the blue mountains eye study. %B Ophthalmic epidemiology %D 2008 %C United Kingdom %I Informa Healthcare %V 15 %N 3 %P 155-161 %@ 0928-6586 %X Purpose: To assess the association between smoking and the long-term incidence of cataract and cataract surgery. Methods: In a population-based cohort of Australians aged 49 years and over, 3654 participants were seen at baseline (1992-94) and 2406 were seen after 5- and/or 10-years and had photographs taken to assess incident cataract. Smoking status was recorded at interview. History, physical examination and fasting blood samples provided data on possible risk factors. Cataract incidence was calculated using the Kaplan-Meier survival approach. Discrete linear logistic models were used to assess risk of incident cataract. Results: After controlling for age, sex and other factors, ever smokers had an increased risk of developing nuclear cataract compared to never smokers (relative risk (RR) 1.41; 95% confidence interval (CI) 1.09-1.83; RR 1.37, CI 1.04-1.81 for past smoking and RR 1.57, CI 1.06-2.31 for current smoking). The effect of smoking was strongest in ever smokers reporting 36 + pack-years of smoking compared to never smokers (RR 1.46; CI, 1.02-2.08). Current smokers also developed nuclear cataract slightly younger than non-smokers (mean age 65.2 versus 67.5 years, p = 0.049). No statistically significant associations were found between smoking status and the incidence of cortical or posterior subcapsular cataract, or cataract surgery. Conclusions: These epidemiological data confirm smoking as a modest risk factor for the development of nuclear cataract. %Z FOR Codes: 111301 111706 111716 %0 Journal Article %A Sanchez Riera, Lidia %A Wilson, Nicholas M %A Sambrook, Philip %A Kok, Cindy %A Cumming, Robert %A Cameron, Ian %A Chen, Jian Sheng %A Simpson, Judy %A Mason, Rebecca %A Seibel, Markus %A March, Lyn %T Trends in calcium and vitamin D usage among older people in nursing care facilities in Australia: still falling short of the guidelines %B International Journal of Rheumatic Diseases %D 2008 %C Australia %I Wiley-Blackwell %V 11 %N %P 430-434 %@ 1756-1841 %X %Z FOR Codes: 110322 111702 %0 Journal Article %~ PubMed %A Clemson, Lindy %A Bundy, Anita C %A Cumming, Robert G %A Kay, Lynn %A Luckett, Tim %T Validating the Falls Behavioural (FaB) scale for older people: a Rasch analysis. %B Disability and Rehabilitation %D 2008 %C United Kingdom %I Informa %V 30 %N 7 %P 498-506 %@ 0963-8288 %X PURPOSE: Rasch modelling was used to establish the validity and robustness of the Falls Behavioural (FaB) Scale for Older people. METHODS: The sample comprised 678 community-residing elderly people aged 65 - 98 years. Data were analysed by calculating goodness of fit statistics, principal components analysis of residuals and by exploring the effectiveness of the category rating response-scale. RESULTS: A partial-credit rating scale was the best fitting solution and the major change to the original version of the FaB. Analysis supported a 29-item intervention version and a briefer 24-item outcome evaluation (research) version. The latter produced item mean infit statistics of 1.00 (Z = 0.0, SD = 0.33) and mean outfit statistics of 1.03 (Z = 0.0, SD = 0.53), a person separation of 2.36 and internal reliability of 0.85. CONCLUSION: The 29 item partial rating scale is valid, reliable and would be useful in clinical situations when used as a prompt for discussion and in raising clients'' awareness of potential hazards; it also can be used as an outcome measure. The short form is a useful alternate for evaluating the effectiveness of fall reduction interventions that aim to encourage protective strategies when negotiating the environment, mobilizing and doing activities of daily living. Both scales would be improved by adding very difficult and very easy items to increase the range of ability levels of the people to whom it can be applied with precision. %Z FOR Codes: 111702 110603 %0 Journal Article %~ PubMed %A Voukelatos, Alexander %A Cumming, Robert G %A Lord, Stephen R %A Rissel, Chris %T A Randomized, Controlled Trial of tai chi for the Prevention of Falls: The Central Sydney tai chi Trial. %B Journal of the American Geriatrics Society %D 2007 %C United States %I Blackwell Publishing, Inc. %V 55 %N 8 %P 1185-1191 %@ 1532-5415 %X OBJECTIVES: To determine the effectiveness of a 16-week community-based tai chi program in reducing falls and improving balance in people aged 60 and older. DESIGN: Randomized, controlled trial with waiting list control group. SETTING: Community in Sydney, Australia. PARTICIPANTS: Seven hundred two relatively healthy community-dwelling people aged 60 and older (mean age 69). INTERVENTION: Sixteen-week program of community-based tai chi classes of 1 hour duration per week. MEASUREMENTS: Falls during 16 and 24 weeks of follow-up were assessed using a calendar method. Balance was measured at baseline and 16-week follow-up using six balance tests. RESULTS: Falls were less frequent in the tai chi group than in the control group. Using Cox regression and time to first fall, the hazard ratio after 16 weeks was 0.72 (95% confidence interval (CI)=0.51-1.01, P=.06), and after 24 weeks it was 0.67 (95% CI=0.49-0.93, P=.02). There was no difference in the percentage of participants who had one or more falls. There were statistically significant differences in changes in balance favoring the tai chi group on five of six balance tests. CONCLUSION: Participation in once per week tai chi classes for 16 weeks can prevent falls in relatively healthy community-dwelling older people. %Z FOR Codes: 110308 %0 Journal Article %~ PubMed %A Hollis, Jean %A Grayson, David %A Forrester, Loelle %A Brodaty, Henry %A Touyz, Stephen %A Cumming, Robert %T Antipsychotic Medication Dispensing and Risk of Death in Veterans and War Widows 65 Years and Older. %B The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry %D 2007 %C United States %I Lippincott Williams & Wilkins %V 15 %N 11 %P 932-941 %@ 1064-7481 %X Objective: To establish the instantaneous relative risk (RR) of death associated with individual antipsychotic drugs, carbamazepine and sodium valproate for those 65 years and older. Methods: Subjects dispensed antipsychotic drugs, sodium valproate or carbamazepine in 2003 or 2004 were analyzed as incident (N = 16,634) or prevalent (N = 9,831) users. Survival curves, mortality rates, and Cox proportional hazards models over two time periods were used to explore risk of death. The models were adjusted for age, sex, residential status, and psychotropic and medical drug dispensing. Olanzapine subjects were the reference group in the Cox regression. Subanalyses were performed for incident subjects with more than 30 days of follow-up and those dispensed cholinesterase inhibitors. Results: In the adjusted Cox proportional hazards models, haloperidol dispensing was consistently associated with an increased risk of death compared with olanzapine users (relative risk [RR] for incident users: 2.26, 95% confidence intervals (CI): 2.08-2.47; Wald statistic: 345.36, df = 1, p 25 decibels hearing level (dB HL) for the four frequencies (0.5 to 4.0 kHz) in the better ear. RESULTS: Of the 2431 participants with complete data (mean age, 67.0 yr), 1347 (55.4%) did not have measured hearing loss, whereas 324 (13.3%) had unilateral (285 mild, 22 moderate, 17 severe) and 760 (31.3%) had bilateral hearing impairment (478 mild, 207 moderate, 75 severe). After adjusting for demographic and medical confounders, bilateral hearing impairment was associated with poorer SF-36 scores in both physical and mental domains (fall in physical component score, PCS of 1.4 points, p = 0.025; fall in mental component score, MCS of 1.0 point, p = 0.13), with poorer scores associated with more severe levels of impairment (PCS p(trend) = 0.04, MCS p(trend) = 0.003). Participants with bilateral hearing impairment who habitually used hearing aids had a slightly better PCS (mean, 43.1; standard error [SE], 0.9) than those with the same impairment who did not have hearing aids or who only used them occasionally (mean, 41.2; SE 0.5), although this finding was not statistically significant (p = 0.055). Persons with self-reported hearing loss had significantly poorer HRQOL than corresponding persons without, but persons with unilateral or high-frequency hearing loss did not have significantly different HRQOL scores than their corresponding counterparts. CONCLUSIONS: This study quantifies the associated disease burden of age-related hearing impairment on health-related quality of life in a population-based cohort of older persons. %Z FOR Codes: 111706 110315 %0 Journal Article %~ PubMed %A Chen, Jian Sheng %A Sambrook, Philip N %A March, Lyn %A Cameron, Ian D %A Cumming, Robert G %A Simpson, Judy M %A Seibel, Markus J %T Hypovitaminosis D and parathyroid hormone response in the elderly: effects on bone turnover and mortality. %B Clinical endocrinology %D 2007 %C 54 University St,P O %I Blackwell Science Asia %V 68 %N 2 %P 290-8 %@ 1365-2265 %X To investigate whether absence of secondary hyperparathyroidism in the presence of hypovitaminosis D has altered bone turnover, fracture risk and mortality. %Z FOR Codes: %0 Journal Article %~ PubMed %A Cumming, Robert G %A Ivers, Rebecca %A Clemson, Lindy %A Cullen, John %A Hayes, Maggie F %A Tanzer, Michael %A Mitchell, Paul %T Improving vision to prevent falls in frail older people: a randomized trial. %B Journal of the American Geriatrics Society %D 2007 %C United States %I Blackwell Publishing, Inc. %V 55 %N 2 %P 175-181 %@ 1532-5415 %X OBJECTIVES: To determine the efficacy of vision and eye examinations, with subsequent treatment of vision problems, for preventing falls and fractures in frail older people. DESIGN: Randomized, controlled trial. SETTING: Community in Sydney, Australia. PARTICIPANTS: Six hundred sixteen men and women aged 70 and older (mean age 81) recruited mainly from people attending outpatient aged care services. INTERVENTIONS: The intervention group received comprehensive vision and eye examinations conducted by a study optometrist. The optometrist arranged for new eyeglasses for 92 subjects and referred 24 for a home visit with an occupational therapist, 17 for glaucoma management, and 15 for cataract surgery. The control group received usual care. MEASUREMENTS: Falls and fractures during 12 months of follow-up were ascertained according to self-report using a monthly postcard system. RESULTS: Fifty-seven percent of subjects fell at least once during follow-up. Falls occurred more frequently in the group randomized to receive the vision intervention (65% fell at least once; 758 falls in total) than in the control group (50% fell at least once; 516 falls in total). The falls rate ratio using the negative binomial model was 1.57 (95% confidence interval (CI)=1.20-2.05, P=.001). Fractures were also more frequent in the intervention group (31 fractures) than the control group (18 fractures; relative risk from proportional hazards model 1.74, 95% CI=0.97-3.11, P=.06). CONCLUSION: In frail older people, comprehensive vision and eye assessment, with appropriate treatment, does not reduce, and may even increase, the risk of falls and fractures. %Z FOR Codes: 111716 %0 Journal Article %~ PubMed %A Sambrook, P %A Cameron, I %A Chen, J %A Cumming, R %A Lord, S %A March, L %A Schwarz, J %A Seibel, M %A Simpson, J %T Influence of fall related factors and bone strength on fracture risk in the frail elderly. %B Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA %D 2007 %C UK %I Springer-Verlag London Ltd. %V 18 %N 5 %P 603-10 %@ 0937-941X %X When subjects are selected on the basis of fall risk alone, therapies for osteoporosis have not been effective. In a prospective study of elderly subjects at high risk of falls, we investigated the influence of bone strength and fall risk on fracture. %Z FOR Codes: 110306 110322 %0 Journal Article %~ PubMed %A Jabbour, James %A Cumming, Robert %A Scolyer, Richard A %A Hruby, George %A Thompson, John F %A Lee, Stephen %T Merkel cell carcinoma: assessing the effect of wide local excision, lymph node dissection, and radiotherapy on recurrence and survival in early-stage disease-results from a review of 82 consecutive cases diagnosed between 1992 and 2004. %B Annals of surgical oncology : the official journal of the Society of Surgical Oncology %D 2007 %C US %I Springer-Verlag New York, Inc. %V 14 %N 6 %P 1943-1952 %@ 1068-9265 %X BACKGROUND: Wide surgical excision, lymph node dissection, and radiotherapy have been used with varying efficacy in the management of early-stage Merkel cell carcinoma. METHODS: Records of 82 patients with early-stage Merkel cell carcinoma between 1992 and 2004 were reviewed. RESULTS: Forty-two patients developed a recurrence, and 44 died during the study period. Twenty-nine patients presented with regional lymph node disease, which was independently associated with diminished survival (hazard ratio [HR], 4.08; 95% confidence interval [CI], 1.55-10.75; P = .005). Lymphadenectomy was independently associated with prolonged disease-free survival (median, 28.5 vs. 11.8 months; HR, .46; 95% CI, .22-.94; P = .034) but not overall survival (P = .25). Margin-negative excision of the primary tumor (60 of 73) was not significantly associated with either prolonged disease-free survival (median, 16 vs. 14 months) or overall survival (median, 54 vs. 34 months). Forty-eight patients received radiotherapy: 36 to the primary site and 31 to the regional lymph nodes. Radiotherapy to both sites was associated with a longer median time to first recurrence (primary site, 24.2 vs. 11.8 months; regional lymph nodes, 46.2 vs. 11.3 months) and survival (primary site, 53.9 vs. 45.7 months; regional lymph nodes, 103.1 vs. 34.2 months). Administration of any radiotherapy was significantly associated with a prolonged time to first recurrence (HR, .39; 95% CI, .20-.75; P = .004) and survival (HR, .39; 95% CI, .18-.82; P = .013) on the Cox regression multivariate analyses. CONCLUSIONS: Adjuvant radiotherapy to the primary site after surgical excision is recommended in early-stage disease. Involved regional lymph nodes should be treated with radiotherapy with or without lymphadenectomy. %Z FOR Codes: %0 Journal Article %~ PubMed %A Merani, Rohan %A Hunyor, Alex P %A Playfair, T Justin %A Chang, Andrew %A Gregory-Roberts, John %A Hunyor, Alex B L %A Azar, Domit %A Cumming, Robert G %T Pars Plana Vitrectomy for the Management of Retained Lens Material After Cataract Surgery. %B American journal of ophthalmology %D 2007 %C US %I Elsevier Inc %V 144 %N 3 %P 364-70 %@ 0002-9394 %X To evaluate the management and outcomes of patients undergoing pars plana vitrectomy (PPV) for retained lens material after cataract surgery; and to evaluate risk factors for poor visual outcome, retinal detachment, raised intraocular pressure (IOP), and cystoid macular edema (CME). %Z FOR Codes: %0 Journal Article %~ Isi %A Clemson, L %A Swann, M %A Cumming, RG %A Taylor, K %A Kendig, H %T Recruiting older participants to a randomised trial of a community-based fall prevention program %B AUSTRALASIAN JOURNAL ON AGEING %D 2007 %C Australia %I Wiley-Blackwell Publishing Asia %V 26 %N 1 %P 35-39 %@ 1440-6381 %X %Z FOR Codes: %0 Journal Article %~ PubMed %A Hollis, Jean %A Forrester, Loelle %A Brodaty, Henry %A Touyz, Stephen %A Cumming, Robert %A Grayson, David %T Risk of death associated with antipsychotic drug dispensing in residential aged care facilities. %B The Australian and New Zealand journal of psychiatry %D 2007 %C United Kingdom %I Taylor & Francis Ltd. %V 41 %N 9 %P 751-8 %@ 1440-1614 %X Objective: To establish the instantaneous relative risk (RR) associated with the dispensing of individual antipsychotic drugs, carbamazepine and valproate for those >/=65 years who resided in an aged care facility. Method: The risk of death for incident users of antipsychotic drugs, carbamazepine and valproate in 2003 or 2004 who resided in an aged care facility was established using mortality rates and Cox proportional hazards models over two time periods. The regression models were adjusted for age, gender, medical and psychotropic drug dispensing, and a measure of overall medical comorbidity. Olanzapine users formed the referent group. Results: Haloperidol and chlorpromazine use were associated with the highest death rates. The instantaneous RR for those dispensed haloperidol was 1.67 (95% confidence intervals (CI) = 1.50-1.84, p < 0.001) and for chlorpromazine it was 1.75 (95%CI = 1.31-2.34, p < 0.001). The RR of death for haloperidol and chlorpromazine was higher in the regression model restricted to 60 days follow up (haloperidol RR = 2.17, 95%CI = 1.86-2.53, p < 0.001, chlorpromazine RR = 2.72, 95%CI = 1.84-4.01). Conclusions: The increased risk associated with haloperidol and chlorpromazine dispensing should be interpreted cautiously because confounding by medical illness cannot be excluded despite adjusting the model for multiple variables. This study supports the findings from other data linkage studies that atypical antipsychotic medications are not associated with increased risk of death compared with conventional antipsychotic drugs. %Z FOR Codes: 110319 %0 Journal Article %~ PubMed %A Latimer Hill, Elizabeth %A Cumming, Robert G %A Lewis, Ray %A Carrington, Susan %A Le Couteur, David G %T Sleep disturbances and falls in older people. %B The journals of gerontology. Series A, Biological sciences and medical sciences %D 2007 %C United States %I Gerontological Society of America %V 62 %N 1 %P 62-66 %@ 1079-5006 %X BACKGROUND: Sleep disturbances are common in older people and may contribute to risk of falling. METHODS: Cross-sectional studies were performed in hostels and with an Internet-based survey. Questionnaires on falls and sleep disturbances were undertaken with clinical measures of cognition, mobility, blood pressure, and vision in the participants in hostels. RESULTS: There were 150 participants in hostels (mean age 81 +/- 8 years) and 150 respondents to the Internet survey (mean age 70 +/- 5 years). Sleep disturbances were reported by most participants in both the hostel and Internet studies. In hostel participants, falls were associated with poor sleep quality (odds ratio = 4.5, 95% confidence interval, 1.9-12.2; p =.002) and number of nocturnal awakenings (2.5 +/- 1.5 vs 2.0 +/- 1.4, p =.04). Other risk factors for falls in these persons included Geriatric Depression Scale score, pain, Timed Get Up and Go Test score, and the use of diuretics. In the Internet respondents, risk factors for falls included poor health rating and the use of spectacles, bifocals, and walking aids; fewer falls were reported by those participants without any sleep disturbances. CONCLUSIONS: Sleep disturbances are common in older people and are associated with their risk of falling. Internet-based surveys may be a useful adjunct method for research in older people. %Z FOR Codes: %0 Journal Article %~ PubMed %A Wang, Jie Jin %A Rochtchina, Elena %A Lee, Anne J %A Chia, Ee-Munn %A Smith, Wayne %A Cumming, Robert G %A Mitchell, Paul %T Ten-year incidence and progression of age-related maculopathy: the blue Mountains Eye Study. %B Ophthalmology %D 2007 %C United States %I Elsevier %V 114 %N 1 %P 92-98 %@ 0161-6420 %X PURPOSE: To assess the 10-year incidence of age-related maculopathy (ARM) in an older Australian cohort. DESIGN: Population-based cohort study. PARTICIPANTS: Three thousand six hundred fifty-four Blue Mountains Eye Study participants > or =49 years old were examined during 1992 through 1994; 2335 (75% of survivors) were reexamined after 5 years (1997-1999) and 1952 (76% of survivors) after 10 years (2002-2004). METHODS: The same graders performed retinal photographic grading in all examinations, using the Wisconsin Age-Related Maculopathy Grading System. Photographs of participants with ARM lesions at any of the examinations were subsequently regraded using a side-by-side comparison method. MAIN OUTCOME MEASURES: The diagnosis of incident late ARM was given if neovascular ARM or geographic atrophy was detected at either follow-up examination in persons free of these lesions at baseline. Incident early ARM was diagnosed if early ARM (soft indistinct or reticular drusen or combined soft distinct drusen and retinal pigment abnormality) was present in persons free of early and late ARM at baseline. Age-related maculopathy incidence was calculated using Kaplan-Meier methods to incorporate information from both 5- and 10-year examinations. Discrete logistic models were used to assess the risk of incident late ARM according to various baseline factors, including early ARM lesion characteristics. RESULTS: After excluding 72 late ARM cases present at baseline, 2395 of 3582 subjects at risk of late ARM (67%) were reexamined at either follow-up time point or both follow-up time points. Over the 10-year period, 72 of 2395 subjects (3.7%) developed late ARM and 266 of 2255 subjects (14.1%) developed early ARM. After age standardization to the Beaver Dam Eye Study population, our 10-year incidences of late and early ARM were 2.8% and 10.8%, respectively. Baseline age and early ARM lesion characteristics and severity were strong predictors of late ARM incidence. CONCLUSIONS: Long-term follow-up of this older population confirms that the risk of ARM progression is related strongly to the severity of early-stage lesions. The study provides evidence-based criteria for identifying persons at high risk of developing late ARM. %Z FOR Codes: 111706 111301 %0 Journal Article %~ PubMed %A Murray, Geoffrey R %A Cameron, Ian D %A Cumming, Robert G %T The consequences of falls in acute and subacute hospitals in Australia that cause proximal femoral fractures. %B American Geriatrics Society. Journal %D 2007 %C United States %I Blackwell Publishing, Inc. %V 55 %N 4 %P 577-582 %@ 1532-5415 %X OBJECTIVES: To compare consequences for patients with proximal femoral fractures (PFFs) sustained in the hospital with patients who sustained PFFs in the community. DESIGN: Data were collected from inpatient notes and incident reports of patients admitted to hospitals over a 6-year period. All patients aged 75 and older sustaining a PFF in the hospital were identified and matched according to sex, age, and fracture date with patients who sustained a PFF in the community. SETTING: Illawarra region hospitals, New South Wales, Australia. PARTICIPANTS: Forty-three patients with a hospital-acquired PFF and 43 patients with a community-acquired PFF; mean age was 84.0 (range 75-92), and 67% were women. MEASUREMENTS: Outcomes at hospital discharge and circumstances of hospital-acquired PFF. RESULTS: Comparing outcomes of subjects with hospital versus community-acquired PFF revealed that 12 versus four died in the hospital (P=.03), 14 versus five were discharged to long-term nursing care facilities (P=.02), six versus 18 returned to preadmission ambulation (P=.004), and four versus 24 returned to preadmission activity of daily living status (P<.001). The median postfracture length of stay was 46 days for subjects with hospital-acquired PFF versus 32 days for those sustaining a PFF in the community (P<.01). Review of circumstances of the 43 hospital-acquired fractures revealed that 26 occurred in subacute wards, 25 occurred in bedrooms, 25 occurred at night, and 38 occurred while unsupervised. CONCLUSION: Patients with hospital-acquired PFF have poor outcomes. Adequate supervision, provision of hip protectors in the hospital, and strategies that address fracture circumstances may hold the keys to prevention. %Z FOR Codes: %0 Journal Article %~ Isi %A Byles, JE %A Cumming, RG %A Mitchell, P %A Browning, C %A Broe, GA %A Shaw, JE %A Gibson, R %A Kendig, H %A Luszcz, MA %A Booth, H %A Christensen, H %A von Sanden, C %A Sargent-Cox, K %A Burns, R %A Windsor, TD %A Butterworth, P %A Anstey, KJ %A Simons, LA %T The value of comparing health outcomes in cohort studies: An example of self-rated health in seven studies including 79 653 participants %B AUSTRALASIAN JOURNAL ON AGEING %D 2007 %C United Kingdom %I Blackwell Publishing Ltd %V 26 %N 4 %P 194-200 %@ 1440-6381 %X %Z FOR Codes: %0 Journal Article %~ PubMed %A Cugati, Sudha %A Cumming, Robert G %A Smith, Wayne %A Burlutsky, George %A Mitchell, Paul %A Wang, Jie Jin %T Visual Impairment, Age-Related Macular Degeneration, Cataract, and Long-term Mortality: The Blue Mountains Eye Study. %B Archives of ophthalmology %D 2007 %C 515 N STATE ST, CHIC %I Amer Medical Assoc %V 125 %N 7 %P 917-924 %@ 0003-9950 %X OBJECTIVE: To assess the association of visual impairment, age-related macular degeneration (ARMD), and cataract with long-term mortality. METHODS: At baseline, 3654 persons 49 years and older were examined in the Blue Mountains Eye Study (1992-1994). Standardized photographic grading was used to assess ARMD and cataract. Mortality and causes of death occurring between baseline and December 31, 2003, were obtained via data linkage with the Australian National Death Index. Age-standardized mortality rates were calculated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were assessed using Cox models. Result Age-standardized mortality was higher in persons with vs without visual impairment (54.0% vs 34.0%), ARMD (45.8% vs 33.7%), and cataract (39.2% vs 29.5%). After adjusting for factors that predict mortality, neither visual impairment (HR, 1.3; 95% CI, 0.98-1.7) nor ARMD (HR, 1.0; 95% CI, 0.8-1.3) was significantly associated with all-cause mortality in all ages. Among persons younger than 75 years, however, ARMD predicted higher all-cause mortality (HR, 1.6; 95% CI, 1.0-2.4). Any cataract (HR, 1.3; 95% CI, 1.0-1.5) and cortical (HR, 1.2; 95% CI, 0.97-1.4), nuclear (HR, 1.2; 95% CI, 0.98-1.5), and posterior subcapsular (HR, 1.3; 95% CI, 1.0-1.7) cataract were also associated with higher all-cause mortality. CONCLUSION: Cataract predicted increased mortality in persons 49 years and older, and ARMD predicted mortality in persons aged 49 to 74 years. %Z FOR Codes: 111706 111301