Background-Behavioral and psychological symptoms of dementia (BPSD) are often considered to be th... more Background-Behavioral and psychological symptoms of dementia (BPSD) are often considered to be the greatest challenge in dementia care, leading to increased healthcare costs, caregiver burden, and placement into care facilities. With potential for pharmacological intervention to exacerbate behaviors or even lead to mortality, the development and rigorous testing of non-pharmacological interventions is vital. A pilot of the Tailored Activities Program (TAP) for reducing problem behaviors in people with dementia was conducted in the United States with promising results. This randomized trial will investigate the effectiveness of TAP for reducing the burden of BPSD on persons with dementia and family caregivers within an Australian population. This trial will also examine the cost-effectiveness and willingness to pay for TAP compared with a control group. Methods-This randomized trial aims to recruit 180 participant dyads of a person with dementia and their caregivers. Participants will have a diagnosis of dementia, exhibit behaviors as scored by
Background: This study investigates the use of an information and communication technology (Elder... more Background: This study investigates the use of an information and communication technology (Elder Tree) designed for older adults and their informal caregivers to improve older adult quality of life and address challenges older adults face in maintaining their independence (for example, loneliness and isolation, falling, managing medications, driving and transportation). Methods/Design: This study, an unblinded randomized controlled trial, will evaluate the effectiveness and cost of Elder Tree. Older adults who are at risk for losing their independence-along with their informal caregivers, if they name them-are randomized to two groups. The intervention group has access to their usual sources of information and communication as well as to Elder Tree for 18 months while the control group uses only their usual sources of information and communication. The primary outcome of the study is older adult quality of life. Secondary outcomes are cost per Quality-Adjusted Life Year and the impact of the technology on independence, loneliness, falls, medication management, driving and transportation, and caregiver appraisal and mastery. We will also examine the mediating effect of self-determination theory. We will evaluate the effectiveness of Elder Tree by comparing intervention-and control-group participants at baseline and months 6, 12, and 18. We will use mixed-effect models to evaluate the primary and secondary outcomes, where pretest score functions as a covariate, treatment condition is a between-subjects factor, and the multivariate outcome reflects scores for a given assessment at the three time points. Separate analyses will be conducted for each outcome. Cost per Quality-Adjusted Life Year will be compared between the intervention and control groups. Additional analyses will examine the mediating effect of self-determination theory on each outcome. Discussion: Elder Tree is a multifaceted intervention, making it a challenge to assess which services or combinations of services account for outcomes in which subsets of older adults. If Elder Tree can improve quality of life and reduce healthcare costs among older adults, it could suggest a promising way to ease the burden that advancing age can place on older adults, their families, and the healthcare system.
dementia, arthritis, stroke, mobility difficulties, falls, and hospitalization (all P's<0.05). We... more dementia, arthritis, stroke, mobility difficulties, falls, and hospitalization (all P's<0.05). We used logistic regression to determine the contribution of recent precipitating events on the adoption of mobility devices among older adults after controlling for 2015 characteristics that were significantly associated with being a New user. Precipitating events were significantly associated with being a New user of mobility equipment. Specifically, older adults who, between the 2015 and 2016 interviews, experienced a fall (OR=1.7; 95% CI=1.1-2.9), hospitalization (OR=3.7; 95% CI=2.3-5.9) or increase in mobility difficulties (OR=3.7; 95% CI=2.3-5.9) were more likely to be New users. Study findings reveal the importance precipitating events on the adoption of mobility devices, signaling the importance of assessing for need for mobility devices after these events.
et al. Recipient and instructor perspectives of an adapted exercise-based fall prevention program... more et al. Recipient and instructor perspectives of an adapted exercise-based fall prevention programme for adults aged 50+ years with vision impairment: a qualitative study nested within a randomised controlled trial. BMJ Open 2020;10:e038386.
Objective: The Stepping On program has been shown to prevent falls among community-dwelling peopl... more Objective: The Stepping On program has been shown to prevent falls among community-dwelling people in a research setting and was implemented statewide by the New South Wales (NSW) Ministry of Health in 2008. This study measured ongoing fall prevention strategies and behaviours undertaken by Stepping On participants during the 6 months after program completion. Secondary objectives were to document participant satisfaction with the program, and to identify motivators for, and barriers to, fall prevention behaviour and uptake of the strategy. Methods: We conducted a pre-post prospective study among Stepping On program participants, with 6-month follow-up. Participants commenced Stepping On in 2015 and 2016 in 15 Local Health Districts across NSW. A study-specific survey was completed at baseline and 6 months after completion of Stepping On. Measures were current self-reported fall prevention strategies and behaviours; the Falls Behavioural (FaB) Scale; the Incidental and Planned Exercise Questionnaire (IPEQ); and motivators for, and barriers to, uptake of fall prevention strategies and behaviours. Results: Baseline questionnaires were completed by 458 participants (mean age 77; standard deviation [SD] 6.7; 76% female). Both baseline and follow-up surveys were completed by 291 participants (64%; mean age 78; SD 6.9; 76% female). Program satisfaction was high-251 participants (86%) completed the whole program, 284 (98%) said it increased their awareness of falls, and 284 (98%) would recommend Stepping On to others. There were statistically significant increases in the proportion of participants who reported doing regular balance and strength exercise (74% vs 24%; p < 0.0001), and using safe walking strategies (78% vs 51%; p < 0.0001) at follow-up compared with baseline. There was also a significant improvement in the FaB Scale, indicating less risk-taking behaviour (mean increase 0.
Background: Reablement is a team-based person-centered health and social care model, most commonl... more Background: Reablement is a team-based person-centered health and social care model, most commonly available for community-dwelling older adults. Understanding the components of reablement and how it is delivered, received, and enacted facilitates best evidence and practice. Determining behavior change techniques (BCTs) or strategies is an important step to operationalize implementation of reablement. Objective: We conducted a scoping review of peer-reviewed literature to identify BCTs used within reablement studies. Methods: We registered our study with the Joanna Briggs Institute and conducted five database searches. Inclusion criteria were peer-reviewed studies focused on adults and older adults without significant cognitive impairment or dementia receiving reablement, and all study designs, years, and languages. We excluded studies focused on reablement for people with dementia or reablement training programs. The last search was on April 8, 2021. Two authors screened independently at Level 1 (title and abstract) and 2 (full text). Two authors adjudicated BCTs for each study, and a third author confirmed the final list.
Trainer-Manual - Aktiv und sicher durchs Leben mit dem LiFE Programm, 2018
Die Trainer müssen das Teilnehmerhandbuch gelesen haben, bevor sie den folgenden Abschnitt lesen.... more Die Trainer müssen das Teilnehmerhandbuch gelesen haben, bevor sie den folgenden Abschnitt lesen. Es enthält Fotos und Bilder, die das Verständnis des folgenden Abschnitts verbessern. Sie sollten darauf zurückgreifen können, während Sie die nun folgenden Informationen durcharbeiten. Es ist wichtig, den Teilnehmern nicht nur die Übungen, sondern auch die Prinzipien, auf die sich die Übungen beziehen, zu vermitteln. Während Sie ein Prinzip erklären, demonstrieren Sie dieses gleichzeitig und geben Sie Beispiele, wie es sich auf die Verbesserung der Funktion oder auf das Gehen auswirkt und zur Reduktion von Stürzen beiträgt. Sie sollten die Übungen auch demonstrieren, während Sie diese unterrichten. 3.1 Das Programm unterrichten Zu Beginn Folgende Struktur sollte bei der Vermittlung des LiFE Programmes berücksichtigt werden: 3 Die Vermittlung des Programms
Aktiv und sicher durchs Leben mit dem LiFE Programm, 2018
Strategien zur Steigerung der körperlichen Aktivität Wenn Sie die Kraft-und Gleichgewichtsübungen... more Strategien zur Steigerung der körperlichen Aktivität Wenn Sie die Kraft-und Gleichgewichtsübungen aus den vorigen Kapiteln regelmäßig durchführen, werden Ihnen alltägliche Bewegungen wie Gehen, Treppensteigen oder Aufstehen von einem Stuhl bald leichter fallen. Sie werden sich bei diesen Bewegungen sicherer und selbstbewusster fühlen. Dadurch wird es Ihnen leichter fallen, im Alltag aktiv zu sein. Sie sollten Ihre verbesserte Fitness dazu nutzen, gezielt mehr körperliche Aktivität in Ihren Alltag zu integrieren. Damit wird es Ihnen gelingen, Ihre neu gewonnene Fitness zu erhalten oder sogar weiter zu verbessern. 5.1 LiFE Prinzipien und Übungen zur Steigerung Ihrer körperlichen Aktivität Die LiFE Prinzipien zur Steigerung körperlicher Aktivität sollen Sie dabei unterstützen, den Umfang, die Intensität und die Häufigkeit Ihres alltäglichen Bewegungsverhaltens zu steigern. Indem Sie die Prinzipien in Ihr alltägliches Leben integrieren, können Sie große Erfolge für Ihren gesamten Bewegungsumfang, Ihre Gesundheit und Unabhängigkeit verzeichnen. Die Prinzipien zur Steigerung Ihrer körperlichen Aktivität lauten: • Im Alltag mehr bewegen. • Weniger sitzen.
Background Subgroups of older patients experience difficulty performing activities of daily livin... more Background Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of “at-risk” older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations. Trial design and methods This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telep...
Introduction. The Medical Outcome Study Short Form 36 (SF-36) is widely used for measuring Health... more Introduction. The Medical Outcome Study Short Form 36 (SF-36) is widely used for measuring Health-Related Quality of Life (HRQoL) and has undergone rigorous psychometric evaluation using Classic Test Theory (CTT). However, Item Response Theory-based evaluation of the SF-36 has been limited with an overwhelming focus on individual scales and cross-sectional data. Purpose. This study aimed to examine the longitudinal item and category stability of the SF-36 using Rasch analysis. Method. Using data from the 1921-1926 cohort of the Australian Longitudinal Study on Women’s Health, responses of the SF-36 from six waves of data collection were analysed. Rasch analysis using Winsteps version 3.92.0 was performed on all 36 items of the SF-36 and items that constitute the physical health and mental health scales. Results. Rasch analysis revealed issues with the SF-36 not detected using classical methods. Redundancy was seen for items on the total measure and both scales across all waves of da...
Objective:To identify distinct behavioral phenotypes of behavioral-variant frontotemporal dementi... more Objective:To identify distinct behavioral phenotypes of behavioral-variant frontotemporal dementia (bvFTD) and to elucidate differences in functional, neuroimaging, and progression to residential care placement.Methods:Eighty-eight patients with bvFTD were included in a cluster analysis applying levels of disinhibition and apathy (Cambridge Behavioural Inventory-Revised) to identify phenotypic subgroups. Between-group (Kruskal-Wallis, Mann-Whitney U) functional differences (Disability Assessment for Dementia) and time to residential care placement (survival analyses) were examined. Cortical thickness differences (whole-brain MRI) were analyzed in patients with bvFTD vs healthy controls (n = 30) and between phenotypic subgroups.Results:Four phenotypic subgroups were identified: primary severe apathy (n = 26), severe apathy and disinhibition (n = 26), mild apathy and disinhibition (n = 27), and primary severe disinhibition (n = 9). Patients with severely apathetic phenotypes were more...
Background: As epidemiological studies have linked vitamin D deficiency to risk of metabolic synd... more Background: As epidemiological studies have linked vitamin D deficiency to risk of metabolic syndrome, we investigated vitamin D deficiency with metabolic syndrome prevalence in immigrant Asian women. Materials and Methods: In a cross-sectional pilot survey of older East Asian women (n=85 aged 60-95) we examined the association between vitamin D status (measured by serum 25-hydroxyvitamin D) with metabolic syndrome risk factors. Results: The population mean for 25-hydroxyvitamin D concentration in serum was 56 ± 22 nmol/L with forty percent being vitamin D deficient (< 50 nmol/L). Ninety-eight percent of the population had at least one metabolicsyndrome risk factor, 85% had two, 55% had three and 8% had four. Having four metabolic syndrome risk factors was associated with a three fold risk of vitamin D deficiency. Vitamin D deficiency was associated with high non-fasting blood glucose levels ≥7.7 mmol/L (OR=5.2, 95%CI=1.8-18) and non-significantly, with being overweight (OR=1.8, 95%CI =0.7-5). In contrast, vitamin D deficiency was not associated with either hypertension or central obesity. Environmental factors associated with vitamin D deficiency in these data were no vitamin tablet intake (calcium or vitamin D) (OR=7.2, 95%CI=1.8-29; OR=6.3, 95%CI=1.2-32, respectively); not being acculturated to an Australian lifestyle, (OR=2.6, 95%CI=0.9-8) or less sun exposure on the weekends (OR=3.6, 95%CI=1.0-13). After adjustment for these predictors, if these Asian immigrants were vitamin D deficient they were at an eight fold risk of having high blood glucose measurements (OR=7.6, 95%CI=1-53). Conclusion: Further larger prospective studies should be conducted to examine the association between vitamin D deficiency and risk of metabolic syndrome in similar immigrant populations.
OBJECTIVES: To determine the efficacy of vision and eye examinations, with subsequent treatment o... more 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 g...
Background-Behavioral and psychological symptoms of dementia (BPSD) are often considered to be th... more Background-Behavioral and psychological symptoms of dementia (BPSD) are often considered to be the greatest challenge in dementia care, leading to increased healthcare costs, caregiver burden, and placement into care facilities. With potential for pharmacological intervention to exacerbate behaviors or even lead to mortality, the development and rigorous testing of non-pharmacological interventions is vital. A pilot of the Tailored Activities Program (TAP) for reducing problem behaviors in people with dementia was conducted in the United States with promising results. This randomized trial will investigate the effectiveness of TAP for reducing the burden of BPSD on persons with dementia and family caregivers within an Australian population. This trial will also examine the cost-effectiveness and willingness to pay for TAP compared with a control group. Methods-This randomized trial aims to recruit 180 participant dyads of a person with dementia and their caregivers. Participants will have a diagnosis of dementia, exhibit behaviors as scored by
Background: This study investigates the use of an information and communication technology (Elder... more Background: This study investigates the use of an information and communication technology (Elder Tree) designed for older adults and their informal caregivers to improve older adult quality of life and address challenges older adults face in maintaining their independence (for example, loneliness and isolation, falling, managing medications, driving and transportation). Methods/Design: This study, an unblinded randomized controlled trial, will evaluate the effectiveness and cost of Elder Tree. Older adults who are at risk for losing their independence-along with their informal caregivers, if they name them-are randomized to two groups. The intervention group has access to their usual sources of information and communication as well as to Elder Tree for 18 months while the control group uses only their usual sources of information and communication. The primary outcome of the study is older adult quality of life. Secondary outcomes are cost per Quality-Adjusted Life Year and the impact of the technology on independence, loneliness, falls, medication management, driving and transportation, and caregiver appraisal and mastery. We will also examine the mediating effect of self-determination theory. We will evaluate the effectiveness of Elder Tree by comparing intervention-and control-group participants at baseline and months 6, 12, and 18. We will use mixed-effect models to evaluate the primary and secondary outcomes, where pretest score functions as a covariate, treatment condition is a between-subjects factor, and the multivariate outcome reflects scores for a given assessment at the three time points. Separate analyses will be conducted for each outcome. Cost per Quality-Adjusted Life Year will be compared between the intervention and control groups. Additional analyses will examine the mediating effect of self-determination theory on each outcome. Discussion: Elder Tree is a multifaceted intervention, making it a challenge to assess which services or combinations of services account for outcomes in which subsets of older adults. If Elder Tree can improve quality of life and reduce healthcare costs among older adults, it could suggest a promising way to ease the burden that advancing age can place on older adults, their families, and the healthcare system.
dementia, arthritis, stroke, mobility difficulties, falls, and hospitalization (all P's<0.05). We... more dementia, arthritis, stroke, mobility difficulties, falls, and hospitalization (all P's<0.05). We used logistic regression to determine the contribution of recent precipitating events on the adoption of mobility devices among older adults after controlling for 2015 characteristics that were significantly associated with being a New user. Precipitating events were significantly associated with being a New user of mobility equipment. Specifically, older adults who, between the 2015 and 2016 interviews, experienced a fall (OR=1.7; 95% CI=1.1-2.9), hospitalization (OR=3.7; 95% CI=2.3-5.9) or increase in mobility difficulties (OR=3.7; 95% CI=2.3-5.9) were more likely to be New users. Study findings reveal the importance precipitating events on the adoption of mobility devices, signaling the importance of assessing for need for mobility devices after these events.
et al. Recipient and instructor perspectives of an adapted exercise-based fall prevention program... more et al. Recipient and instructor perspectives of an adapted exercise-based fall prevention programme for adults aged 50+ years with vision impairment: a qualitative study nested within a randomised controlled trial. BMJ Open 2020;10:e038386.
Objective: The Stepping On program has been shown to prevent falls among community-dwelling peopl... more Objective: The Stepping On program has been shown to prevent falls among community-dwelling people in a research setting and was implemented statewide by the New South Wales (NSW) Ministry of Health in 2008. This study measured ongoing fall prevention strategies and behaviours undertaken by Stepping On participants during the 6 months after program completion. Secondary objectives were to document participant satisfaction with the program, and to identify motivators for, and barriers to, fall prevention behaviour and uptake of the strategy. Methods: We conducted a pre-post prospective study among Stepping On program participants, with 6-month follow-up. Participants commenced Stepping On in 2015 and 2016 in 15 Local Health Districts across NSW. A study-specific survey was completed at baseline and 6 months after completion of Stepping On. Measures were current self-reported fall prevention strategies and behaviours; the Falls Behavioural (FaB) Scale; the Incidental and Planned Exercise Questionnaire (IPEQ); and motivators for, and barriers to, uptake of fall prevention strategies and behaviours. Results: Baseline questionnaires were completed by 458 participants (mean age 77; standard deviation [SD] 6.7; 76% female). Both baseline and follow-up surveys were completed by 291 participants (64%; mean age 78; SD 6.9; 76% female). Program satisfaction was high-251 participants (86%) completed the whole program, 284 (98%) said it increased their awareness of falls, and 284 (98%) would recommend Stepping On to others. There were statistically significant increases in the proportion of participants who reported doing regular balance and strength exercise (74% vs 24%; p < 0.0001), and using safe walking strategies (78% vs 51%; p < 0.0001) at follow-up compared with baseline. There was also a significant improvement in the FaB Scale, indicating less risk-taking behaviour (mean increase 0.
Background: Reablement is a team-based person-centered health and social care model, most commonl... more Background: Reablement is a team-based person-centered health and social care model, most commonly available for community-dwelling older adults. Understanding the components of reablement and how it is delivered, received, and enacted facilitates best evidence and practice. Determining behavior change techniques (BCTs) or strategies is an important step to operationalize implementation of reablement. Objective: We conducted a scoping review of peer-reviewed literature to identify BCTs used within reablement studies. Methods: We registered our study with the Joanna Briggs Institute and conducted five database searches. Inclusion criteria were peer-reviewed studies focused on adults and older adults without significant cognitive impairment or dementia receiving reablement, and all study designs, years, and languages. We excluded studies focused on reablement for people with dementia or reablement training programs. The last search was on April 8, 2021. Two authors screened independently at Level 1 (title and abstract) and 2 (full text). Two authors adjudicated BCTs for each study, and a third author confirmed the final list.
Trainer-Manual - Aktiv und sicher durchs Leben mit dem LiFE Programm, 2018
Die Trainer müssen das Teilnehmerhandbuch gelesen haben, bevor sie den folgenden Abschnitt lesen.... more Die Trainer müssen das Teilnehmerhandbuch gelesen haben, bevor sie den folgenden Abschnitt lesen. Es enthält Fotos und Bilder, die das Verständnis des folgenden Abschnitts verbessern. Sie sollten darauf zurückgreifen können, während Sie die nun folgenden Informationen durcharbeiten. Es ist wichtig, den Teilnehmern nicht nur die Übungen, sondern auch die Prinzipien, auf die sich die Übungen beziehen, zu vermitteln. Während Sie ein Prinzip erklären, demonstrieren Sie dieses gleichzeitig und geben Sie Beispiele, wie es sich auf die Verbesserung der Funktion oder auf das Gehen auswirkt und zur Reduktion von Stürzen beiträgt. Sie sollten die Übungen auch demonstrieren, während Sie diese unterrichten. 3.1 Das Programm unterrichten Zu Beginn Folgende Struktur sollte bei der Vermittlung des LiFE Programmes berücksichtigt werden: 3 Die Vermittlung des Programms
Aktiv und sicher durchs Leben mit dem LiFE Programm, 2018
Strategien zur Steigerung der körperlichen Aktivität Wenn Sie die Kraft-und Gleichgewichtsübungen... more Strategien zur Steigerung der körperlichen Aktivität Wenn Sie die Kraft-und Gleichgewichtsübungen aus den vorigen Kapiteln regelmäßig durchführen, werden Ihnen alltägliche Bewegungen wie Gehen, Treppensteigen oder Aufstehen von einem Stuhl bald leichter fallen. Sie werden sich bei diesen Bewegungen sicherer und selbstbewusster fühlen. Dadurch wird es Ihnen leichter fallen, im Alltag aktiv zu sein. Sie sollten Ihre verbesserte Fitness dazu nutzen, gezielt mehr körperliche Aktivität in Ihren Alltag zu integrieren. Damit wird es Ihnen gelingen, Ihre neu gewonnene Fitness zu erhalten oder sogar weiter zu verbessern. 5.1 LiFE Prinzipien und Übungen zur Steigerung Ihrer körperlichen Aktivität Die LiFE Prinzipien zur Steigerung körperlicher Aktivität sollen Sie dabei unterstützen, den Umfang, die Intensität und die Häufigkeit Ihres alltäglichen Bewegungsverhaltens zu steigern. Indem Sie die Prinzipien in Ihr alltägliches Leben integrieren, können Sie große Erfolge für Ihren gesamten Bewegungsumfang, Ihre Gesundheit und Unabhängigkeit verzeichnen. Die Prinzipien zur Steigerung Ihrer körperlichen Aktivität lauten: • Im Alltag mehr bewegen. • Weniger sitzen.
Background Subgroups of older patients experience difficulty performing activities of daily livin... more Background Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of “at-risk” older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations. Trial design and methods This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telep...
Introduction. The Medical Outcome Study Short Form 36 (SF-36) is widely used for measuring Health... more Introduction. The Medical Outcome Study Short Form 36 (SF-36) is widely used for measuring Health-Related Quality of Life (HRQoL) and has undergone rigorous psychometric evaluation using Classic Test Theory (CTT). However, Item Response Theory-based evaluation of the SF-36 has been limited with an overwhelming focus on individual scales and cross-sectional data. Purpose. This study aimed to examine the longitudinal item and category stability of the SF-36 using Rasch analysis. Method. Using data from the 1921-1926 cohort of the Australian Longitudinal Study on Women’s Health, responses of the SF-36 from six waves of data collection were analysed. Rasch analysis using Winsteps version 3.92.0 was performed on all 36 items of the SF-36 and items that constitute the physical health and mental health scales. Results. Rasch analysis revealed issues with the SF-36 not detected using classical methods. Redundancy was seen for items on the total measure and both scales across all waves of da...
Objective:To identify distinct behavioral phenotypes of behavioral-variant frontotemporal dementi... more Objective:To identify distinct behavioral phenotypes of behavioral-variant frontotemporal dementia (bvFTD) and to elucidate differences in functional, neuroimaging, and progression to residential care placement.Methods:Eighty-eight patients with bvFTD were included in a cluster analysis applying levels of disinhibition and apathy (Cambridge Behavioural Inventory-Revised) to identify phenotypic subgroups. Between-group (Kruskal-Wallis, Mann-Whitney U) functional differences (Disability Assessment for Dementia) and time to residential care placement (survival analyses) were examined. Cortical thickness differences (whole-brain MRI) were analyzed in patients with bvFTD vs healthy controls (n = 30) and between phenotypic subgroups.Results:Four phenotypic subgroups were identified: primary severe apathy (n = 26), severe apathy and disinhibition (n = 26), mild apathy and disinhibition (n = 27), and primary severe disinhibition (n = 9). Patients with severely apathetic phenotypes were more...
Background: As epidemiological studies have linked vitamin D deficiency to risk of metabolic synd... more Background: As epidemiological studies have linked vitamin D deficiency to risk of metabolic syndrome, we investigated vitamin D deficiency with metabolic syndrome prevalence in immigrant Asian women. Materials and Methods: In a cross-sectional pilot survey of older East Asian women (n=85 aged 60-95) we examined the association between vitamin D status (measured by serum 25-hydroxyvitamin D) with metabolic syndrome risk factors. Results: The population mean for 25-hydroxyvitamin D concentration in serum was 56 ± 22 nmol/L with forty percent being vitamin D deficient (< 50 nmol/L). Ninety-eight percent of the population had at least one metabolicsyndrome risk factor, 85% had two, 55% had three and 8% had four. Having four metabolic syndrome risk factors was associated with a three fold risk of vitamin D deficiency. Vitamin D deficiency was associated with high non-fasting blood glucose levels ≥7.7 mmol/L (OR=5.2, 95%CI=1.8-18) and non-significantly, with being overweight (OR=1.8, 95%CI =0.7-5). In contrast, vitamin D deficiency was not associated with either hypertension or central obesity. Environmental factors associated with vitamin D deficiency in these data were no vitamin tablet intake (calcium or vitamin D) (OR=7.2, 95%CI=1.8-29; OR=6.3, 95%CI=1.2-32, respectively); not being acculturated to an Australian lifestyle, (OR=2.6, 95%CI=0.9-8) or less sun exposure on the weekends (OR=3.6, 95%CI=1.0-13). After adjustment for these predictors, if these Asian immigrants were vitamin D deficient they were at an eight fold risk of having high blood glucose measurements (OR=7.6, 95%CI=1-53). Conclusion: Further larger prospective studies should be conducted to examine the association between vitamin D deficiency and risk of metabolic syndrome in similar immigrant populations.
OBJECTIVES: To determine the efficacy of vision and eye examinations, with subsequent treatment o... more 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 g...
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Papers by Lindy Clemson