National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people


Chapter 5. The health of older people
Introduction
☰ Table of contents


Overview


Aboriginal and Torres Strait Islander communities have different age structures to the non-Indigenous population, due to high fertility and increased mortality at all ages, giving a much lower median age (21.8 years versus 37.6 years).1 The aged population is therefore smaller as a proportion, with 8.8% of Aboriginal and Torres Strait Islander people being over 55 years of age and only 3.3% over 65 years of age. The corresponding figures for non-Indigenous Australians are 22% and 13% respectively.2 In 2006 this amounted to 60,000 Aboriginal and Torres Strait Islander people over 50 years of age, contrasting with almost 6.2 million non-Indigenous people in the same age group.3 Of the total Australian population aged 75 years and older, only 0.4% (5000 people) identify as an Aboriginal and/or Torres Strait Islander person.3 However, demographic shifts are occurring, and the number of Aboriginal and Torres Strait Islander people over 55 years of age is projected to double between 2011 and 2026.2 The care of older people is becoming more important as the population ages. In addition, many of the disorders that affect older people occur at younger ages for Aboriginal and Torres Strait Islander people.

Many areas of preventive care for older people are covered in other chapters of this guide; in particular, vision (Chapter 6: Eye health), hearing (Chapter 7: Hearing loss), respiratory disease (Chapter 9: Respiratory health) and cardiovascular health (Chapter 11: Cardiovascular disease prevention). This chapter will cover three important issues relating to older people not covered elsewhere in this guide: osteoporosis, falls and dementia.

National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people

 





 
 
  1. Australian Bureau of Statistics. Estimates of Aboriginal and Torres Stait Islander Australians, June 2011. Canberra: ABS, 2013. [Accessed 15 November 2017].
  2. Australian Bureau of Statistics. Experimental estimates and projections, Aboriginal and Torres Strait Islander Australians. Cat. no. 3238.0. Canberra: ABS, 2009. [Accessed 15 November 2017].
  3. Australian Bureau of Statistics. Population characteristics, Aboriginal and Torres Strait Islander Australians 2006. Canberra: ABS, 2010.    [Accessed 15 November 2017].
  4. Wold Health Organization Scientific Group on the Prevention and Management of Osteoporosis. Prevention and management of osteoporosis: Report of a WHO scientific group. WHO Technical Report Series 921 [Internet]. Geneva: WHO, 2000.  [Accessed 15 November 2017].
  5. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice (Red Book). 9th edn. East Melbourne, Vic: RACGP, 2016.  [Accessed 15 November 2017].
  6. Henry MJ, Pasco JA, Nicholson GC, Kotowicz MA. Prevalence of osteoporosis in Australian men and women: Geelong Osteoporosis Study. Med J Aust 2011;195(6):321–22.
  7. Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV. Residual lifetime risk of fractures in women and men. J Bone Miner Res 2007;22(6):781–88.
  8. The Royal Australian College of General Practitioners. Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. 2nd edn. East Melbourne, Vic: RACGP, 2017.
  9. Australian Institute of Health and Welfare. The problem of osteoporotic hip fracture in Australia. Canberra: AIHW, 2010.  [Accessed 15 November 2017].
  10. Wong YY, Flicker L, Draper G, Lai MM, Waldron N. Hip fractures among indigenous Western Australians from 1999 to 2009. Intern Med J 2013;43(12):1287–92.
  11. Maple-Brown LJ, Hughes J, Piers LS, et al. Increased bone mineral density in Aboriginal and Torres Strait Islander Australians: Impact of body composition differences. Bone 2012;51(1):123–30.
  12. Eisman J, Clapham S, Kehoe L, Australian BoneCare S. Osteoporosis prevalence and levels of treatment in primary care: The Australian BoneCare Study. J Bone Miner Res 2004;19(12):1969–75.
  13. Ewald DP, Eisman JA, Ewald BD, et al. Population rates of bone densitometry use in Australia, 2001–2005, by sex and rural versus urban location. Med J Aust 2009;190(3):126–28.
  14. Jones G, Nguyen T, Sambrook P, Kelly P, Gilbert C, Eisman J. Symptomatic fracture incidence in elderly men and women: The Dubbo Osteoporosis Epidemiology Study (DOES). Osteoporos Int 1994;4(5):277–82.
  15. Cooley H, Jones G. A population-based study of fracture incidence in southern Tasmania: Lifetime fracture risk and evidence for geographic variations within the same country. Osteoporos Int 2001;12(2):124–30.
  16. Klotzbuecher C, Ross P, Landsman P, Berger M. Patients with prior fractures have an increased risk of future fractures: A summary of the literature and statistical synthesis. J Bone Miner Res 2000;15(4):721–39.
  17. Ross PD, Davis JW, Epstein RS, Wasnich RD. Pre-existing fractures and bone mass predict fracture incidence in women. Ann Intern Med 1991;114(11):919–23.
  18. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996;312(7041):1254–58.
  19. Nguyen TV, Center JR, Sambrook PN, Eisman JA. Risk factors for proximal humerus, forearm, and wrist fractures in elderly men and women: The Dubbo Osteoporosis Study (DOES). Am J Epidemiol 2001;153(6):587–95.
  20. Scottish Intercollegiate Guidelines Network. Management of osteoporosis and the prevention of fragility fractures. Edinburgh: SIGN, 2015. [Accessed 15 November 2017].
  21. Kanis JA, Johnell O, Oden A, et al. Smoking and fracture risk: A meta-analysis. Osteoporos Int 2005;16(2):155–62.
  22. Drake MT, Murad MH, Mauck KF, et al. Clinical review. Risk factors for low bone mass-related fractures in men: A systematic review and meta-analysis. J Clin Endocrinol Metab 2012;97(6):1861–70.
  23. Warensjo E, Byberg L, Melhus H, et al. Dietary calcium intake and risk of fracture and osteoporosis: Prospective longitudinal cohort study. BMJ 2011;342:d1473.
  24. Cancer Council Australia. Sun exposure and vitamin D: Risks and benefits. Sydney: Cancer Council Australia, 2016.   [Accessed 21 April 2017].
  25. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: A systematic review and meta-analysis. J Am Geriatr Soc 2008;56(12):2234–43.
  26. Minne HW. Make it or break it: How exercise helps to build and maintain strong bones, prevent falls and fractures, and speed rehabilitation. Nyon, Switzerland: International Osteoporosis Foundation, 2006. Available at www.osteoporosis.org.au/images/stories/ documents/research/Invest_IOF_2006.pdf [Accessed October 2011].
  27. Cornuz J, Feskanich D, Willett WC, Colditz GA. Smoking, smoking cessation, and risk of hip fracture in women. Am J Med 1999;106(3):311–14.
  28. Santesso N, Carrasco-Labra A, Brignardello-Petersen R. Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev 2014(3):CD001255.
  29. Wells GA, Cranney A, Peterson J, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 2008(1):CD001155.
  30. Department of Health. PBS Online: Pharmaceutical Benefits Scheme. Canberra: Deparment of Health, 2017.  [Accessed 15 November 2017].
  31. Cummings SR, San Martin J, McClung MR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009;361(8):756–65.
  32. Department of Health. Medicare Benefits Schedule. MBS online.  [Accessed 15 November 2017].
  33. World Health Organization. Falls: Fact sheet no. 344. Geneva: WHO, 2010. Available at www.who.int/mediacentre/factsheets/fs344/en [Accessed 15 November 2017].
  34. Australian Commission on Safety and Quality in Health Care. Preventing falls and harm from falls in older people: Best practice guidelines for Australian Community Care, 2009. Canberra: ACSQHC, 2009. [Accessed 15 November 2017].
  35. Bradley C, Pointer S. Hospitalisations due to falls by older people, Australia 2005–06. Adelaide: Australian Institute of Health and Welfare, 2009.
  36. Hu F, Jiang C, Shen J, Tang P, Wang Y. Preoperative predictors for mortality following hip fracture surgery: A systematic review and meta-analysis. Injury 2012;43(6):676–85.
  37. Cenzer IS, Tang V, Boscardin WJ, et al. One-year mortality after hip fracture: Development and validation of a prognostic index. J Am Geriatr Soc 2016;64(9):1863–68.
  38. El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: Systematic review and meta-analysis of randomised controlled trials. BMJ 2013;347:f6234.
  39. Sherrington C, Lord S, Close J. Best practice recommendations for physical activity to prevent falls in older adults: A rapid review. Sydney: NSW Department of Health, 2008.
  40. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012(9):CD007146.
  41. Cameron ID, Gillespie LD, Robertson MC, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2012;12:CD005465.
  42. Campbell A, Robertson M, Gardner M, Norton R, Buchner D. Psychotropic medication withdrawal and a home based exercise program to prevent falls: A randomized, controlled trial. J Am Geriatr Soc 1999;47(7):850–53.
  43. Cameron I, Murray G, Gillespie L, et al. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev 2010;20(1):CD005465.
  44. Michael Y, Whitlock EP, Lin J, Fu R, O’Connor E, Gold R. Primary care-relevant interventions to prevent falling in older adults: A systematic evidence review for the US Preventive Services Task Force. Ann Intern Med 2010;153:815–25.
  45. Pit SW, Byles JE, Henry DA, Holt L, Hansen V, Bowman DA. A quality use of medicines program for general practitioners and older people: A cluster randomised controlled trial. Med J Aust 2007;187(1):23–30.
  46. Australian Institute of Health and Welfare. Dementia in Australia. Canberra: AIHW, 2012.  [Accessed 15 November 2017].
  47. Australian Institute of Health and Welfare. Dementia in Australia: National data analysis and development. Canberra: AIHW, 2006.
  48. UpToDate DSM-IV and DSM-5 criteria for dementia, 2017. [Accessed 15 November 2017].
  49. Radford K, Mack HA, Draper B, et al. Prevalence of dementia in urban and regional Aboriginal Australians. Alzheimers Dement 2015;11(3):271–79.
  50. Li SQ, Guthridge SL, Eswara Aratchige P, et al. Dementia prevalence and incidence among the Indigenous and non-Indigenous populations of the Northern Territory. Med J Aust 2014;200(8):465–69.
  51. Smith K, Flicker L, Dwyer A, et al. Factors associated with dementia in Aboriginal Australians. Aust N Z J Psychiatry 2010;44(10):888–93.
  52. LoGiudice D, Smith K, Fenner S, et al. Incidence and predictors of cognitive impairment and dementia in Aboriginal Australians: A follow-up study of 5 years. Alzheimers Dement 2016;12(3):252–61.
  53. Alzheimer’s Disease International. World Alzheimer Report 2014: Dementia and risk reduction. An analysis of protective and modifiable risk factors. London: Alzheimer’s Disease International, 2014.
  54. Anstey KJ, Cherbuin N, Herath PM. Development of a new method for assessing global risk of Alzheimer’s disease for use in population health approaches to prevention. Prev Sci 2013;14(4):411–21.
  55. Dementia Collaborative Research Centre. Australian National University Alzheimer’s Disease Risk Index (ANU-ADRI). Canberra: ANU, 2017.  [Accessed 15 November 2017].
  56. US Preventive Services Task Force. Final recommendation statement. Cognitive impairment in older adults: Screening. USPSTF, 2016. [Accessed 15 November 2017].
  57. Terpening Z, Hodges JR, Cordato NJ. Towards evidence-based dementia screening in Australia. Med J Aust 2011;194(2):60–61.
  58. Flicker L, Holdsworth K. Aboriginal and Torres Strait Islander people and dementia: A review of the research. A report for Alzheimer’s Australia. North Ryde, NSW: Alzheimer’s Australia, 2014.
  59. Henderson S, Broe G. Dementia in Aboriginal Australians. Aust N Z J Psychiatry 2010;44:869–71.
  60. Radford K, Mack HA, Draper B, et al. Comparison of three cognitive screening tools in older urban and regional Aboriginal Australians. Dement Geriatr Cogn Disord 2015;40(1–2):22–32.
  61. LoGiudice D, Smith K, Thomas J, et al. Kimberley Indigenous Cognitive Assessment (KICA) tool: Development of a cognitive assessment tool for older Indigenous Australians. Int Psychogeriatr 2006;18(2):269–80.
  62. Boustani M, Peterson B, Hanson L, Harris R, Lohr KN. Screening for dementia in primary care: A summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2003;138(11):927–37.
  63. National Collaborating Centre for Mental Health. Dementia: A NICE-SCIE guideline on supporting people with dementia and their carers in health and social care. London, 2007.
  64. Patterson CJ, Gass DA. Screening for cognitive impairment and dementia in the elderly. Can J Neurol Sci 2001;28(Suppl 1):S42–S51.
  65. Guideline Adaptation Committee. Clinical practice guidelines and principles of care for people with dementia. Sydney: Guideline Adaptation Committee, 2016.
  66. Brodaty H, Pond D, Kemp N, et al. The GPCOG: A new screening test for dementia designed for general practice. J Am Geriatr Soc 2002;50:530–34.
  67. Western Australian Centre for Health Ageing and Harry Perkins Institute of Medical Research. Kimberley Indigenous Cognitive Assessment (KICA). [Accessed 15 November 2017].
  68. Burns A, O’Brien J. Clinical practice with anti-dementia drugs: A consenus statement from the British Association for Psychopharmacology. J Psychopharmacol 2006;20(6):732–55.