Suchergebnisse

Abstract
This paper will highlight current evidence about health and well-being that could encourage investment in health for older populations. The paper uses the example of hypertension throughout to illustrate how data collection efforts are translating research to policy. Hypertension, is a global scourge for poor and wealthy, younger and older adults, increasing the risk of stroke and cardiovascular disease. Although it is easily diagnosed and can be effectively treated the burden of hypertension continues to grow as awareness, prevention and treatment lags, particularly for the poor and old. The focus is brought back to how current research can inform policy for ageing populations in the final section, using Ireland's experience to demonstrate how to legislate the good life for older adults.

Objective The aim of the present study was to examine non-communicable disease (NCD) policy formation and implementation in Indonesia. Methods Interviews were conducted with 13 Indonesian health policy workers. The processes and issues relating to NCD policy formation were mapped, exploring the interactions between policy makers, technical/implementation bodies, alliances across various levels and the mobilisation of non-policy actors. Results Problems in NCD policy formation include insufficient political interest in NCD control, disconnected policies and difficulty in multisectoral coordination. These problems are well illustrated in relation to tobacco control, but also apply to other control efforts. Nevertheless, participants were optimistic that there are plentiful opportunities for improving NCD control policies given growing global attention to NCD, increases in the national health budget and the growing body of Indonesia-relevant NCD-related research. Conclusion Indonesia's success in the creation and implementation of NCD policy will be dependent on high-level governmental leadership, including support from the President, the Health Minister and coordinating ministries. What is known about the topic? The burden of NCD in Indonesia has increased gradually. Nationally, NCD-related mortality accounted for 65% of deaths in 2010. Indonesia is also a country with the highest burden of tobacco smoking in the world. However, the government has not instituted sufficient policy action to tackle NCDs, including tobacco control. What does this paper add? This paper deepens our understanding of current NCD control policy formation in Indonesia, including the possible underlying reason why Indonesia has weak tobacco control policies. It describes the gaps in the current policies, the actors involved in policy formation, the challenges in policy formation and implementation and potential opportunities for improving NCD control. What are the implications for practitioners? An effective NCD control program requires strong collaboration, including between government and health professionals. Health professionals can actively engage in policy formation, for example through knowledge production.

AbstractPast research has identified the salience of the notion of "good motherhood" in countries such as Australia, where women are expected to invest significant time and energy, often through self‐sacrifice, to raise their children. We analysed free‐text comments provided in response to an open‐ended question from the Australian Longitudinal Study on Women's Health (ALSWH) to examine whether the discourse of "good motherhood" played any role in how women articulate their experiences of juggling paid employment with motherhood. Eighty women from the cohort born 1973–78 were included, providing 223 comments. "Good motherhood" underpinned many of the accounts about combining motherhood with paid employment. Women reported life as stressful and hectic as they attempted to juggle the demands of childcare with paid employment and domestic chores. Although some identified "good motherhood" as an unachievable ideal, most were largely unable to disengage with this discourse. Broader social structures, such as inflexible working conditions, were found to reinforce and support this ideal, contributing to the strength of the discourse.

ABSTRACT
ObjectivesTo examine the trend of the healthcare cost of arthritis in a population-based cohort of older women and to estimate the mean adjusted incremental healthcare costs, and selected percentiles.
ApproachThis is a healthcare cost study based on individual-level data. Data included health survey and linked administrative data, from 2003 to 2009, from the Australian Longitudinal Study on Women's Health. The Medicare Australia datasets include the Pharmaceutical Benefits Scheme (unit record data on claims for government-subsidized prescription medicines) and the Medicare Benefits Schedule (listing of health services subsidized by the Australian Government) datasets; they were the source for all healthcare utilization and cost data in this study. The main outcome measure was the incremental healthcare cost of arthritis (estimated from the Australian Government's cost perspective) expressed as dollars per person per year. All costs were expressed in 2012 Australian dollars. Regression models were used to estimate the adjusted incremental costs of arthritis. The mean adjusted incremental healthcare cost of arthritis was computed using GLMs with a logarithmic-link function and a gamma distribution for costs. The adjusted incremental costs at the 25th, 50th, 75th, 90th and 95th percentiles were computed using Quantile Regression. These percentiles were chosen because cost data are skewed to the right and it was expected that there would be smaller differences between the lower percentiles but bigger differences between upper adjacent percentiles.
ResultsData from 4287 women were included in the analysis. Adjusted incremental healthcare cost of arthritis did not increase significantly from 2003 to 2009. However, there were indications that costs at the lower percentiles decreased slightly over the study period while costs at higher (above 50th) percentiles increased. The estimated median cost was $480 (95% CI: $498 - $759) per person per year in 2009. However, ten percent of women had more than 300% higher cost than the "average person" with arthritis.
ConclusionHealthcare cost of arthritis represents a substantial burden. However, considering only overall cost does not provide a detailed picture of expenditure. Our results suggest that higher cost patients had different experiences in arthritis cost over time, compared to patients with lower costs, although overall cost has not increased over time. As healthcare spending is concentrated in the high-cost patients, characterising these patients and formulating initiatives that target them could have a considerable impact on improving care and lowering health expenditure due to arthritis.

ABSTRACT
ObjectivesAnticholinergic medicines burden is common, can have negative impacts, and is problematic to identify. Many medicines used by older women have anticholinergic effects. Importantly for older women, where multimorbidity and use of multiple medicines is common, even when anticholinergic effect of an individual medicine is small, the anticholinergic effects of multiple medicines may be additive, constituting cumulative anticholinergic burden. This study describes medicines contributing to and predictors of anticholinergic burden among community-dwelling older Australian women.
ApproachRetrospective longitudinal analysis of data from the Australian Longitudinal Study on Women's Health linked to Pharmaceutical Benefits Scheme medicines data from 1 January 2008 to 30 December 2010; for 3694 women born in 1921–1926.Anticholinergic medicines were assigned anticholinergic potency levels 0 to 3, according to the Anticholinergic Drug Scale. Anticholinergic Drug Scale ratings for all medicines used by each woman were summed across each six months to give an Anticholinergic Drug Scale score. Commonly used medicines were identified for women with high ADS scores (defined as 75th percentile of scores). Predictors of high ADS scores were analysed using generalised estimating equations.
ResultsDuring 2008-2010, 1126 (59.9%) of women used at least one anticholinergic medicine. Median Anticholinergic Drug Scale score was 4. Most anticholinergic medicines used by women who had a high anticholinergic burden (Anticholinergic Drug Scale score > 9) had a low anticholinergic potency (Anticholinergic Drug Scale level 1). Increasing age, cardiovascular disease, and number of other medicines used were predictive of a higher anticholinergic burden.
ConclusionHigh anticholinergic medicines burden in this group was driven by use of multiple lower anticholinergic potency medicines rather than use of higher potency medicines. While we might expect that doctors would readily identify anticholinergic burden risk for those using high potency medicines, they may be less likely to identify this risk for users of multiple low potency anticholinergic medicines. The paper will also discuss how GPs view these findings, and how to translate them into the prescribing setting.

Population ageing and its future implications for governments and individuals have been central to much policy debate and research targeted to retain older people in the workforce. This study identified workforce participation patterns across the adult life course for women and men entering later life, and explored the influences of various early and adult life socio-demographic circumstances. Data were collected from 1261 men and women aged 60 to 64 years in the Life History and Health (LHH) Survey (a sub-study of the Sax Institute's 45 and Up Study, Australia) in 2010–11. LHH provides detailed information on personal histories of paid work, socio-economic resources from childhood (number of books and father's occupation) and adult life factors such as educational attainment, marital histories, childcare and informal caring. Latent class analysis (LCA) was undertaken to identify patterns of workforce participation for participants across their adult life. Significant gender differences were confirmed. Further analysis (LCA with covariates) showed that women who reported having books during childhood, and those who had post-school qualification, were more likely to have mostly been in paid work and less likely to have not been in paid work; while ever partnered women had significantly higher odds of increasing part time work over time. Men who had reported ever having had informal caring activities were likely to have had decreasing participation in paid work over time, and were highly likely to be not in paid work after 55 years. Ever partnered status was protective for being in paid work for men. These findings indicate the need for gender-specific policies and strategies to enable continued workforce participation throughout adult life and into later working years, particularly for people who had fewer social or economic opportunities earlier in life. ; This research was supported by the Australian Research Council Centre of Excellence in Population Ageing Research (project number CE110001029).

Population ageing and its future implications for governments and individuals have been central to much policy debate and research targeted to retain older people in the workforce. This study identified workforce participation patterns across the adult life course for women and men entering later life, and explored the influences of various early and adult life socio-demographic circumstances. Data were collected from 1261 men and women aged 60 to 64 years in the Life History and Health (LHH) Survey (a sub-study of the Sax Institute's 45 and Up Study, Australia) in 2010–11. LHH provides detailed information on personal histories of paid work, socio-economic resources from childhood (number of books and father's occupation) and adult life factors such as educational attainment, marital histories, childcare and informal caring. Latent class analysis (LCA) was undertaken to identify patterns of workforce participation for participants across their adult life. Significant gender differences were confirmed. Further analysis (LCA with covariates) showed that women who reported having books during childhood, and those who had post-school qualification, were more likely to have mostly been in paid work and less likely to have not been in paid work; while ever partnered women had significantly higher odds of increasing part time work over time. Men who had reported ever having had informal caring activities were likely to have had decreasing participation in paid work over time, and were highly likely to be not in paid work after 55 years. Ever partnered status was protective for being in paid work for men. These findings indicate the need for gender-specific policies and strategies to enable continued workforce participation throughout adult life and into later working years, particularly for people who had fewer social or economic opportunities earlier in life. ; This research was supported by the Australian Research Council Centre of Excellence in Population Ageing Research (project number CE110001029).