Poorer oral health was not uncommon and was associated with dementia and renal impairment even after adjustment for anticholinergic medication and oral pH. Oral health screening should be considered for vulnerable populations.

BackgroundAccurate population-based data regarding hospital-based care utilisation by older persons during their last year of life are important in health services planning. We investigated patterns of acute hospital-based service use at the end of life, amongst older decedents in New South Wales (NSW), Australia.MethodsData from all persons aged ≥70 years who died in the state of NSW Australia in 2007 were included. Several measures of hospital-based service utilisation during the last year of life were assessed from retrospectively linked data comprising data for all registered deaths, cause of death, hospital care during the last year of life (NSW Admitted Patient Data Collection [APDC] and Emergency Department [ED] Data Collection [EDDC]), and the NSW Cancer Registry.ResultsAmongst 34,556 decedents aged ≥70 years, 82% (n = 28,366) had ≥1 hospitalisation during the last year of life (median 2), and 21% > 3 hospitalisations. Twenty-five percent (n = 5485) of decedents attended ED during the last week of life. Overall, 21% had a hospitalisation > 30 days in the last year of life, and 7% spent > 3 months in hospital; 79% had ≥1 ED attendance, 17% > 3. Nine percent (n = 3239) spent time in an intensive care unit. Fifty-three percent (n = 18,437) died in an inpatient setting. Hospital records had referenced palliative care for a fifth (7169) of decedents. Adjusting for age group, sex, place of residence, area-level socioeconomic status, and cause of death, having > 3 hospitalisations during the last year of life was more likely for persons dying from cancer (35% versus 16% non-cancer deaths, adjusted odds ratio [aOR] 2.33), ‘younger’ old decedents (29% for age 70–79 and 20% for age 80–89 versus 11% for 90+, aOR 2.42 and 1.77 respectively) and males (25% versus 17% females, aOR 1.38). Patterns observed for other hospital-based service use were similar.ConclusionsThis population-based study reveals high use of hospital care among older persons during their last year of life, although this decreased with increasing older age, providing important data to inform health services planning for this population, and highlighting aspects requiring further study.

Moderate to severe visual impairment was associated with an increased likelihood of community service utilization in this aged care client sample.

Background Appropriate antibiotic stewardship is of great importance given increasingly high rates of microbial antibiotic resistance and the vulnerability of older persons to adverse drug effects. Aim To assess prescriber compliance with Antibiotic Therapeutic Guidelines when prescribing for older patients admitted to our geriatric service, and if deficits were identified in the initial audit, to conduct an educational intervention, with re‐audit planned thereafter. Method Patients admitted to our geriatric Medical Admissions Unit (MAU) and treated with antibiotics for infection (confirmed or presumed) were prospectively audited (August–October 2013). Demographic details, antibiotics treatment, microbiology culture and sensitivities, and prescribing teams were recorded. Following educational intervention, MAU admissions were re‐audit (January 2014). Results Initial (electronic) Therapeutic Guidelines (eTG) compliance for both audits was similar with no statistical significance (15%). Compliance rates ‘at any stage of admission’ was also not statistically significantly different 43% in 2013, 54% in 2014 (p = 0.81). There was no association between the team initiating therapy (emergency vs medical team) and compliance. Conclusion Rates of compliance with eTG are suboptimal in our institution. Furthermore, the brief, targeted educational intervention was not effective and further exploration of means to improve antibiotic compliance is needed.