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Women more frail but more resilient than men
Women tend to have poorer health status and are more frail but are more resilient and have longer life expectancy than men, according to the authors of a narrative review on frailty, published by the MJA. “It has been estimated that just over 10% of community dwelling adults aged 65 years and over are frail,” wrote the authors, Dr Emily Gordon, a consultant geriatrician, and Professor Ruth Hubbard, from the Centre for Health Services Research at the University of Queensland. “Increasing frailty is associated with syndromic disease presentations; falls, delirium, functional decline and new urinary incontinence may reflect acute illness in a frail older person and should never be dismissed as ‘normal for age’.” The authors described the differences in frailty between men and women as the “sex–frailty paradox”. “In community dwelling populations aged over 65 years, women are more likely to be frail and to have a greater burden of frailty than men of the same age. Yet women appear to be more resilient — at any given age or level of frailty, their mortality rates are lower.
The life expectancy of females continues to be about 4 years longer than that of males. Yet throughout their lives, women are burdened by chronic disease and disability to a greater extent than men and, unsurprisingly, women have poorer self-rated health.” Exercise and nutrition-based interventions were found to have the highest levels of evidence. “Cognitive training strategies and comprehensive geriatric assessment with interdisciplinary interventions address important non-physical health domains. Researchers have reported benefits from multifactorial interventions incorporating exercise, a nutritional intervention, and cognitive training with social support or medication review. The evidence base for interventions to prevent or reduce frailty in institutionalised or hospitalised older adults is limited.” Some evidence implies that some interventions work better for one sex than the other. “Exercise programs appear to be effective in both sexes. However, sarcopenia, low physical activity and functional impairment are more prevalent in older women than men, and it is possible that women may benefit from a different type or intensity of exercise intervention than men. With respect to nutrition, men may benefit from interventions to a greater extent than women. Several studies have indicated that men tend to have a poorer understanding of nutrition and make unhealthy dietary decisions. Sex differences in frailty highlight that older men and women may respond to interventions in different ways and may benefit from more sex-specific strategies.”
Lead levels in pre-school kids lower but vigilance needed
Lead levels in the blood of pre-school children have dropped overall, but those living in houses 50 or more years old, or children living in proximity to a lead-producing source have higher levels, according to research published by the MJA. Researchers led by Dr Christos Symeonides, a paediatrician and post-graduate research scholar from the Murdoch Children’s Research Institute and the Royal Children’s Hospital Melbourne, measured the blood lead levels in 523 of 708 children appraised in the Barwon Infant Study pre-school review. They found that the median blood lead level was 0.8 μg/dL (range, 0.2–3.7 μg/dL); the geometric mean blood lead level after propensity weighting was 0.97 μg/dL (95% CI, 0.92–1.02 μg/dL). Children in houses 50 or more years old had higher blood lead levels – “this association is consistent with the restriction of the lead content of house paint since 1965” – as did children of families with lower household income and those living closer to the Point Henry aluminium smelter, which operated between 1962 and 2015. Associations between hygiene factors and lead levels were evident only for children living in older homes. The researchers compared blood lead levels in this study with other studies – including recent surveys of Australian children in Mount Isa and Port Pirie – and concluded: “Blood lead levels in our pre-school children were lower than in previous Australian surveys and recent surveys in areas at risk of higher exposure. None of the children in our study had blood levels exceeding 5 μg/dL, the threshold for notification and investigation recommended by the [National Health and Medical Research Council]; indeed, the highest level measured was 3.7 μg/dL, suggesting that regulatory measures for reducing the lead exposure of children in the general Australian population have been effective. Our findings support current recommendations for reducing exposure of children to lead in the home, including reducing the risks connected with sand contamination, and lead-containing paint”. The researchers concluded that “as no safe limit of exposure for children has been established, minimising exposure to lead remains essential”.
Policy directions reinforce AHPRA’s first duty as patient safety
New policy directions from the COAG Health Council have reinforced that the Australian Health Practitioner Regulation Agency (AHPRA) and the National Boards are to prioritise public protection and patient safety. The two directions clearly state that public protection is paramount and require consultation with patient safety and health care consumer bodies on any new and revised registration standards, codes and guidelines, as well as other considerations. The first policy direction provides clarity on the considerations that National Boards and AHPRA must give to the public (including vulnerable people in the community) when determining whether to take regulatory action about a health practitioner. It also authorises limited sharing of information to employers and state and territory health departments about serious conduct matters by a registered health practitioner. The second policy direction requires National Boards to consult with patient safety bodies and consumer bodies on registration standards, codes and guidelines when they are being developed or revised. It also provides that National Boards and AHPRA must consider the impacts of the new or revised registration standard on vulnerable members of the community and Aboriginal and Torres Strait Islander people, and prepare and publish a “patient health and safety impact statement” with each new or revised registration standard, code or guideline. AHPRA CEO Martin Fletcher emphasised that in implementing these policy directions, AHPRA and the National Boards will continue to ensure fairness for health practitioners in regulatory processes. “We know that fairness is important to practitioners and patients alike, and this will continue to be an important focus in our processes and procedures.”
What’s new online at the MJA
Research: Estimating the magnitude of cancer overdiagnosis in Australia
Glasziou et al; doi: 10.5694/mja2.50455
Cancer overdiagnosis is a substantial problem that urgently requires changes in public health policy … GOLD OPEN ACCESS
Podcast: Professor Paul Glasziou from the Institute for Evidence-Based Healthcare at Bond University … OPEN ACCESS permanently
Research: Pre-school child blood lead levels in a population-derived Australian birth cohort: the Barwon Infant Study
Symeonides et al; doi: 10.5694/mja2.50427
Blood lead levels in the pre-school children in our sample were lower than in previous surveys … OPEN ACCESS permanently
Narrative review: Differences in frailty in older men and women
Gordon et al; doi: 10.5694/mja2.50466
Compared with age-matched men, women tend to have poorer health status but longer life expectancy … FREE ACCESS for one week
Podcast: Dr Emily Gordon, consultant geriatrician with the Centre for Health Services Research at the University of Queensland … OPEN ACCESS permanently
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