Background: Research on the association between socioeconomic status (SES) and frailty in older Australian adults is limited, despite evidence supporting the health-wealth relationship. This study explores the association between SES and frailty among community-dwelling older adults.

Methodology: This prospective cohort study used data from 12,603 older adults (mean age 75.2 years, 53.2% female) participating in the ASPREE clinical trial. Participants self-reported education level and income, while area-level SES was assessed using IRSAD scores. Frailty was defined using the Fried phenotype and the Deficit Accumulation Index (DAI). The association between SES and frailty was explored using Cox proportional hazards regression adjusted for age, sex, behavioural and clinical factors.

Results: Over a 6 years follow-up period, 14.4% developed Fried frailty and 26.0% developed frailty as measured by DAI. Risk of frailty was lower amongst participants with tertiary education compared to those who only completed primary school (HR: 0.74, 95% CI: 0.65-0.84). Those living in more advantaged areas were at lower risk of frailty (HR: 0.57, 95% CI: 0.48-0.67) compared to their counterparts living in most disadvantaged areas. Individuals reporting an income above AUD$50,000 had a lower risk of frailty compared to those earning below $20,000 (HR: 0.61, 95% CI: 0.51-0.72). In the analysis where education, income and area-level SES were mutually adjusted for, associations were slightly attenuated but remained significant.

Conclusion: Higher level of formal education, higher income and living in more advantaged areas was associated with a lower risk of frailty in older adults. Further research is needed to explore the pathways linking SES to frailty. Health policies should address SES-related disparities to reduce frailty and improve health outcomes through community support programs that promote healthy ageing.

Interpersonal violence is a global challenge for communities and governments, requiring responses that consider public health, human rights and development. In the Northern Territory (NT), injury was the leading contributor to the burden of disease in 2014-2018, with assault or interpersonal violence the largest factor in years lived with a disability (8.7%). We aimed to describe the epidemiology of assault injury emergency department (ED) presentations and estimate the proportion of involvement of domestic violence (DV) in assault injury presentations.

Methods: We conducted a retrospective analysis of injury presentations to all EDs in the NT from 1 January 2005 to 31 December 2022. We undertook descriptive analyses and calculated assault involvement against all injury presentations. We examined trends in assault injuries overall, and for all assaults due to DV.

Results: Assault injuries accounted for 14.8% (n=85,967/580,129) of all ED injury presentations in the NT. The NT rate of assault presentations increased by 16% during the study period, contributed by increased rates among Aboriginal females (20%), Aboriginal males (5%), and non-Aboriginal females (4%). In 2020-2022, Aboriginal females had the highest rate of assault presentations (7,836 per 100,000), two times higher than Aboriginal males (4,045 per 100,000) and 28 times higher than non-Aboriginal females (284 per 100,000). The pattern of assault differed by regions with the highest rates observed in Central Australia and Barkly. Trends in assault presentation demonstrated an increasing contribution of DV, with greater than 58% of assault presentations related to DV from 2011 onwards.

Conclusion: An increase in assault injury presentations to EDs in the NT was observed from 2005 to 2022. This burden disproportionately impacts the NT’s Aboriginal population and particularly females. Over half of assault presentations were related to DV. Given the burden, the NT would benefit from more standardised and systemic approaches to ED injury surveillance. Better data can inform place-based public health and community response that works with agencies and Aboriginal leaders.

Falls remain a major contributor to hospitalisation and mortality among older Australians, representing 43% of injury-related hospital admissions and 42% of deaths. Addressing falls prevention in adults aged 65 and over is a critical focus for the South East Public Health Unit (SEPHU), Victoria. This retrospective study aimed to analyse the causes, risk factors, and cost burden associated with falls, using data from Monash Health, a leading public tertiary health service provider in Melbourne, over a 12-month period (1 May 2022 to 30 April 2023).
A total of 2,732 admissions for falls in this age group met the study criteria, with 768 records (28%, every fifth record) selected for detailed review. Demographic data, fall causes, and risk factors were analysed using Microsoft Power BI and Excel. The findings highlighted that 69% of hospitalisations involved individuals aged 65 and older, with a median age of 82 years; 63% were female, and 45% were from non-English-speaking backgrounds. The predominant causes of falls included same level falls including slips and trips (38%), with 31% being due to unknown causes and the remainder linked to medical conditions, household hazards, and other activities.
Risk factor analysis revealed that 70% of the patients had at least one contributing risk factor, most frequently a history of medical issues (77%), walking difficulties (35%), and frailty (29%). Additionally, 39% had a risk factor that could influence fall outcomes, with osteoporosis (64%), anticoagulant use (37%), and a history of fractures (10%) being prominent. Implementing targeted, evidence-based prevention programs that address these risk factors could reduce hospitalisations and associated costs, while significantly enhancing the health and well-being of older adults. Effective prevention can contribute to healthier aging and more years of life lived well, preserving independence and quality of life.
This study underscores the importance of collaborative prevention strategies that include targeted primary prevention and partnerships with general practitioners. Expanding this research to encompass other tertiary health services and private providers could enhance comprehensive, community-level interventions that not only prevent falls and save healthcare costs, but also support sustained health, well-being, and independence in older adults in South East Metropolitan Victoria.

Background
Falls in older adults cost Australia’s health systems over 2.4 billion each year and can have devastating personal consequences, with 140,000 older Australians hospitalised for a fall and 5000 Australians dying from a fall each year. There is strong evidence from over 250 randomised controlled trials to support fall prevention interventions including exercise for the general community and targeted multifactorial assessments for higher risk people. Australia’s Fall Prevention Guidelines have not been updated since 2009.

Objective
We were commissioned by the Australian Commission for Safety and Quality in Health Care to update the Australian Fall Prevention Guidelines for release in 2025.

Methods
We updated the Cochrane review on fall prevention in care facilities and hospitals to inform guidance for these settings (without screening abstracts/trial records). We used Cochrane reviews and the World Falls Guidelines to inform guidance for community settings. We used a modified GRADE approach to assess the certainty of evidence and strength of recommendations.

Results
For fall prevention in hospital we recommend tailored education, personalised multifactorial interventions after assessment, post-operative geriatric orthopaedic care after hip fracture and home safety interventions after discharge. For fall prevention in residential aged care settings we recommend personalised multifactorial interventions after assessment, tailored supervised exercise, menu assessment by dietitians, daily or weekly Vitamin D, bone protective medicines, and hip protectors. For fall prevention in community settings we recommend exercise for all, home safety interventions and personalised multifactorial interventions after assessment for higher risk people, and single interventions should be provided for older people at increased risk of falls with particular risk factors affecting vision, feet, cardiac function, Vitamin D levels and bone health.

Conclusion
Implementation and scale-up of these evidence-based recommendations could help address Australia’s rising costs and consequences from falls but is not currently planned, a missed opportunity.

References
1. Cameron ID et al. Cochrane Database. 2018(9).
2. Montero-Odasso M et al. Age Ageing. 2022;51(9).
3. Sherrington et al. Cochrane Database. 2019.

Problem
Falls are not an inevitable part of ageing. Yet over one third of Australians aged over 65 years fall at least once each year. On average 365 Australians are admitted to hospital each day due to fall-related injuries. Evidence-based approaches, such as balance exercise programs, have demonstrated success in significantly reducing falls risk in older people. Despite this, fall prevention remains underrepresented in national policy, notably absent from the National Preventive Health Strategy. State-level actions remain sporadic, with insufficient investment and prioritisation to effectively address preventable falls in older adults.
Initiative overview
The proposed Fall Prevention Alliance has partnered with influential academia, community and health organisations, including the Australia and New Zealand Falls Prevention Society, Centre for Research Excellence in Prevention of Falls Injuries, Neuroscience Research Australia, University of Melbourne, Rotary, Council on the Ageing NSW and many others. The NSW Clinical Excellence Commission’s Fall Prevention in NSW White Paper provided economic costings and evidence-based recommendations.
A strategic plan was drafted, and representatives from over 30 organisations participated in a national planning workshop to refine objectives, identify collaborative opportunities and outline medium-term goals. Concurrently Rotary, a foundational Alliance partner, piloted a series of community fall prevention awareness events in Northern NSW, aiming to extend reach and engagement at the community level.
Results
Alliance partners committed to formalising the association, adopting consistent messaging and using shared visual assets. This collaboration aims to build stronger community awareness, increase the impact of local fall prevention events and support coordinated advocacy to local members of parliament and community leaders.
Key Lessons
The Alliance is positioned to strengthen advocacy for fall prevention, leveraging Rotary’s extensive grassroots network and addressing a critical yet under-represented issue. Whilst in its formative stages, members recognise the need for shared goals, consistent professional communications and coordinated policy advocacy.

Previous research found an association between antidepressant medication use and low bone mineral density in adults; however, the relationship is under-researched in Australia. This longitudinal study examined osteoporosis and fracture risk among antidepressant-user middle-aged Australian women.
We analysed the survey and linked Pharmaceutical Benefits Scheme (PBS) data of 9,349 women from the Australian Longitudinal Study on Women’s Health (ALSWH), born from 1946 to 1951 and followed up from 2004 to 2021. Antidepressant use was measured by at least two dispenses of any PBL-listed antidepressant medication corresponding to each survey period. Osteoporosis was measured by the first prescription date of any PBS-listed antiosteoporosis medications from PBS. Survey responses measured fracture incidence. The Fine and Gray competing risk regression model with death as a competing risk was used to ascertain osteoporosis and fracture risk among antidepressant-user women. Directed Acyclic Graphs were used to select potentially confounding variables.
A total of 1,437 (13.2%) women used antidepressants at the baseline. Women who reported a diagnosis or treatment of osteoporosis or fracture at or before baseline (n 1,226 for osteoporosis and n 344 for fracture) and did not consent to PBS data linkage (n 758) were excluded from the analyses. Both unadjusted (SHR: 1.2; 95% CI: 1.14-1.26; p <0.001) and adjusted (SHR: 1.2; 95% CI: 1.11-1.26; p <0.001) models showed increased hazard of osteoporosis in antidepressant medication users than non-users. Unadjusted (SHR: 1.4; 95% CI: 1.36-1.50; p <0.001) and adjusted (SHR: 1.2; 95% CI: 1.16-1.32; p <0.001) models also showed increased hazard of fractures in antidepressant medication users than non-users.
We concluded that among the middle-aged women of the ALSWH 1946-1951 birth cohort, antidepressant medication use increased the risk of osteoporosis and fracture in seventeen years. These results emphasise regular bone screening to prevent fractures among antidepressant user women in the community.

Background: Falls are a leading cause of injury-related hospitalisations and deaths in Australians aged 65 and over. There is some evidence that falls rates differ between urban and regional areas of Australia. The aim of this study is to investigate falls injury admission rates in Victoria and examine the influence of sociodemographic factors and level of remoteness on these rates.

Methods: Data from the Victorian Admitted Episodes Dataset between 1 January 2018 and 31 December 2022 was used to identify hospital admissions for falls among individuals aged 65 and over. Falls rates per 100,000 population were calculated by local public health unit catchment area, age group, sex, socio-economic index for area (SEIFA) and level of remoteness. Generalised linear modelling was used to explore the association between these factors and falls admission rates.

Results: Between 2018 and 2022, there were 171,100 falls-related hospitalisations, at a rate of 3,281 per 100,000 population. The highest falls rates were among females, in individuals aged 85+ years and from the South East Public Health Unit catchment area. Falls rates were highest in metropolitan areas and in the highest SEIFA quintile.

Conclusion: This study found significant geographic variations in falls-related hospitalisations in Victoria even after adjusting for sociodemographic factors and remoteness. These disparities may be attributable to individual-level factors such as the physical environment and patterns of health-seeking behaviour and healthcare utilisation between geographic areas. System-level factors such as access to the appropriate level of healthcare and local health service operations may also play a role. It is essential that public health authorities understand the geographic variations of falls-related hospitalisations to effectively target interventions in high-risk regions and populations.