Taking multiple medicines can be appropriate but has the potential to be problematic. The Implementing Stimulating Innovation in the Management of Polypharmacy and Adherence THrough the Years (iSIMPATHY) project used the 7-Steps person-centred approach for medication reviews, supporting patients and clinicians to define and achieve realistic goals for drug treatment, and helping enable patients to lead healthy and active lives.

To assess the impact of pharmacist-led comprehensive person-centred medication reviews using the 7-Steps methodology.

iSIMPATHY sought to transform the approach to optimisation of medicinces through the delivery of person-centred medication reviews for people taking multiple medicines in primary care, hospital and outpatient clinics. The reviews were conducted by embedding a single approach for polypharmacy management, building on key recommendations from SIMPATHY.

Interventions made were graded, with 82% being classified as clinically significant and 4% potentially preventing major organ failure, adverse drug reactions or incidents of similar clinical importance. The average number of medications reduced from 12 to 11, with 92% of the reviews resulting in more appropriate medication use, thereby decreasing the likelihood of medication-related harm. Inappropriate medicines were stopped, reduced or altered to improve appropriateness. There were significant healthcare resource utilisation benefits as indicated by a positive return on investment for both medication and healthcare costs with a quality-adjusted life year gain of 7.4 per 100 patients.

Pharmacist-led, person-centred medication review using the 7-Steps approach was delivered across jurisdictions and healthcare settings, with positive impacts on the number and appropriateness of medicines, clinical interventions and cost savings outweighing expenditure on the service. The approach is scalable by means of the tools and resources developed over the duration of the project.

The McMaster Monitoring My Mobility (MacM3) study aims to understand trajectories of mobility decline in later life using multisensor wearable technology. To our knowledge, MacM3 is the first major cohort to combine accelerometry and a Global Positioning System (GPS) to track real-world mobility in community-dwelling older adults.

Between May 2022 and May 2024, MacM3 recruited 1555 community-dwelling older adults (mean age 73.9 years, SD=5.5) from Hamilton and Toronto, Ontario. Of the cohort, 68.4% were female, 62.4% married/partnered, 75.3% had post-secondary education and 62.9% had≥3 comorbidities. Most were Canadian born (69.4%) and white/Caucasian (88.0%), with greater ethnocultural diversity observed at the Toronto site.

At baseline, 56.7% of participants reported no mobility limitations, 15.9% had preclinical limitations and 27.4% had minor mobility limitations. Mean gait speed for the total sample was 1.23 m/s, with a mean Timed Up and Go time of 9.4 s and a 5x sit-to-stand time of 13.0 s. A total of 1301 participants had valid wrist-worn device data, and 1008 participants who agreed to wear the thigh-worn device had valid data (≥7 days with ≥10 hours of wear per day). Step count data (n=1008) revealed a mean of 8437 steps per day (SD=2943), with 5073 steps in the lowest quartile and 12 303 steps in the highest.

Ongoing work aims to develop predictive models of mobility decline by integrating wearable, clinical and environmental data. Pipeline enhancements will enable GPS/inertial measurement unit fusion to explore mobility-environment interactions and support ageing-in-place tools.

Young-onset type 2 diabetes (YOD), diagnosed before 40 years of age, entails a high disease burden and potential for early dependence on disability benefits. The risk of type 2 diabetes (T2D) varies with socio-economic status and ethnic background, yet the relationship between these factors and age at diagnosis is insufficiently explored. We aimed to study associations between YOD and living on disability benefits, educational level and country background.

Cross-sectional data on 8640 individuals with T2D, linked to data on educational level and country background, were compared with population data from the same residential areas. Similar comparisons were made for data on disability benefits among 3854 individuals of working age (

The risk of being dependent on disability benefits was three times higher in YOD (adjusted incidence rate ratio, aIRR (95% CI) 3.1 (2.7 to 3.5)) and twice as high in later-onset T2D (1.9 (1.8 to 2.1)) as in the general population. People of Norwegian background with low educational levels had threefold higher YOD risk (3.3 (2.4 to 4.4)) than those with a tertiary degree, while people of non-Western backgrounds with low educational levels had a smaller increase in YOD risk (1.5 (1.1 to 2.1)). People of non-Western backgrounds had higher YOD risk than those of Norwegian background (4.2 (3.5 to 5.0)), while people of south Asian background had an even greater relative YOD risk (9.0 (7.3 to 11.0)), threefold higher than for later-onset T2D (3.2 (2.8 to 3.7)).

Lifetime risk of being dependent on disability benefits was substantially higher for individuals with YOD than in later onset T2D. Non-Western and particularly south Asian backgrounds were associated with increased YOD risk. Low education was an important YOD risk factor only for people with Norwegian background.

Diabetic foot disease (DFD) requires proactive healthcare management to minimise the risk of complications. Healthcare delivery has been shown to present significant challenges in rural and regional settings with Central Queensland being a large geographic area with limited local healthcare resources. Our objectives are to describe the distribution of DFD in a regional setting and assess the impact of remoteness on healthcare accessibility for this cohort.

A retrospective analysis of hospital admissions for DFD data between January 2017 and December 2023.

All recorded episodes of care for DFD patients provided by Central Queensland Hospital and Health Service (CQHHS) were included.

Primary outcome was the number of DFD episodes. Secondary outcomes included the number of hospital bed days used by DFD cases, the number of lower extremity amputations and the number of interhospital transfers (IHTs) for DFD cases.

1597 DFD episodes, 15 528 bed days, 340 lower extremity amputations and 452 IHTs were recorded. Population-adjusted outcomes showed 1054 DFD episodes per 100 000 males compared with 383 per 100 000 females (incidence rate ratio (IRR) 2.75, 95% CI: 2.46 to 3.07), and 1384 per 100 000 Indigenous Australians compared with 669 per 100 000 non-Indigenous Australians (IRR 2.07, 95% CI: 1.80 to 2.38). Remoteness was associated with lower DFD treatment completion rates at local hospitals, with only 9.3% of patients from the most remote regions completing treatment locally, compared with 76.3% from the least remote regions (p

Males and Indigenous Australians were disproportionately affected by DFD in Central Queensland. Remoteness poses a significant risk factor to completing treatment for DFD at a local facility. Further research into key drivers leading to the disproportionate outcomes demonstrated in this study between specific cohorts of people with DFD is suggested to help design future interventions to improve accessibility and outcomes.