OBJECTIVESOur aim was to (1) describe the clinical characteristics and symptoms of people diagnosed with dementia at the time of admission to inpatient palliative care; and (2) compare the nature and severity of these palliative care–related problems to patients with other chronic diseases.DESIGNDescriptive study using assessment data on point of care outcomes (January 1, 2013, to December 31, 2018).SETTINGA total of 129 inpatient palliative care services participating in the Australian Palliative Care Outcomes Collaboration.PARTICIPANTSA total of 29,971 patients with a primary diagnosis of dementia (n = 1,872), lung cancer (n = 19,499), cardiovascular disease (CVD, n = 5,079), stroke (n = 2,659), or motor neuron disease (MND, n = 862).MEASUREMENTSThis study reported the data collected at the time of admission to inpatient palliative care services including patients' self‐rated levels of distress from seven common physical symptoms, clinician‐rated symptom severity, functional dependency, and performance status. Other data analyzed included number of admissions, length of inpatient stay, and palliative care phases.RESULTSAt the time of admission to inpatient palliative care services, relative to patients with lung cancer, CVD, and MND, people with dementia presented with lower levels of distress from most symptoms (odds ratios [ORs] range from .15 to .80; P < .05 for all) but higher levels of functional impairment (ORs range from 3.02 to 8.62; P < .001 for all), and they needed more assistance with basic activities of daily living (ORs range from 3.83 to 12.24; P < .001 for all). The trends were mostly the opposite direction when compared with stroke patients. Patients with dementia tended to receive inpatient palliative care later than those with lung cancer and MND.CONCLUSIONThe unique pattern of palliative care problems experienced by people with dementia, as well as the skills of the relevant health services, need to be considered when deciding on the best location of care for each individual. Access to appropriately trained palliative care clinicians is important for people with high levels of physical or psychological concerns, irrespective of the care setting or diagnosis. J Am Geriatr Soc 68:1825‐1833, 2020.

BackgroundOne of the opposing arguments to restricting or banning the sale of tobacco products stem from a perception that this would adversely impact on small retail stores that rely on tobacco sales for viability. It has also been argued that purchases of tobacco leads to unplanned purchasing of other items that yield income for small store owners. This study tested the veracity of these arguments in the Australian context.MethodsConsumer intercept surveys (n=1487) were conducted outside a comprehensive sample of small stores (n=136) selling tobacco in lower socioeconomic suburbs. Data were collected over a 2-hour period outside each store using the same methodology (36% consumer response rate). Descriptive statistics examined the proportion of tobacco and non-tobacco purchases and most common products purchased.ResultsPurchasing tobacco was the primary motivation for store visits for only 3% of consumers. The vast majority of products purchased (92%) were not tobacco, with hot food, groceries and lottery tickets most frequent. Only 8% of consumers purchased tobacco. When unplanned purchasing patterns were compared, consumers’ who purchased tobacco were no more likely to buy other products.ConclusionTobacco purchasing was rarely the reason for store visits, indicating that it is not a key driver of consumer foot traffic for small retailers. There was also no evidence that tobacco contributes to spontaneous purchases of other products that might bring retailers profit. Findings suggest that restricting the retail availability of tobacco would be unlikely to have a pronounced negative impact on small retail stores.

Purpose Co-existing health conditions and frequent hospital usage are pervasive in homeless populations. Without a home to be discharged to, appropriate discharge care and treatment compliance are difficult. The Medical Respite Centre (MRC) model has gained traction in the USA, but other international examples are scant. The purpose of this paper is to address this void, presenting findings from an evaluation of The Cottage, a small short-stay respite facility for people experiencing homelessness attached to an inner-city hospital in Melbourne, Australia. Design/methodology/approach This mixed methods study uses case studies, qualitative interview data and hospital administrative data for clients admitted to The Cottage in 2015. Hospital inpatient admissions and emergency department presentations were compared for the 12-month period pre- and post-The Cottage. Findings Clients had multiple health conditions, often compounded by social isolation and homelessness or precarious housing. Qualitative data and case studies illustrate how The Cottage couples medical care and support in a home-like environment. The average stay was 8.8 days. There was a 7 per cent reduction in the number of unplanned inpatient days in the 12-months post support. Research limitations/implications The paper has some limitations including small sample size, data from one hospital only and lack of information on other services accessed by clients (e.g. housing support) limit attribution of causality. Social implications MRCs provide a safe environment for individuals to recuperate at a much lower cost than inpatient admissions. Originality/value There is limited evidence on the MRC model of care outside of the USA, and the findings demonstrate the benefits of even shorter-term respite post-discharge for people who are homeless.

Issue addressed Tobacco products remain widely available and unplanned purchasing of tobacco has been implicated in cessation relapse. Little is known however about the frequency of consumers’ unplanned tobacco purchases or the type of retail outlets where this is more likely to occur. Methods Questions on cigarette purchasing were added to a post‐campaign telephone survey for the Make Smoking History Campaign in Western Australia. Respondents (n=200) were aged 25 to 54 years and were either current smokers or had quit in the last 4‐5 weeks. Two‐thirds of respondents had tried to quit in the past 2 years. Survey responses were analysed to look at place of purchase (the usual and after cessation relapse) and frequency and reasons for unplanned purchases. Results Supermarkets were the “usual” purchase location for the majority of respondents overall (78%), but the proportion who reported buying cigarettes from a supermarket after taking up smoking again declined substantially (52%), while purchases from convenience stores and service stations increased. Nearly a third (30%) of respondents indicated that they sometimes bought cigarettes unplanned or on impulse, and for 16%, this was at least once a week. Conclusions Among smokers who have tried to quit but not succeeded, unplanned cigarette purchases are common. There is evidence to suggest that when people resume smoking after a cessation attempt, the cigarette purchase is not necessarily made at their “usual” type of retail outlet. So what? The banning of point of sale tobacco display has not eliminated the pervasive availability and retail presence of tobacco, and unplanned purchasing of cigarettes is an impediment to successful smoking cessation. This study adds weight to growing momentum internationally and in Australia to reduce the widespread availability of tobacco products and decrease the barriers to quitting use of a product that kills over half of its consumers.

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