Professor Mark Hughes

Background: There is a growing recognition of the need for collaborative partnerships between carers and healthcare professionals to ensure the delivery of safe and equitable healthcare for older persons. Involving and empowering carers to participate in healthcare decisions is beneficial for patients at risk of delirium, as carers are well placed to notice small behavioural changes that indicate delirium. The Prevention & Early Delirium Identification Carer Toolkit (PREDICT) to prevent and manage delirium in the acute hospital setting was co-designed to support these care partnerships.
Aim: To explore carers' experience of PREDICT to support partnerships with healthcare professionals in the prevention and management of delirium
Method: A qualitative study grounded in empowerment theory explored carers' experience of PREDICT to support care partnerships in the prevention and management of delirium. Carers of older people at risk of delirium on a general medical ward in a regional hospital were exposed to PREDICT. Semi structured interviews were conducted with these carers following discharge. Reflective inductive thematic analysis was used to identify and analyse key themes from the data.
Results: Two key themes were identified: 'Carers Well Placed' and 'They Weren't Quite Themselves', and two sub themes: 'Feeling Unsupported' and 'Fear, Loss and Grief '.
Conclusions: PREDICT supports carers to better understand delirium and strengthens opportunities for partnership with nurses in its prevention and management. Approaches that prioritise education, engagement, empowerment, emotional support and empathy may enhance nurse-carer collaboration and contribute to more person-centred delirium care in acute hospital settings.

Research into the lives of sexually and gender diverse (SGD) people is expanding globally. As visibility increases and social contexts shift, new opportunities are emerging in SGD research, policy, and practice. Yet the lives of SGD people remain largely invisible and insufficiently represented despite progress in civil rights protections across many countries. Health, social and economic disparities as well as community strengths remain significant worldwide, and inequities by sexuality, gender and age are well documented (Fredriksen, 2026; Fredriksen-Goldsen & de Vries, 2019). At the same time, in many regions, SGD communities face renewed backlash, censoring, and erasure. The lack of attention to sexuality, gender and age diversity, combined with escalating threats, constitutes a call to action for culturally grounded research, services and policies.

LGBTIQ+ people continue to experience barriers to accessing palliative care and poor palliative care outcomes, including fear ofdiscrimination, risk of abuse and neglect, and having their end-of-life wishes unmet. While co-design is increasingly being used toaddress the needs of minoritized communities, little is known about the processes of co-designing programs to improve palliativecare with LGBTIQ+ communities. This research evaluated a co-design process used to develop an eLearning intervention toimprove Australian palliative care providers’ awareness of the issues and needs of LGBTIQ+ people. Semistructured qualitativeinterviews (n = 11) were conducted with co-design team members (n = 8), which explored their expectations and experiences of theprocess over 10 months from 2022 to 2023. Co-designers were diverse people with a range of lived and professional experiences inpalliative care–related roles. Thematic analysis identifed three themes: co-designers shared common goals, the facilitation processenabled the participation of LGBTIQþ participants, and the substantial work required outside of co-design meetings to completethe intervention design. The study highlighted conditions that constrain co-design processes and the importance of specialistfacilitation and organizational support to manage these conditions within tight time and funding limitations. Limitations to co-design best practice can be mitigated by transparent and accountable communication with efective and supportive facilitation.

Introduction: Despite recent reforms, social exclusion and discrimination continue to impact sexually and gender diverse (SGD) Australians. Of concern is the greater loneliness reported among SGD people, particularly transgender and nonbinary people. Age is a factor related to loneliness that is much debated with further research needed to understand the extent to which it predicts loneliness among this population.
Methods: We analysed Australian data (n = 271) from the Global Pride Survey, administered in 2022, to understand age-based loneliness patterns among groups of SGD people. Drawing on the Health Equity Promotion Model, we examined the extent to which indicators of social positions, environmental context and individual- and social-level health risk and health pathways predicted loneliness.
Results: Through regression analysis, we identified that sexual diversity, gender diversity and being transgender did not appear as predictors of loneliness. However, being younger or middle-aged did emerge as a predictor of a higher level of loneliness, as did less social support, lower resilience and more frequent functional limitations.
Conclusions: While younger and middle-aged SGD people might be expected to be faring better than older people, in this study we identified that the older cohort reported less loneliness.
Policy Implications: SGD people continue to face the consequences of social exclusion and discrimination despite equality reforms. Social policy should ensure that loneliness programs are accessible to SGD people and that targeted programs are developing, including those that enhance intergenerational connections.

This chapter explores the complex and multifaceted nature of loneliness within LGBTQ+ communities, highlighting how experiences of loneliness differ from those in the general population due to intersecting social, psychological, and structural factors. Drawing on empirical research and theoretical frameworks, including the Minority Stress Model and the Health Equity Promotion Model, the chapter examines how discrimination, stigma, internalized negativity, and social exclusion contribute to elevated loneliness among LGBTQ+ individuals. Particular attention is given to subgroups such as bisexual, transgender, and nonbinary people, who often face compounded marginalization. The chapter identifies both general and LGBTQ+-specific risk factors for loneliness, including low income, chronic illness, living alone, and concealment of identity. It also emphasizes protective factors such as community connection, social support, and resilience. While loneliness is prevalent, many LGBTQ+ individuals demonstrate significant resilience and maintain strong social ties through chosen families and community engagement. The chapter concludes by advocating for multi-level interventions—individual, relational, and structural—to address loneliness. These include inclusive mental health services, community-building initiatives, and policy reforms that combat discrimination and promote equity. Ultimately, there is a need for a nuanced understanding of LGBTQ+ loneliness that recognizes diversity within the community and centers both vulnerability and strength.

Background: Delirium, a common, serious and often preventable complication in older hospitalised adults, contributes to significant health and social care costs. Carers are uniquely positioned to identify early signs and support delirium prevention. The Prevention & Early Delirium Identification Carer Toolkit (PREDICT), a novel model of care designed to educate carers about delirium management and prevention strategies, enables them to actively participate in the care and recovery of their person. Developed through a comprehensive literature review, a co-designed eDelphi and pilot study, PREDICT demonstrated acceptability and feasibility.
Aims: To evaluate the effectiveness, implementation and cost-benefit of a PREDICT in hospital settings.
Method: A stepped-wedge cluster randomised controlled trial (SW-cRCT), consisting of a cohort study, healthcare service evaluation, and process evaluation. The study will assess carer and staff knowledge of delirium, carer care giving stress, health service outcomes (e.g., incidence, length of stay, readmissions) and cost-benefit.
Discussion: PREDICT is a scalable, person-centred approach that supports both patients and carers, with the potential to embed best-practice delirium management into routine healthcare.
Public and Patient Involvement: This study was developed in consultation with older adults, carers and healthcare staff. Two consumer representatives joined the project steering committee and contributed to shaping the research question, refining the study protocol and selecting outcome measures relevant to families and healthcare staff. Carers were involved in reviewing participant information sheets and the PREDICT website, providing feedback to ensure clarity and accessibility. Results will be shared with participants and the wider community through plain-language summaries and public presentations.
Trial Registration: Australian and New Zealand Clinical trial: ACTRN12625000705482 registered on the 3rd of July 2025.

So much is being written about artificial intelligence (AI) at the moment that it is hard to know what another editorial on the topic might be able to contribute. But I do know that people are asking whether the Australasian Journal on Ageing (AJA) has an AI policy. So, I am taking this opprotunity to explain some of the ways AI is being embedded in academic publishing and the work of the AJA, as well as highlight the guardrails we have in place to ensure academic integrity.

Gay men collectively participate in fewer sports than heterosexual men. An understanding of older gay men’s early sport experiences may pro-vide insights into what may have contributed to this reduced participation. Nonetheless, there is limited research focussing on older gay men’s experiences with sport. Via semi-structured online interviews, this hermeneutic phenomenological research investigated the early experiences of 21 Australian gay men aged 60 and over. Most participants spoke of homonegative experiences. Themes that emerged from the analysis were: Junior school sport was unpleasant; Sport was violence; My masculinity was denigrated; and I hate sport. Aimed at improving the health of older gay men, this research provides insights about the implementation of sport and physical activity programs. For this population, it is recommended that individual activities are con-ducted within inclusive and supportive environments that are sensitive to those who have had adverse childhood experiences.

COVID-19 exacerbated inequities for Australian LGBTQ+ older adults and impacted their ability to stay engaged in civic activities. This research note examines the extent to which voluntaryactivity changed for Australian LGBTQ+ older adults during COVID-19 and whether community connectedness predicts volunteering both pre-COVID and during COVID-19. We recruited an online sample of Australian LGBTQ+ older adults. 525 participants completed the survey, with 341 participants reporting data on volunteerism and connection to the LGBTQ+ community. The analysis revealed statistically significant differences between time, but not gender and sexuality, nor between gender and sexuality and time. Pairwise comparisons reveal that volunteering was statistically significantly higher pre-COVID than during COVID for these Australian LGBTQ+ older adults. COVID-19 changed volunteerism among older LGBTQ+ Australians. Over a third reported volunteering at least once a week or more prior to COVID. The sample saw an overall reduction of about 10% of volunteering during COVID-19, which is consistent with other national reports of a pandemicrelated reduction in volunteering among older Australians. The findings of this study suggest that, while volunteering plays an important role in the mental health and well-being of LGBTQ+ people, these participants were possibly willing to sacrifice the benefits of staying physically connected to the community to protect their own welfare, which may have implications for the social and political engagement of LGBTQ+ Australians.