Adults In Aged Care Research Articles

FRAILTY REDUCTION VIA IMPLEMENTATION OF EXERCISE, NUTRITION AND DEPRESCRIBING (FRIEND) TRIAL: NOVEL IMPLEMENTATION OF THE ASIA-PACIFIC FRAILTY GUIDELINES IN AGED CARE

INTRODUCTION Virtually all adults in aged care are frail, contributing to falls, cognitive decline, hospitalisation, and mortality. polypharmacy, malnutrition, sedentariness, and sarcopenia are risk factors amenable to intervention. Asia-Pacific Frailty treatment guidelines recommend anabolic exercise, medication and dietary optimisation. However, no study has evaluated this best practice intervention in aged care. AIM: Evaluate institutional translation of best-practice frailty treatment in aged care residents. METHODS The Frailty Reduction via Implementation of Exercise, Nutritional support and Deprescribing (FRIEND) trial (ANZCTR#:ACTRN12622000926730p) is a 6-month translational trial evaluating resident outcomes, staff/caregiver knowledge and institutional translation in a Townsville aged care facility. Residents received high-intensity resistance and balance training, medication and nutrition optimisation co-implemented by investigators (AEP, geriatrician, pharmacist, nutritionist) and facility staff. Staff and caregivers completed comprehensive education modules and training. We report resident outcomes for Phase-one (6 months exercise with staggered implementation of medication/nutritional arms) in preparation for full implementation (Phase-two). RESULTS 29 residents (21 female, age:88.6±6.3yrs) were recruited. At baseline, residents were frail (FRAIL-NH;6.3±2.4/14), cognitively-impaired (MoCA;13.8±6.8/30), had low physical function/capacity (SPPB;4.9±3.1/12, 6MWT;222.2±104.4m) and numerous prescribed medications (15.5±5.9). Two residents died & one withdrew before intervention, and nine residents declined exercise intervention. Exercising residents’ adherence was 73.4±18.3% (28±7/38 sessions), with non-significant baseline differences compared to decliners (p>0.05). FRAIL-NH worsened significantly across the entire sample (0.93±1.87,p=.019), however this progression was attenuated in exercisers (0.71±1.83,p=0.35). Furthermore, clinically meaningful improvements in frailty (Fried phenotype;-0.73±1.09,p=.022), Leg press (median{IQR}:40.9%{26.5%)) and knee extension strength (median{IQR):61.9%(259%),p<0.001), 6MWD (35.4±45.8m,p=0.022;30m-MCID), Physical Function (SPPB;1.9±2.3,p=0.007;1-point MCID), and cognition (MoCA;1.31±3.4,p=.131;1.22-point MCID) were observed in exercisers. Only 1 minor exercise-related adverse event occurred. CONCLUSION Six months of AEP-led high-intensity exercise with preliminary, staggered implementation of medication and nutrition optimisation in aged care improved frailty and risk factors in residents. Phase-two results following 6-months of full, concurrent implementation of exercise, medication and nutrition arms are anticipated May, 2024.

Co-production processes for translation and validation of psychosocial assessments for older adults in aged care.

Given the diverse ethnic backgrounds of aged care clients, there is a critical requirement to translate psychosocial assessment tools into various languages to effectively evaluate social engagement and quality of life in older adults receiving aged care services. This study aimed to translate psychosocial tools into Turkish, Korean and Mandarin, the primary languages spoken by clients of an Australian community aged care provider. A co-development approach encompassing forward and backward translations of the Australian Community Participation Questionnaire and ICEpop CAPability measure for Older people tools, along with focus group discussions involving bilingual staff (n = 7) and clients (n = 16), was employed to ensure precision and cultural relevance. Multiple iterations were undertaken until linguistic, conceptual and scaling equivalence was achieved, with recorded sessions transcribed and analysed thematically. Cultural appropriateness significantly impacted the delivery of questions within the tools, emphasising translation challenges tied to specific queries. These difficulties included the lack of terms for unique places of worship, the use of outdated language (e.g., references to reading newspapers), and varying priorities in social and well-being matters between Western and Eastern/Asian cultures. Staff feedback identified that formal translated tool versions eased administration for culturally and linguistically diverse (CALD) clients, enabling them to independently interpret questions, resulting in improved questionnaire completion rates. Insights indicate the need for continued efforts in tailoring assessment tools to diverse cultural contexts to ensure accurate and meaningful data collection.

Increasing consumption of milk, yoghurt, and cheese in older adults in aged care reduces falls and fractures without adverse effects on serum lipids: a cluster randomised controlled trial

Correction of dietary calcium and protein undernutrition using milk, yoghurt, and cheese in older adults in aged care homes is associated with reduced fractures and falls(1). As these foods contain potentially atherogenic fats, we aimed to determine whether these dietary changes adversely affect serum lipid profiles. Sixty aged care homes in Australia were randomised to intervention (n = 30 milk, yoghurt, and cheese enriched menu) or control (n = 30 regular menu) for 2 years. A sample of 159 intervention and 86 control residents (median age 87.8 years) had dietary intakes recorded using plate waste analysis and fasting serum lipids measured at baseline and 12 months. Diagnosis of cardiovascular disease and use of relevant medications were determined from medical records. Data were analysed using mixed effects linear regression model adjusting for clustering (aged care home) and other confounders. Intervention increased daily dairy servings from 1.9 ± 1.0 to 3.5 ± 1.4 (p<0.001) while controls continued daily intakes of £ 2 servings daily (1.7 ± 1.0 to 2.0 ± 1.0 (p<0.05). No group differences were observed for serum total cholesterol/high-density lipoprotein-C (TC/HDL-C) ratio, Apoprotein B/Apoprotein A (ApoB/ApoA) ratio, low-density lipoprotein-C (LDL-C), non-HDL-C, or triglycerides (TGs) at baseline and 12 months. Among older adults in aged care homes, correcting insufficiency in the daily intake of calcium and protein using milk, yoghurt and cheese does not alter serum lipid levels, suggesting that this is a suitable intervention for reducing the risk of falls and fractures.

Australian dietitians' confidence in their knowledge and skills working with older adults in aged care: A national survey.

This study aimed to describe dietitians' confidence in their knowledge and skills working with older adults in residential aged care facilities or home care services. A novel, quantitative online survey was distributed to aged care dietitians. Activities, knowledge, and skills areas outlined by the Dietitians Australia 'Older Persons and Aged Care Dietitian Role Statement' were included in the 23-item survey. Likert scales captured participant responses. Median responses (n, %) are presented. Associations between participants' confidence in their knowledge and skills and years of experience working in aged care were explored using Pearson's chi-squared tests. Dietitians completed the survey (N = 125; age: 40 ± 13 years [mean ± SD]; 97.6% female). Dietitians reported they "always" worked collaboratively (n = 65%, 52%) and 'often' prescribed supplements (n = 52%, 41.6%) and utilised a food-first approach (n = 36%, 28.8%). Dietitians 'sometimes' conducted malnutrition screening (n = 28%, 22.4%), audits (n = 36%, 28.8%), nutrition education (n = 53%, 42.4%) and quality improvement activities (n = 28%, 22.4%). Dietitians 'rarely' utilised food service/standards (n = 38%, 30.4%) and nutrition/hydration procedures (n = 35%, 28.0%). Dietitians with ≥6 years of experience were more confident than dietitians with 0-5 years in providing support programs (p = 0.003), utilising healthcare policies (p = 0.013), interpreting quality assessment (p = 0.014) and communication skills (p = 0.047). Dietitians felt 'completely' or 'fairly' confident in all knowledge and skill areas, except for government and community support programs (n = 38%, 30.4%) rated 'somewhat' confident. Aged care dietitians are confident in most aspects of their role but have opportunities to be better supported. Developing the confidence of higher-level systems and communication in early career dietitians is warranted.

Motivation, challenges, skills and understanding: Musicians’ perspectives on working in a curated performance programme for older adults in aged care and community settings

Musicians have long worked with older adults and vulnerable populations across the lifespan to support emotional and social well-being. However, there is limited research concerning the experiences and preparation of professional musicians who work with social aims transitioning to working as community musicians. This project is unique in its attempt to further understand the motivations, skills and understanding of professional musicians working with social aims in a social outreach programme. Utilizing qualitative case study methodology, this study identified musicians’ experience, motivations and required skills to present a programme curated by an Australian performing arts organization for older adults, residents and care staff in aged care facilities and community centres. The participating musicians navigated challenges posed by the COVID-19 pandemic such as performing online, in PPE, and the unexpected emotional impact of working with vulnerable populations. The participating musicians addressed these challenges through developing a sense of connection through a digital medium, adaptability and by fostering a sense of shared hospitality. Additional research is needed to further explore and understand the experiences of community musicians’ skills, expertise and development.

Provision of High Protein Foods Slows the Age-Related Decline in Nutritional Status in Aged Care Residents: A Cluster-Randomised Controlled Trial

ObjectivesMalnutrition, particularly protein insufficiency, is common in institutionalised older adults and increases morbidity, mortality, and costs. We aimed to determine whether 12 months supplementation using high-protein foods (milk, cheese, yoghurt) prevents malnutrition in older adults.DesignCluster randomised control study.SettingSixty Australian aged care facilities.ParticipantsOlder adults living in aged care homes (n=654, mean age 86.7±7.2 years, 72% females).InterventionFacilities randomly allocated to a high-protein (n=30 intervention) or regular (n=30 controls) menu.MeasurementsNutritional status assessed using the Mini Nutrition Assessment (MNA) tool and fasting morning blood samples (n=302) assayed for haemoglobin (Hb) and albumin. Food intake was monitored 3-monthly using visual plate waste assessment. Measurements at baseline and month 12 were analysed using random effects model accounting for clustering (facility), repeated measure and confounders.ResultsAddition of 11g of protein as 1.5 servings of high-protein foods daily preserved nutritional status that deteriorated in controls [MNA screen (−0.68, 95%CI: −1.03, −0.32, p<0.001) and total (−0.90, 95%CI: −1.45, −0.35, p=0.001) scores], resulting in group differences in MNA screen (0.62, 95%CI: 0.17, 1.06, p=0.007) and total (0.81, 95%CI: 0.11, 1.51, p=0.023) scores and group difference in Hb (3.60g/L, 95%CI: 0.18, 7.03, p=0.039), the net result of preservation with intervention (0.19g/L, 95%CI: −2.04, 2.42, p=0.896) and a decline in controls (−3.41g/L, 95%CI: −6.01, −0.82, p=0.010). No group differences were observed for serum albumin.ConclusionConsumption of high-protein foods is a pragmatic approach to maintaining nutritional status in older adults in aged-care.

Nutritional status and quality-of-life of older adults in aged care: A systematic review and meta-analysis.

The effect of malnutrition beyond morbidity and mortality has become a critical area of investigation in older people with an increased focus on quality-of-life (QoL), but as yet the relationship between malnutrition and QoL remains to be reviewed in older people from aged care settings. The current study conducted a systematic review and meta-analyses of studies published between the years 1995 and 2020 examining the relationship between nutritional status and QoL or the effects of a nutrition-based intervention on QoL in older people in residential aged care. Based on searches of the databases MEDLINE, PsycINFO, Emcare, and Embase, 21 studies were identified. Meta-analyses of the cross-sectional and quasi-experimental studies revealed a significant positive relationship between nutritional status and QoL and that nutritional intervention significantly improved QoL. By contrast, meta-analysis of randomised controlled trials revealed a non-significant but improved trend post-intervention in QoL. Although the effect sizes were small, the present findings indicate that nutrition-based interventions improve QoL in older people in residential aged care and align with previous reviews based on findings from other aged settings. Future research is needed to determine causality and to better identify and control for confounding factors which may influence both nutritional status and QoL.

Effects of 3 months of multi-nutrient supplementation on the immune system and muscle and respiratory function of older adults in aged care (The Pomerium Study): protocol for a randomised controlled trial

IntroductionImmunosenescence leads to increased morbidity and mortality associated with viral infections and weaker vaccine responses. This has been well documented for seasonal influenza and the current pandemic with SARS-CoV-2 (COVID-19),...

New musical interfaces for older adults in residential care: assessing a user-centred design approach

Purpose:For older adults in aged-care, group music-making can bring numerous physical and psychological benefits, ultimately improving their quality of life. However, personalising music-making to optimise these benefits is often difficult given their diverse ages, experiences, abilities, cognitive and motor skills, and their experience with music technology. Materialsandmethods:In this study, we conducted a 10-week group music-making intervention with twenty participants in an aged-care home, using a prototype digital musical instrument that we iteratively refined by following a user-centred design approach from direct resident feedback. The prototype instrument adopted a novel method for errorless learning in music-making settings, which we also refined, by increasing the difficulty level of the instrument's operation. We also assessed the residents' engagement with the sessions by obtaining feedback from caregivers and facilitators. Results:Results show that residents' enjoyment decreased as the complexity (difficulty) of our errorless learning implementation increased. We also found that resident engagement increased when changes to the prototype digital musical instrument were provided, but not when residents were giving feedback. Results also found that participation over the course of the intervention, and the number of songs played during each session also enhanced engagement. Conclusions: Overall, our results show the intervention was beneficial to residents, although we note some areas of enhancement for further interventions in designing prototype musical instruments for group music-making in aged-care settings. IMPLICATIONS FOR REHABILITATION Older adults positively engage with novel music technology, and do so increasingly over subsequent sessions. Repeated sessions may have the potential to enhance longer-term adoption of technologies as well as any rehabilitative effects of the group music-making activity. There is significant potential for residents with different abilities to all make music together, although to maximise the sustainability of the devices, the sessions, and the subsequent rehabilitative benefits, residents must be given the right adaptation for individual interfaces that balances ambition and ability. Rapid DMI prototyping positively enhances engagement among older adults, suggesting that in the case of a custom DMI, an upgrade schedule should be aligned with key rehabilitative milestones. Similarly, in the case of pre-developed digital music systems, resident exposure to new features or functionality should be strategically introduced, so as to maximise engagement for key phases of resident rehabilitation.

胸部大動脈瘤ステントグラフト内挿術を受けた後期高齢者の治療体験と看護支援の検討

【目的】胸部大動脈瘤に対するステントグラフト内挿術（以下TEVAR）を受けた後期高齢者の治療体験を通して療養生活を明らかにし，TEVARを受ける高齢患者への看護支援の示唆を得る．【方法】75歳以上で調査期間中に外来受診し研究の参加に同意を得られた者に，半構造的面接調査を行い，得られたデータを修正版グラウンデットセオリーアプローチに基づき分析した．【結果】対象は13名，平均年齢78.3（± 3.9）歳だった．対象者は治療前に低侵襲治療に期待を持つ一方で，手術か天寿全うか葛藤を抱き，治療後は体の負担の軽い手術と感じる者と楽ではないと感じる者がみられた．退院後は「治療と老いの双方の影響で生じた日常生活上の困難」がある一方で，「治療と老いに対して抱いた前向きな価値観」を見出していた．【結論】後期高齢患者が治療を受けるが故，療養生活において治療の影響だけではなく老いに伴う変化がみられた．そのため，治療後も自立した日常生活が維持出来るような看護援助が重要である．

Enhancing Communication in End‐of‐Life Care: A Clinical Tool Translating Between the Clinical Frailty Scale and the Palliative Performance Scale

To create a clinical tool to translate between the Clinical Frailty Scale (CFS), which geriatrics teams use, and Palliative Performance Scale (PPS), which palliative care teams use, to create a common language and help improve communication between geriatric and palliative care teams. Cross-sectional. Two academic health centers: inpatient palliative care and chronic care units, an outpatient geriatric clinic, and inpatient referrals to a palliative care consultation service. Older adults (≥65) aged 80.9±8.0, with malignant (51%) and nonmalignant (49%) terminal diagnoses (N=120). Each participant was assigned four scores: a CFS score each from a geriatric physician and nurse and a PPS score each from a palliative care physician and nurse. Interrater reliability of each measure was calculated using kappa coefficients. For each measure, the mean of physician and nurse scores was used to calculate every possible combination of CFS and PPS scores to determine the combination with maximum agreement. Interrater reliability of each measure was very high for the CFS (weighted κ=0.92) and PPS (weighted κ=0.80). The CFS-PPS score matching that achieved maximum agreement (weighted κ=0.71) was used to create a conversion chart between the two measures. This conversion chart is a reliable means of translating scores between the CFS and PPS and is useful for geriatric and palliative care teams collaborating in the care of elderly adults.

Standardized Patient and Standardized Interdisciplinary Team Meeting: Validation of a New Performance‐Based Assessment Tool

The interdisciplinary team (IDT) approach is critical in the care of elderly adults. Performance-based tools to assess IDT skills have not been well validated. A novel assessment tool, the standardized patient (SP) and standardized interdisciplinary team meeting (SIDTM), consisting of two stations, was developed. First, trainees evaluate a SP hospitalized after a fall. Second, trainees play the role of the physician in a standardized IDT meeting with a standardized registered nurse (SRN) and standardized medical social worker (SMSW) for discharge planning. The SP-SIDTM was administered to 52 fourth-year medical students (MS4s) and six geriatric medicine fellows (GMFs) in 2011/12. The SP, SRN, and SMSW scored trainee performance on dichotomous checklists of clinical tasks and Likert scales of communication skills, which were compared according to level of training using t-tests. Trainees rated the SP-SIDTM experience as moderately difficult, length of time about right, and believability moderate to high. Reliability was high for both cases (Cronbach α = 0.73-0.87). Interobserver correlation between SRN and SMSW checklist scores (correlation coefficient (r) = 0.82, P < .001) and total scores (r = 0.69, P < .001) were high. The overall score on the SP-SIDTM case was significantly higher for GMF (75) than for MS4 (65, P = .002). These observations support the validity of this novel assessment tool.

Auditing Access to Primary Care for Elderly Adults with Public Insurance

Auditing Access to Primary Care for Elderly Adults with Public Insurance

Efficacy of spinal magnetic stimulation in elderly persons with chronic constipation

BackgroundThe development of primary constipation in elderly adults usually has a multifactorial etiology. Slow transit constipation and pelvic floor dysfunction (PFD) are the two most commonly seen constipation subtypes in the elderly. PFD is usually a persistent condition that remains unresponsive to treatment in spite of various therapies currently available to relieve constipation. The aim of this study was to assess the usefulness of spinal magnetic stimulation (SMS) in controlling intractable constipation in elderly patients. MethodsNineteen patients over the age of 65 with intractable constipation were enrolled in this study, and participated in a 12-session magnetic conditioning protocol consisting of a 20-minute stimulation session once daily. Colonic transit time (CTT) and the dynamics of evaluation as revealed in defecography were measured, and the Knowles–Eccersley–Scott Symptom (KESS) Questionnaire was administered before the intervention, and after finishing the protocol. ResultsThere was a statistically significant improvement in CTT and defecography following the intervention. The difference in the anorectal angles between resting and evacuation (p = 0.001) and the changes in pelvic floor descent (p = 0.011) both reached significance after the intervention. The mean CTT (p = 0.001), Knowles–Eccersley–Scott Symptom score (p = 0.001), frequency of bowel movement (p = 0.005), unsuccessful evacuation (p = 0.018), and time needed for bowel hygiene (p = 0.032) all showed marked improvement after SMS conditioning. ConclusionOur findings reveal that SMS intervention may benefit elderly patients with severe constipation. The amelioration of geriatric bowel dysfunction across the subtypes of slow transit constipation and PFD indicated that SMS, featuring broad-spectrum applications, can be an effective form of adjuvant treatment in the care of elderly adults.

Setting the Stage for a New Strategic Plan for Geriatrics and Extended Care in the Veterans Health Administration: Summary of the 2008 VA State of the Art Conference, “The Changing Faces of Geriatrics and Extended Care: Meeting the Needs of Veterans in the Next Decade”

The Department of Veterans Affairs (VA) assumed an early leadership role in focusing on care of elderly adults. In 1998, the Federal Advisory Committee on the Future of VA Long-Term Care, appointed by the VA Undersecretary for Health, recommended redirection of VA's extended care programs toward noninstitutional forms. A decade later, VA's Office of Geriatrics and Extended Care (GEC) initiated a strategic planning process by convening experts in geriatrics and health care, policy, and finance in Virginia on March 25 to 27, 2008, to present to VA clinicians and clinical managers the "State of the Art" of VA GEC. Recurring clinical themes included rising numbers and complexity of aging veterans, recent addition of younger veterans to VA's extended care mix, challenges that dementia and mental illness exert throughout GEC, and need for seamlessness in delivery of care across multiple venues. Ongoing research efforts quantifying demand and resources and validating models of care will remain indispensible for meeting clinical challenges. Serious undersupply of clinicians of all disciplines with general or specialty geriatrics knowledge persists. Much of VA's healthcare workforce and leadership are approaching retirement age, driving the need for new educational approaches, recruitment and retention strategies, and innovative delivery systems. Growing dependence on informal caregivers highlights the need for supporting these partners. VA's healthcare budget allocation illustrates how national policy dictates systemic, regional, and local clinical decisions. Rehabilitation of the newest veterans is resulting in systemwide efficiencies. Educating and empowering patients and families results in optimized utilization of health resources.

Employee Family Care Responsibilities

This study examined the full range of family care responsibilities, including care for children and for ill and disabled adults, among employees of a government-funded research center Utilizing a family care model drawn from stress and coping and role theory perspectives, caregiving strain and occupational impacts were modeled in terms of type of care provided, work and family demands, resources available at home and at work, and background characteristics. Significant contributors to both caregiving strain and occupational impacts included type of care provided, as well as employee age and ethnicity, care recipient disability, problems with care arrangements, work demands, and lack of assistance with family responsibilities. Employees with child care responsibilities were found to experience higher levels of caregiving strain and occupational impacts than were employees caring for adults only. The implications of these findings for practitioners and for the development of programs geared toward employees' differential family responsibilities are discussed. Key Words: caregiving, dependent care, family, work. Resulting from a variety of social and demographic factors, such as the increased numbers of women in the formal labor market (U.S. Department of Labor, 1994) and the growing number of adult persons in need of long-term care assistance (U.S. Bureau of the Census, 1993), more persons than ever before are combining family care and employment responsibilities. Today nearly 60% of mothers and 80% of fathers with children under the age of 6 are employed (U.S. Department of Labor, 1994). In addition, more than 80% of the long-term care assistance needed by older adults is provided by family members (U.S. Senate Special Committee on Aging, 1985-86), of whom approximately one-half are employed full-time (NAC/AARP, 1997). It is estimated that approximately 1.8 million women are caring for both children and an elderly relative, and that more than 50% of these women are employed (Older Women's League, 1989). Approximately 3% of working women have children under the age of 15 as well as care for a disabled parent (Stone & Kemper, 1989). Moreover, increased life expectancies (U.S. Bureau of the Census, 1993) combined with a tendency among many families to delay childbearing (Wetzel, 1990) may lead to an increase in the number of employees with multigenerational caregiving responsibilities. Existing research has documented personal strain and work disruptions experienced by persons combining family care and employment responsibilities (Meisenheimer, 1990; Neal, Chapman, Ingersoll-Dayton, & Emlen, 1993). Workplace and family accommodations which employees make in order to meet their multiple role responsibilities include missing time from work, missing work promotions, decreasing social activities, and giving up free time (Emlen & Koren, 1984; Fredriksen, 1993; Neal et al., 1993; Scharlach & Boyd, 1989). To date, the vast majority of research on employees with family care responsibilities has focused on only one type of family care, either the care of children or the care of elderly adults, with relatively few attempts to examine the full range of family care responsibilities. For example, only a few studies have incorporated disabled working age adults in the research on family caregiving and the workplace (Scharlach & Fredriksen, 1994). Yet, 4% of the noninstitutionalized U.S. population under the age of 55 have difficulty meeting their personal care needs due to health-related mobility or self-care limitations (U.S. Bureau of the Census, 1990). It has often been suggested that middle age adults who are juggling multiple responsibilities are likely to experience higher levels of caregiving stress (Brody, 1981; Hogan, 1990; Older Women's League, 1989; Schlesinger, 1989). Yet, in one study the assumption of multigenerational caregiving responsibilities was found to have no effect on the caregivers' well-being (Loomis & Booth, 1995). …