Aged Care Facilities Research Articles

Rehabilitation after surgery for hip fracture – the impact of prompt, frequent and mobilisation-focused physiotherapy on discharge outcomes: an observational cohort study

PurposeTo determine the relationship between three postoperative physiotherapy activities (time to first postoperative walk, activity on the day after surgery, and physiotherapy frequency), and the outcomes of hospital length of stay (LOS) and discharge destination after hip fracture.MethodsA cohort study was conducted on 437 hip fracture surgery patients aged ≥ 50 years across 36 participating hospitals from the Australian and New Zealand Hip Fracture Registry Acute Rehabilitation Sprint Audit during June 2022. Study outcomes included hospital LOS and discharge destination. Generalised linear and logistic regressions were used respectively, adjusted for potential confounders.ResultsOf 437 patients, 62% were female, 56% were aged ≥ 85 years, 23% were previously living in a residential aged care facility, 48% usually walked with a gait aid, and 38% were cognitively impaired prior to their injury. The median acute and total LOS were 8 (IQR 5–13) and 20 (IQR 8–38) days. Approximately 71% (n = 179/251) of patients originally living in private residence returned home and 29% (n = 72/251) were discharged to a residential aged care facility. Previously mobile patients had a higher total LOS if they walked day 2–3 (10.3 days; 95% CI 3.2, 17.4) or transferred with a mechanical lifter or did not get out of bed day 1 (7.6 days; 95% CI 0.6, 14.6) compared to those who walked day 1 postoperatively. Previously mobile patients from private residence had a reduced odds of return to private residence if they walked day 2–3 (OR 0.38; 95% CI 0.17, 0.87), day 4 + (OR 0.38; 95% CI 0.15, 0.96), or if they only sat, stood or stepped on the spot day 1 (OR 0.29; 95% CI 0.13, 0.62) when compared to those who walked day 1 postoperatively. Among patients from private residence, each additional physiotherapy session per day was associated with a -2.2 (95% CI -3.3, -1.0) day shorter acute LOS, and an increased log odds of return to private residence (OR 1.76; 95% CI 1.02, 3.02).ConclusionHip fracture patients who walked earlier, were more active day 1 postoperatively, and/or received a higher number of physiotherapy sessions were more likely to return home after a shorter LOS.

Analysis of the Occurrence and Influencing Factors of Oral Frailty in Elderly Residents of Elderly Care Facilities

To investigate the occurrence and influencing factors of oral frailty in elderly residents of elderly care facilities and to provide a basis for the development of effective intervention programs for oral frailty in this population. A combination of subjective and objective measurements of oral frailty, a general information questionnaire, a leisure activity questionnaire, the Dietary Variety Score (DVS), the Short Nutritional Assessment Questionnaire (SNAQ), the Short-Form Mini Nutritional Assessment (MNA-SF), Barthel Index (BI), the Mini-Mental State Examination (MMSE), 15-Item Geriatric Depression Scale (GDS-15), and the Generalized Anxiety Disorder Scale-2 (GAD-2) were used to survey 348 elderly residents in three elderly care facilities in Chengdu and to analyze the factors related to oral frailty. The prevalence of oral frailty in elderly residents of elderly care facilities was 31.0% (108/348). Multivariate logistic regression analysis revealed that advanced age (odds ratio [OR]=1.347, 95% confidence interval [CI]: 1.237-1.496, P<0.001), cognitive impairment (OR=6.769, 95% CI: 2.628-18.916, P<0.001), and depression (OR=8.632, 95% CI: 1.931-44.387, P=0.007) were risk factors for oral frailty in elderly residents of elderly care facilities. High scores in leisure activities (OR=0.883, 95% CI: 0.786-0.986, P=0.030), and dietary diversity (OR=0.199, 95% CI: 0.069-0.530, P=0.002) were protective factors against oral frailty. The prevalence of oral frailty is relatively high among elderly residents of elderly care facilities. Risk factors for oral frailty include advanced age, cognitive impairment, and depression, while increased levels of leisure activities and dietary diversity can help prevent the occurrence of oral frailty in elderly individuals.

The influence of individual factors on the career preferences and specialty choices of final-year nursing students

BackgroundStatistical evidence shows that nursing students prefer a professional career in hospital settings, leading to a lack of career interest in non-hospital settings such as community and residential aged care facilities. The lack of preference for non-hospital settings has persisted over several decades and presents a need for different approaches that may reveal new information to better understand the individual factors that influence specialty choices and preferences from the students' viewpoints. PurposeThe aims of this study were to (1) explore individual factors that impact the nursing specialty choices of final-year nursing students and (2) explore how these factors influence the final-year nursing students' career decision-making process. MethodA narrative inquiry approach using semi-structured interviews was carried out with purposively sampled nursing students (n = 12) who had undertaken a final-year clinical placement(s). Data was analysed using two main steps. First, the interviews were restoried and then analysed using the three-dimensional framework. Subsequently, thematic analysis was applied to generate themes. ResultsData analysis generated three main themes: demographic factors, social factors, and career goals. Participants' characteristics and interactions with other individuals and systems influenced their nursing specialty preferences and professional career plans. ConclusionNursing students' career interests are influenced by individual factors external to their nursing education, such as their age, gender, and life experiences. These student characteristics and experiences facilitated or inhibited a career in some nursing specialties, with the students gauging their ability to practice in a specialty during their CPs. Nursing education should expose and inform students about the core skills, career opportunities, and how to advance their careers in the different nursing specialties. Most importantly, final-year students may need formal career guidance to encourage nursing students' positive attitudes and career interests in different nursing specialties and make realistic career decisions.

The place and cause of death of Japanese peritoneal dialysis patients

BackgroundAlthough 70% of Japanese individuals wish to die at home, the in-hospital death rate in Japan is 71%. The in-hospital death rate is more than 80% in dialysis patients, most of whom are hemodialysis patients. Few reports exist on the relationship between place and cause of death in peritoneal dialysis (PD) patients.MethodsWe conducted a retrospective study of PD patients who died between January 2008 and June 2022 at three facilities.ResultsNinety-four patients died, 71% in hospital, 25% at home, and 4% in elderly care facilities. The in-hospital death rates were 67%, 74%, and 71% (P = 0.90) in the three facilities. Of the 67 in-hospital deaths, infection was the most common cause of death (30%), followed by sudden cardiac death (SCD) (15%), senility/cachexia (15%), heart failure (12%), and malignancy (9%). In the out-of-hospital deaths, there were no cases of infection, and SCD accounted for the majority (59%), followed by senility/cachexia (11%), heart failure (7%), stroke (4%), and malignancy (4%). Limiting to SCD, patients who died outside the hospital were significantly younger and had a higher prevalence of ischemic heart disease than those who died in hospital.ConclusionsThe in-hospital death rate for PD patients was lower than that previously reported for dialysis patients and similar to that of the Japanese population. Based on the place and cause of death in PD patients, to further increase the death rate at home, which many PD patients would have preferred, it may be necessary to prevent infectious diseases, strengthen interventions for patients at high risk of SCD, and shift to home care for patients with senility/cachexia and malignancies.

Understanding Dementia Carer Experiences Before Admission to a Residential Aged Care Facility: Implications for Integrated Care.

In-depth understanding of dementia carer experience can assist clinicians by providing insight into dementia onset, symptoms and management, and help conceptualize and understand the pattern of dementia progress over time and what help is needed. We undertook a qualitative study to understand dementia carers experiences of providing care and reasons for admission to a residential aged care facility (RACF). Three themes were identified: (1) Challenges in the path to diagnosis and care, leading to delays accessing support; (2) Carer role impacted by living circumstances; and (3) Variation in decision support prior to admission to a RACF. Identifying dementia carer experiences, reinforces the need for more timely diagnosis, referral for support and interventions to promote better quality of life for a people living with dementia and their carer and to delay premature RACF placement.

Synergistic Polymer Coatings with Antibacterial and Antiviral Properties for Healthcare Applications.

The role of frequently touched surfaces in the transmission of infectious diseases is well-documented, and the urgent need for effective surface technologies with antipathogen activity has been highlighted by the recent global pandemic and rise in antimicrobial resistance. Here, we have explored combinations of up to 3 different classes of compounds within a polymeric matrix to enable the fabrication of coatings with broad-spectrum activity. Compounds were either based on metals or metal oxides, namely, copper, silver, and copper oxide, essential oils, namely, cinnamaldehyde, tea tree oil, and carvacrol oil, or cationic polymers, namely, poly(ε-lysine) and poly(hexamethylene biguanide). These compounds were mixed into a polymer matrix, coated, and dried to yield durable coatings. Coatings containing up to 7.5% (w/w) of the compounds were assessed in the zone of inhibition and biofilm assays using Staphylococcus aureus and Pseudomonas aeruginosa, as well as infectivity assays using human coronavirus OC43. Our data demonstrate that a selected combination of additives was able to provide a 5-log reduction in the colony-forming units of both bacteria and a 4-log reduction in viral infectivity. This simple but highly effective technology is expected to find applications in environments such as hospitals, aged care facilities, or public transport.

Changes in norovirus incidence in Victoria, Australia, 2022: are we back to normal yet after COVID?

There were 108 norovirus-positive outbreaks in 2022, with 45 (41.7%) occurring during the first quarter (Q1), January-March. Aged care facilities accounted for 44.4% of norovirus-positive outbreaks; 43.5% were in childcare settings. Overall, the GII.P31/GII.4 genotype was the most common, involved in 39.4% of outbreaks; however, there were shifts in the most common genotype across the year. In Q1, the GII.P31/GII.4 genotype accounted for 73.3% of typed outbreaks, but by Q3 (July-September) the GII.P7/GII.6 was the most prominent genotype at 45.0%. In Q4 (October-December), the dominant genotype had changed again to GII.P16/GII.4 (52.6%). While the incidence of norovirus outbreaks in 2022 was average regarding overall prevalence and genotype diversity, there are still ongoing effects from the coronavirus disease 2019 (COVID-19) pandemic in relation to seasonality, outbreak demographics and specimen referral.

Longitudinal cohort study of discrepancies between prescribed and administered polypharmacy rates: implications for National Aged Care Quality Indicator Programs

BackgroundPolypharmacy is frequently used as a quality indicator for older adults in Residential Aged Care Facilities (RACFs) and is measured using a range of definitions. The impact of data source...

Factors Affecting Clinician Readiness to Adopt Smart Home Technology for Remote Health Monitoring: A Systematic Review.

Background: The population of older adults across the world continues to increase, placing higher demands on primary health care and long-term care. The costs of housing older people in care facilities have economic and societal impacts which are unsustainable without innovative solutions. Many older people wish to remain independent in their homes and age-in-place. Assistive technology such as health-assistive smart homes with clinician monitoring could be a widely adopted alternative to aged care facilities in the future. Whilst studies have found that older persons have demonstrated a readiness to adopt health-assistive smart homes, little is known about clinician readiness to adopt this technology to support older adults to age as independently as possible. Objective: The purpose of this systematic review was to identify the factors that affect clinician readiness to adopt smart home technology for remote health monitoring. Methods: The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42020195989) prior to the commencement of the database searches. This review was conducted in accordance with the Joanna Briggs Institute Methodology for Systematic Reviews and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. Results: Several factors affected clinicians' perspectives on their readiness to adopt smart home technology for remote health monitoring including challenges such as patient privacy and dignity, data security, and ethical use of 'invasive' technologies. Perceived benefits included enhancing the quality of care and outcomes. Conclusion: Clinicians including nurses reported both challenges and benefits to adopt smart home technology for remote health monitoring. Clear strategies and frameworks to allay fears and overcome professional concerns and misconceptions form key parts of the Readiness to Adoption Pathway proposed. The use of more rigorous scientific methods and reporting is needed to advance the state of the science. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42020195989) prior to the commencement of the database searches.

Distributive justice and value trade-offs in antibiotic use in aged care settings.

Residential aged care facilities (RACF) are sites of high antibiotic use in Australia. Misuse of antimicrobial drugs in RACF contributes to antimicrobial resistance (AMR) burdens that accrue to individuals and the wider public, now and in the future. Antimicrobial stewardship (AMS) practices in RACF, e.g. requiring conformation of infection, are designed to minimise inappropriate use of antibiotics. We conducted dialogue groups with 46 participants with a parent receiving aged care to better understand families' perspectives on antibiotics and care in RACF. Participants grappled with value trade offs in thinking about their own parents' care, juggling imagined population and future harms with known short term comfort of individuals and prioritising the latter. Distributive justice in AMR relies on collective moral responsibility and action for the benefit of future generations and unknown others. In RACF, AMS requires value trade-offs and compromise on antimicrobial use in an environment that is heavily reliant on antimicrobial drugs to perform caring functions. In the context of aged care, AMS is a technical solution to a deeply relational and socio-structural problem and there is a risk that carers (workers, families) are morally burdened by system failures that are not addressed in AMS solutions.

Surveillance of Antimicrobial Use in Long-Term Care Facilities: An Antimicrobial Mapping Survey

ObjectivesTo explore antimicrobial management processes in Australian residential aged care facilities (RACFs), including antimicrobial prescribing, supply, administration, and documentation to inform surveillance activities. DesignVoluntary, online cross-sectional survey. Setting and ParticipantsThe survey was disseminated to all South Australian RACFs (n = 237) seeking participation from an infection prevention and control lead (preferred respondent), a nurse or senior RACF staff member, or an aged care pharmacist. MethodsThe survey was open during May-June 2023. Questions aimed to understand clinical and medication management systems, sources of antimicrobial prescription and supply, management by external health care providers and documentation of antimicrobial administration. A process map of antimicrobial management in RACFs was developed. ResultsOf the 54 RACFs included in the analysis (29.5% response rate), most used an electronic clinical documentation system (74.1%) or a hybrid electronic paper-based system (22.2%). Medication charts were either electronic (81.0%), hybrid (5.6%), or paper-based (13.0%). Antimicrobials were prescribed by the resident's usual general practitioner, but also by locums, hospital or specialist physicians, nurse practitioners, virtual care physicians, and dentists. Oral, topical, and inhaled antimicrobial formulations were usually supplied by community pharmacies, and intravenous formulations were predominately supplied by hospitals for administration by outreach nurses. Almost all RACFs (96.2%) had imprest stock of antimicrobials that included both oral and intravenous formulations. Antimicrobials were predominately administered by an enrolled nurse or a registered nurse. Conclusions and ImplicationsAntimicrobial management in RACFs is complex, particularly during care transitions. Multiple prescribers and sources of antimicrobials, use of different systems for clinical documentation, particularly by external health care providers, and clinical governance relating to imprest supplies were identified as key areas where medication management could be improved. Addressing these gaps will facilitate comprehensive, real-time antimicrobial surveillance in Australian RACFs.

Medication administration in aged care facilities: A mixed-methods systematic review.

To synthesize aged care provider, resident and residents' family members' perspectives and experiences of medication administration in aged care facilities; to determine the incidence of medication administration errors, and the impact of medication administration on quality of care and resident-centredness in aged care facilities. A mixed-methods systematic review. CRD42023426990. The AMED, CINAHL, MEDLINE, EMBASE, EMCARE, PsycINFO, Scopus and Web of Science core collection databases were searched in June 2023. Included studies were independently screened, selected and appraised by two researchers. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist was followed, with the Mixed Methods Appraisal Tool was used for critical appraisal. Convergent synthesis of data, thematic synthesis and meta-analysis were performed. One hundred and twenty-eight studies were included (33 qualitative, 85 quantitative and 10 mixed-methods). Five themes were formulated, including 1) Staffing concerns, 2) The uncertain role of residents, 3) Medication-related decision-making, 4) Use of electronic medication administration records and 5) Medication administration errors. Educational interventions for aged care workers significantly reduced medication administration errors, examined across five studies (OR = 0.37, 95%CI 0.28-0.50, p < .001). Medication administration in aged care facilities is challenging and complex on clinical and interpersonal levels. Clinical processes, medication errors and safety remain focal points for practice. However, more active consideration of residents' autonomy and input by aged care workers and providers is needed to address medication administration's interpersonal and psychosocial aspects. New directions for future research should examine the decision-making behind dose form modification, aged care workers' definitions of medication omission and practical methods to support residents' and their family members' engagement during medication administration. It is important that medication administration in aged care facilities be more clearly acknowledged as both a clinical and interpersonal task. More attention is warranted regarding aged care workers clinical decision-making, particularly concerning dose form modification, covert administration and medication omissions. Resident-centred care approaches that support resident and family engagement around medication administration may improve adherence, satisfaction and quality of care. What Problem Did the Study Address? Medication administration in aged care facilities is a complex clinical and interpersonal activity. Still, to date, no attempts have been made to synthesize qualitative and quantitative evidence around this practice. There is a need to establish what evidence exists around the perspectives and experiences of aged care workers, residents and resident's family members to understand the challenges, interpersonal opportunities and risks during medication administration. What Were the Main Findings? There is a lack of empirical evidence around resident-centred care approaches to medication administration, and how residents and their families could be enabled to have more input. Dose form modification occurred overtly and covertly as part of medication administration, not just as a method for older adults with swallowing difficulties, but to enforce adherence with prescribed medications. Medication administration errors typically included medication omission as a category of error, despite some omissions stemming from a clear rationale for medication omission and resident input. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The findings of this systematic review contribute to aged care policy and practice regarding medication administration and engagement with older adults. This review presents findings that provide a starting point for aged care workers in regards to professional development and reflection on practice, particularly around clinical decision-making on dose form modification, medication administration errors and the tension on enabling resident input into medication administration. For researchers, this review highlights the need to develop resident-centred care approaches and interventions, and to assess whether these can positively impact medication administration, resident engagement, adherence with prescribed medications and quality of care. This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Page etal., 2021). No patient or public contribution to this systematic review.

COVID-19 restrictions limited interactions of people and resulted in lowered E. coli antimicrobial resistance rates.

Antibiotic resistance is rising globally and is a major One Health problem. How much person-to-person transmission or 'contagion' contributes to the spread of resistant strains compared with antibiotic usage remains unclear. As part of its COVID-19 response, Australia introduced strict people movement restrictions in early 2020. Along with internal lockdown measures, movement of people into Australia from overseas was severely restricted. These circumstances provided a unique opportunity to examine the association of people movements with changes in resistance rates. Monthly resistance data on over 646 000 Escherichia coli urine isolates from 2016 till 2023 were modelled for statistical changes in resistance trends during pre-lockdown, lockdown and post-lockdown periods. Data were available for three clinical contexts (community, hospital and aged-care facilities). Data were also available for antibiotic usage volumes and movements of people into Australia. In 2020, arrivals into Australia decreased by >95%. Antibiotic community use fell by >20%. There were sharp falls in trend rates of resistance for all antibiotics examined after restrictions were instituted. This fall in trend rates of resistance persisted during restrictions. Notably, trend rates of resistance fell in all three clinical contexts. After removal of restrictions, an upsurge in trend rates of resistance was seen for nearly all antibiotics but with no matching upsurge in antibiotic use. Restricting the movement of people appeared to have a dramatic effect on resistance rates in E. coli. The resulting reduced person-to-person interactions seems more closely associated with changes in antibiotic resistance than antibiotic usage patterns.

Diabetes in residential aged care: Pharmacological management and concordance with clinical guidelines.

Existing studies have highlighted suboptimal diabetes management in residential aged care facilities (RACFs). However, understanding of diabetes management in Australian metropolitan RACFs has been limited. This retrospective cohort study aimed to explore the pharmacological management of diabetes in 25 RACFs in Sydney Australia and assess concordance with clinical practice guidelines (CPGs). Data from 231 permanent RACF residents aged ≥65 years and over with type 2 diabetes mellitus over the period from 1 July 2016 to 31 December 2019 were used. Concordance was measured by assessing the medications and medical history data for each individual resident for concordance with evidence-based CPGs. Multivariable logistic regression was used to estimate the effect of resident characteristics on concordance with CPGs. Of the 231 residents with diabetes, 87 (38%) were not taking any antidiabetic medication. Pharmacological management inconsistent with CPG recommendations was observed for 73 (32%) residents, with the most common reason for non-concordance being the use of medications with significant adverse effects in older adults (47, 2%). Residents with hypertension or other heart diseases in addition to their diabetes had greater odds of their diabetes management being non-concordant with CPGs (OR = 2.84 95% CI = 1.54, 5.3 and OR = 2.64, 95% CI = 1.07, 6.41, respectively). Pharmacological diabetes management in metropolitan Australian RACFs is suboptimal, with a high prevalence of inconsistency with CPGs (32%) observed. Additionally, having hypertension or heart diseases significantly increased the possibility of non-concordance among diabetic RACF residents. Further investigation into the underlying relationships with comorbidities is required to develop better strategies.

“He’s Not the Person I Married:” A Situation-Specific Theory for Negotiating Personhood in Residential Dementia Care

This article introduces a situation-specific theory describing how staff work to negotiate the personhood of people with dementia who are living in residential aged care facilities. In providing person-centered care to individuals living with dementia, residential care staff are often challenged to care for a person whose preferences and decision-making depart significantly from those expressed before disease progression. They encounter the person as they are now, but they also encounter traces of the person as they were then. This theory considers how staff reckon with residents’ personhood in flux and, ultimately, how they affirm and bestow personhood through person-centered care.

The Effectiveness of Palliative Care Interventions in Long-Term Care Facilities: A Systematic Review.

The increasing elderly population is driving higher utilization rates of long-term care facilities, where residents often have multiple chronic diseases, making them potential candidates for palliative care. Timely palliative care interventions can improve their quality of life and medical autonomy. This study systematically reviews the effectiveness of palliative care programs in long-term care facilities. Databases such as PubMed, EMBASE, Cochrane Library, and Airiti Library were searched up to 31 December 2023, using PICO criteria and the following keywords: 'care home', 'nursing home', 'residential aged care facility', and 'long-term care facility' for patients; and 'Gold Standard Framework in Care Homes', 'integrated care pathway', 'care home project', and 'palliative care program' for interventions. Seven articles were included. The results indicate that the Program of All-Inclusive Care for the Elderly (PACE) intervention did not significantly influence overall quality of life but did improve the quality of death. There were no statistical differences in comfort or quality of death between the dementia and non-dementia groups. However, PACE significantly reduced healthcare costs. The implementation of the Liverpool Care Pathway (LCP) notably enhanced the control of terminal symptoms, while the Gold Standard Framework in Care Homes (GSFCH) effectively improved end-of-life care rates, do-not-resuscitate (DNR) signing rates, advance care planning (ACP) completion rates, and reduced inappropriate readmission rates. While palliative care interventions are shown to improve the quality of end-of-life care, their practical application should be adapted to fit the implementation conditions and capabilities of domestic long-term care facilities.

Malnutrition Prevalence in Australian Residential Aged Care Facilities: A Cross-Sectional Study.

Long-term or residential services are designed to support older people who experience challenges to their physical and mental health. These services play an important role in the health and well-being of older adults who are more susceptible to problems such as malnutrition. Estimates of the significance of malnutrition require up-to-date prevalence data to inform government strategies and regulation, but these data are not currently available in Australia. The aim of this study was to collect malnutrition prevalence data on a large sample of people living in residential aged care facilities in Australia. A secondary aim was to examine the relationship between malnutrition and anthropometry (body mass index (BMI) and weight loss). This prevalence study utilised baseline data collected as part of a longitudinal study of malnutrition in 10 Residential Aged Care facilities across three states in Australia (New South Wales, South Australia, and Queensland). The malnutrition status of eligible residents was assessed by dietitians and trained student dietitians using the Subjective Global Assessment (SGA) with residents categorised into SGA-A = well nourished, SGA-B = mildly/moderately malnourished, and SGA-C = severely malnourished. Other data were extracted from the electronic record. Of the 833 listed residents, 711 residents were eligible and had sufficient data to be included in the analysis. Residents were predominantly female (63%) with a mean (SD) age of 84 (8.36) years and a mean (SD) BMI of 26.74 (6.59) kg/m2. A total of 40% of residents were categorised as malnourished with 34% (n = 241) categorised as SGA-B, and 6% (n = 42) SGA-C. Compared to the SGA, BMI and weight loss categorisation of malnutrition demonstrated low sensitivity and high specificity. These findings provide recent, valid data on malnutrition prevalence and highlight the limitations of current Australian practices that rely on anthropometric measures that under-detect malnutrition. There is an urgent need to implement a feasible aged care resident screening program to address the highly prevalent condition of malnutrition in Australia.

Attitudes and arrangements: owner predictions of growing older with an assistance dog

Assistance dog ownership is beneficial for older adults, but also involves unique age-related challenges, particularly changes in independent living status. How younger assistance dog owners see their future playing out with their assistance dog, particularly on relocating to an aged care facility, has received little focus. Most younger assistance dog owners have considered their future with their assistance dog, and while retirement of the dog may become necessary, most intend to retain them into older age. Understanding the future needs of assistance dog owners creates the opportunity to influence key future planning and supports, policies, procedures, and infrastructure through dog owners, aged care facilities, assistance dog organisations, animal welfare organisations and government bodies.

Analysis of the Construction of Rural Home-Based Elderly Care Service System

As my country's aging problem worsens, more and more attention is being paid to the construction of elderly care services in rural areas. This article aims to investigate the current status, problems, and challenges of rural home care services through the analysis of research literature. In the research, it was determined that the number of elderly people living alone in empty nests in rural areas increases every year, and problems such as inadequate elderly care services, low use of community elderly care facilities, and inadequate medical services are becoming more common. its importance is increasing. The current rural home care system has many drawbacks and disadvantages. It is recommended to fulfill the federal government's responsibility for community elderly care services, establish urban elderly care services, improve community elderly care services, and home care of the elderly, and participate in city and community care services for the elderly. Integration of medical and nursing care in rural areas.

Relationship between medication safety‐related processes and medication use in residential aged care facilities

AbstractObjectiveTo explore the association between the implementation of medication safety‐related processes measured with the Medication Safety Self‐Assessment for Long‐Term Care (MSSA‐LTC) tool and medication use in residential aged care facilities (RACFs).MethodsA descriptive cross‐sectional study was conducted in Australian RACFs. Data on facility characteristics, aggregated medication use at the facility level for selected medications commonly associated with a high risk of harm and the MSSA‐LTC were completed by clinical pharmacists providing clinical pharmacy services. The Spearman's correlation test was used to evaluate the association between the MSSA‐LTC score and medication use. A scatter plot between the MSSA‐LTC score and medication use data was generated, and a linear trend line was plotted using the least squares method.ResultsData were collected from 31 RACFs servicing 2986 residents. Most medication safety‐related processes were implemented in Australian RACFs. A higher facility MSSA‐LTC score was associated with a lower proportion of residents with polypharmacy (r = −.48, p = .01) and one or more benzodiazepines (r = −.41, p = .03). In addition, a negative linear trend was observed between the MSSA‐LTC score and the average number of medications per resident, the proportion of residents with one or more anticonvulsants and the proportion of residents using one or more opioid analgesics.ConclusionsThis study indicates that implementing medication safety‐related processes may improve medication use in RACFs.