Aged Care Services In Australia Research Articles

Economic burden of frailty in older adults accessing community-based aged care services in Australia.

To explore the utilization of permanent residential aged care (PRAC), healthcare costs, and mortality for frail compared with non-frail individuals following their first assessment by an aged care assessment team (ACAT) for a government-funded home care package. The study involved people aged 65 years and over who completed their first ACAT assessment in 2013 and were followed for up to 36 months. Frail and non-frail study participants were matched through caliper matching without replacement to adjust for potential unobserved confounders. Poisson regression estimated the impact of frailty on PRAC admission and mortality rates. Healthcare costs, encompassing hospital admissions, emergency department presentations, primary care consultations, and pharmaceutical use, from ACAT assessment to end of follow-up, PRAC entry or death were summarized monthly by frailty status. 13 315 non-frail controls were matched with up to three frail individuals (52 678 total). Frail individuals experienced higher mortality (incidence rate ratio [IRR] = 1.76; 95% confidence interval [CI] 1.70-1.83) and greater likelihood of entering PRAC (IRR = 1.73; 95% CI 1.67-1.79) compared with non-frail individuals. Total healthcare costs over the 3-year post-assessment period for 39 363 frail individuals were $1 277 659 900, compared with expected costs of $885 322 522 had they not been frail. The primary contributor to the mean monthly excess cost per frail individual (mean = $457, SD = 3192) was hospital admissions ($345; 75%). Frailty is associated with higher rates of mortality and of entering PRAC, and excess costs of frailty are substantial and sustained over time. These findings emphasize the potential economic value of providing home care for older people before they become frail. Geriatr Gerontol Int 2024; ••: ••-••.

The Evolving Role of Aged Care Managers in Australia: A content analysis of aged care manager job descriptions

The Evolving Role of Aged Care Managers in Australia: A content analysis of aged care manager job descriptions

Development of person-centred quality indicators for aged care assessment services in Australia: A mixed methods study.

This study developed a proposed set of person-centred quality indicators (PC-QIs) for services that assess older adults' care and support needs to determine their eligibility to receive government-funded aged care services in Australia. Individual proposed PC-QIs amenability for change within current organizational structures were explored. Barriers and opportunities to adapt service elements of the aged care assessment service to better align with the intent of the proposed PC-QIs were identified. A mixed methods study was conducted over five phases. A scoping review identified domains of quality for aged care services as perceived by older adults. Service elements of an aged care assessment service were mapped alongside quality domains informing key attributes of each quality domain. Self-determination theory was used to formulate each proposed PC-QI to align with key attributes and quality domains. Consultation with a consumer group enabled revision of the proposed PC-QIs. A focus group with clinicians evaluated the amenability of each proposed PC-QI for change and identified barriers and opportunities to better align service elements with older adults' perceptions of quality. Results were informed by qualitative and quantitative data from a structured focus group. Focus group discussions were audio recorded and subsequently transcribed verbatim. Qualitative data were analyzed using a deductive thematic approach by two independent researchers. Twenty-four proposed PC-QIs were developed. Refinement to descriptors of the proposed PC-QIs were made by the consumer group (n = 18) and all were affirmed as being amenable to change by aged care assessors. Barriers in meeting the intent of the proposed PC-QIs were identified across five domains including: health care staff knowledge (18.7%; n = 3); clear communication (31%; n = 5); person-centred approach (18.7%; n = 3); respect for client (18.7%; n = 3); and collaborative partnership with client (12%; n = 2). Participants made 21 recommendations. Of the five service elements in delivering an aged care assessment service, barriers in meeting the intent of the proposed PC-QIs were identified at the intake and booking of an assessment and during the assessment. Recommendations identified provide assessment services guidance on ways to adapt service elements to better align with older adults' perceptions of quality. Patients and carers were involved as collaborators in this project at the protocol stage which included participating in discussions regarding the refining and modification of the protocol, refinement of the proposed PC-QIs, data collection forms and supplementary information for participants.

Job satisfaction and regulation in the aged care sector: staff perspectives

BackgroundThe quality of care provided in residential aged care facilities is largely dependent on the job satisfaction of employees and the organisational framework and systems that they provide care in. This study aimed to explore aged care staff perceptions of job satisfaction, regulation of the sector and the Royal Commission into Aged Care Quality and Safety.MethodsA cross-sectional survey conducted in 2019-early 2020 with staff employed in various roles at residential aged care services in Australia. The study specific survey collected views and experiences about working in the aged care sector as well as information about their role.ResultsA total of 167 aged care staff completed the survey of which 71% worked in a direct care role. Most participants indicated they thought they were doing a worthwhile and important job (98%), were proud to work in the sector (94%) and found the job personally rewarding (94%). However, participants also reported feeling emotionally drained by the work (37%) and fatigued by having to face a day of work (30%). 72% of participants felt the Royal Commission would lead to improvements in the care provided to residents.ConclusionAged care staff have an overall positive feeling towards their work. Additional support including increasing skills to deliver high-quality care, creating a supportive work environment to reduce job stressors and changes to the way the sector is regulated, are likely to lead to improved care.

Strategies that support cultural safety for First Nations people in aged care in Australia: An integrative literature review.

The 2019 Royal Commission into Aged Care Quality and Safety highlighted the need for First Nations peoples to have improved, culturally safe care. This paper is a call to action for First Nations peoples to be involved in developing culturally safe care and services to be embedded within Australian aged care services. The first screening examined the Australian literature (peer-reviewed articles published since 2010 in English) detailing key aspects relevant to Cultural Safety for First Nations peoples supported by aged care services in Australia. The second screening assessed whether the findings of these studies aligned with the key aspects of Cultural Safety of First Nations peoples in aged care. The initial literature search yielded 198 papers, of which 13 met the inclusion criteria for the final review. Topics that required further interrogation included barriers to communication, racism and discrimination, impacts on health outcomes, health-care workforce education needs and the importance of cultural connections to Country and kin. These topics influenced the perception of First Nations peoples feeling culturally safe when supported by aged care services. The literature identified a need to recruit more First Nations peoples into the aged care workforce, involve more First Nations family and community members in aged care and retain a consistent workforce overall. Together these strategies were seen to address the barriers that continue to affect aged care provision for First Nations peoples.

Gathering the evidence: health and aged care carbon inventory study.

Objective This study aimed to calculate the baseline carbon inventory of Mercy Health, a provider of health and aged care services in Australia, across emission Scopes 1, 2 and 3. The carbon inventory has clarified the baseline environmental impact, identified carbon hotspots and will inform emissions reduction interventions and a decarbonisation trajectory. Methods A hybrid carbon footprinting methodology was devised. Established carbon footprinting standards provided methodological guidance. A consulting firm with health service carbon accounting experience provided expertise, rigour and objectivity to the work. Results In the 2020-21 financial year, the carbon footprint of Mercy Health was 102.96k tCO2-e. Scope 1 emissions accounted for 11.07% (11.40k tCO2-e), followed by Scope 2 with 29.80% (30.68k tCO2-e) and Scope 3 with 59.13% (60.88k tCO2-e). The largest carbon impost group was Building energy (42.01%; 43.25k tCO2-e), followed by Food and catering (9.42%; 9.70k tCO2-e) and Business services (7.74%; 7.97k tCO2-e). Mercy Health's Health Services, Aged Care and Support Services divisions contributed 49.16, 47.81 and 3.03% (50.61k, 49.23k and 3.12k tCO2-e) of total greenhouse gas emissions respectively. Conclusions Mercy Health's Health Services division and Aged Care division each comprised around half of total organisation carbon emissions. Building energy dominated emissions, particularly electricity. The study discovered meaningful differences in the composition of carbon emissions in operational divisions of the organisation, indicating tailored interventions will be required to meet carbon abatement targets. The study demonstrates the benefit of conducting carbon footprinting within individual organisations, and the importance of studies within the Australian context.

What the UAE Population Thinks of Aging and Aged Care

Compared to other highly developed countries such as the United States, United Kingdom, Australia, South Korea, Japan, and Germany, the United Arab Emirates’ (UAE) population is young, with a median age of 32.6 years in 20201. By comparison, Germany’s median age was 45.7 years, and Japan’s was 48.4 in the same year. Given these age demographics, public policy in the UAE is currently focused on meeting the needs of youth and working-age individuals below the age of 65, who comprise 98.7% of the total population. Going forward, however, the topic of aged care is becoming a matter of concern. In 2020, only 1.6 people older than 65 were dependent on 100 working-aged people in the UAE. By 2050, however, this number will increase to 18.5, a twelve-fold increase, which will create financial, social, and medical pressures for families and the UAE government. As of 2017, official statistics report that there are approximately only 15,000 Emiratis over the age of 60. Accordingly, provisions for aged care in the UAE remain limited. While some emirates have local entities that offer a range of services to Senior Emiratis2, only two residential aged care facilities are exclusively dedicated to the elderly. In the entire country, Senior Emiratis are thus forced to rely on a limited range of services typically provided by local hospitals, with only a few specialized medical staff. Therefore, the UAE is not yet prepared to cater to the greater number of older people who will exist in the future. In addition to a lack of physical infrastructure, there are also reportedly changing social dynamics, particularly with regard to the decline of the extended family model and the increasing trend toward smaller nuclear families. This will also impact care for the elderly as currently, the majority are cared for at home by their families or with the assistance of housemaids. The UAE, therefore, needs to explore and plan for the creation of a sustainable and effective aged care system. In light of the current scarcity of senior care facilities and lack of research on aging in the UAE, the Sheikh Saud bin Saqr Al Qasimi Foundation for Policy Research has undertaken this study. Its design draws heavily on a study carried out by the Australian Government’s Royal Commission into Aged Care Quality and Safety. That study focused on significant issues with aged care services in Australia, including their quality and person-centeredness, and how best to deliver such services to a wide range of people. We have modified the Australian survey to explore the following areas in the UAE: (1) population attitudes towards older people, (2) knowledge and perceptions of aged care, and (3) Emiratis’ experiences, expectations, and preferences for older age. This survey was answered by 2,375 individuals, divided between 2,074 Emiratis and 661 non-Emiratis, with 49% of respondents being female and the remaining 51% being male. The findings are discussed in the Strategic Report.

Use of health and aged care services in Australia following hospital admission for myocardial infarction, stroke or heart failure

BackgroundCardiovascular diseases (CVD), including myocardial infarction (MI), stroke and heart failure (HF) are the leading cause of death amongst the older population worldwide. The aim of this study is to investigate trajectories of use of health and aged care services after hospital admission for MI, stroke or HF among community-dwelling people not previously receiving aged care services.MethodsThe study population comprised people aged 65+ years from the 45 and Up Study with linked records for hospital stays, aged care services and deaths for the period 2006–14. Among those with an index hospital admission for MI, stroke or HF, we developed Sankey plots to describe and visualize sequences and trajectories of service use (none, re-hospitalization, community care, residential care, death) in the 12 months following discharge. We used Cox proportional hazards models to estimate hazard ratios (HRs), for commencing community care and entering residential care (and the other outcomes) within 3, 6 and 12 months, compared to a matched group without MI, stroke or HF.ResultsTwo thousand six hundred thirty-nine, two thousand five hundred and two thousand eight hundred seventy-three people had an index hospitalization for MI, stroke and HF, respectively. Within 3 months of hospital discharge, 16, 32 and 29%, respectively, commenced community care (multivariable-adjusted HRs: 1.26 (95%CI:1.18–1.35), 1.53 (95%CI:1.44–1.64) and 1.39 (95%CI:1.32–1.48)); and 7, 18 and 14%, respectively, entered residential care (HRs: 1.25 (95%CI:1.12–1.41), 2.65 (95%CI:2.42–2.91) and 1.50 (95%CI:1.37–1.65)). Likewise, 26, 15 and 28%, respectively, were rehospitalized within 3 months following discharge (multivariable-adjusted HRs: 4.78 (95%CI:4.31–5.32), 3.26 (95%CI:2.91–3.65) and 4.94 (95%CI:4.47–5.46)).ConclusionsOlder people hospitalized for major CVD may be vulnerable to transition-related risks and have poor health trajectories, thus emphasizing the value of preventing such events and care strategies targeted towards this at-risk group.

The new dynamics of residential aged care in Australia: continuity and change.

Objective This paper tests the hypothesis that increases in recorded dependency levels of permanent residential aged care clients are associated with reduced length of stay and higher turnover. A secondary objective is to compare the Aged Care Funding Instrument with its predecessor, the Resident Classification Scale, on a common schema. Methods Administrative data for all Commonwealth-subsidised residential aged care services in Australia from 2008-09 to 2018-19 were obtained from the National Aged Care Data Clearinghouse. More than 750000 episodes of permanent residential aged care were analysed. The categories from the two rating systems were mapped to a six-level schema, primarily based on the dollar value of the categories at the time of transition. Results There was a strong trend towards higher dependency ratings across admissions, residents, and separations. However, contrary to expectation, measures of system activity showed a slowing of the system: length of stay increased and turnover decreased. Conclusions The mapping of dependency rating schemes to a common rating enables the analysis of long-term trends in residential care dynamics. There is no evidence that the marked increases in reported dependency ratings led to accelerated system activity, consistent with an earlier study. This analysis forms a solid base for ongoing analysis of care appraisals in the context of a possible new rating scheme. It highlights the interplay between policy changes and provider behaviour, and the need for robust data to monitor care appraisals and system dynamics. What is known about the topic? Residential aged care subsidies are determined by care needs in relation to assessed dependency levels, using the Aged Care Funding Instrument since 2008, and before that, the Resident Classification Scale. Between 2008-09 and 2018-19, there was considerable growth in residents classified at more dependent levels, and this would be expected to result in greater turnover in the system. What does this paper add? This paper maps the rating schemes to a simplified, common rating that enables the analysis of long-term trends in residential care dynamics. It shows that the system is slowing, contrary to the trends expected if residents were more frail as the reported ratings imply. The paper examines possible explanations of these trends, and addresses policy implications. What are the implications for practitioners? In the context of a potential new client-dependency classification, this study shows the importance of robust measures of the dynamics of the system-and the underlying data-vis -à -vis the means by which client dependency is assessed.

Mortality in the first year of aged care services in Australia

To examine the one-year mortality of Australians entering aged care services compared with the general population. A population-based analysis evaluating one-year mortality among people who received first ever aged care services in 2013 compared with the general population was conducted. In 2013, 3.3 million Australians were≥65years and 34919 (1%) entered permanent residential care, 23288 (0.7%) respite care, 20265 (0.6%) commenced home care packages, and 15387 (0.5%) transition care. Individuals receiving aged care services had higher mortality than the general population, with those entering permanent residential care (age and sex direct standardised mortality rate ratio=10.1, 95% CI: 9.8-10.5) having the greatest difference, followed by people accessing respite (7.2, 95% CI: 6.9-7.6), transition (4.6, 95% CI: 4.4-4.9) and home care (4.1, 95% CI: 3.9-4.4). Significant variation by sex and age was observed. Our study has identified significant variations in mortality rates that highlight which cohorts entering aged care are the most vulnerable.

Older lesbian and gay adults' perceptions of barriers and facilitators to accessing health and aged care services in Australia.

Older lesbian and gay people can face considerable marginalisation, which may affect their perceptions and experiences of accessing health and aged care services. To inform strategies promoting accessibility, this study aimed to investigate perceived barriers and facilitators to health and aged care service access among older lesbian and gay adults. A sample of 752 cisgender lesbian women and gay men aged 60years and older living in Australia responded to questions on a broad range of potential barriers and facilitators to service access. Several barriers and facilitators were commonly reported, with some differences between the women and the men. LGBTI inclusiveness was among commonly reported concerns. A majority of participants reported a lack of LGBTI-inclusive service providers and professionals as a barrier. A majority also reported a perceived lack of professionals adequately trained and competent to work with LGBTI individuals, with significantly more women than men indicating this as a barrier. Almost all participants indicated LGBTI-inclusive mainstream services as a facilitator for access. In all, inclusiveness appears to be a key issue for service access among older lesbian and gay people, which may need to be further addressed by service providers and policy makers for improving service accessibility.

Factors associated with accessing aged care services in Australia after approval for services: Findings from the historical cohort of the Registry of Senior Australians.

ObjectiveTo evaluate the access of approved aged care services and factors associated with accessing these services.MethodsA retrospective cohort study was conducted (1/7/2003‐30/6/2013). The incidence of accessing permanent residential, home and respite care services within one year or transition care within 28 days of approval was evaluated. The association of participants’ socio‐demographic characteristics, limitations, health conditions and assessment characteristics with service use was evaluated.ResultsIn 799 750 older Australians, the incidence of accessing approved permanent residential care within one year was 70.9% (95% confidence interval [CI] 70.8%‐71.0%), home care 49.5% (95% CI 49.3%‐49.7%) and respite 41.8% (95% CI 41.7%‐41.9%). The incidence of accessing transition care at 28 days was 78.5% (95% CI 78.2%‐78.7%). Aged care seekers’, assessments’ and assessors’ characteristics are associated with service access.ConclusionMonitoring the use of aged care service approvals is necessary for the identification of service access barriers to support evidence‐based policy changes.

Residential Respite Care Use Is Associated With Fewer Overall Days in Residential Aged Care

ObjectivesTo examine the use of residential respite care and determine associations between respite care and total days spent in residential care (respite days plus long-term care days). DesignA retrospective cohort study of individuals accessing aged care services in Australia using the National Historical Cohort of the Registry of Senior Australians was conducted. SettingResidential respite care (short stays in residential aged care homes) and long-term residential care accessed in all government-subsidized residential aged care homes in Australia. ParticipantsThis study included people who were approved for government-subsidized residential respite care between January 2005 and June 2012 (n = 480,862) and included a 2-year follow-up period. MethodsPoisson regression models were used to examine associations between use of residential respite care and number of days spent in residential care. ResultsOf people approved for residential respite care, 36.9% used their approval within 12 months (32.0% used respite once and went directly to long-term care without returning home, 40.7% used respite once and did not go directly to long-term care, and 27.3% used respite ≥2 times). Compared with people who did not use respite care, using respite care once and not going directly to long-term care was associated with less total days in residential care [incidence rate ratio (IRR) 0.68, 95% confidence interval (CI) 0.67-0.69; P < .001] and using respite care ≥2 times was also associated with fewer days (IRR 0.86, 95% CI 0.84-0.87, P < .001). Using respite care once and going directly to long-term care was associated with more days in residential care (IRR 1.11, 95% CI 1.10-1.12, P < .001). Conclusions and ImplicationsUsing residential respite care was associated with fewer days spent in residential care when people returned home after using respite. The findings suggest that using residential respite as intended by returning home after use achieves the goal of helping people stay living at home longer.

Trends in the utilisation of aged care services in Australia, 2008\u20132016

BackgroundAged care support services in Australia are delivered through home care packages, permanent residential care, respite care and transition care. This study aimed to determine age and gender specific incidence rates of aged care service utilisation in Australia between 2008-09 and 2015–16.MethodsThis is a population-based epidemiological study of people accessing aged care services in Australia. The trends and characteristics of people (over the age of 65 years old) accessing aged care services in Australia were evaluated, using data (2008–09 and 2015–16) from the Australian Institute of Health and Welfare and Australian Bureau of Statistics. The yearly utilisation incidence rates (per 1000 people) per service type were calculated and changes in incidence rate ratios (IRR) of service utilisation for the study period were estimated using Poisson regression models.ResultsThe proportion of older Australians aged ≥65 years who used aged care services remained similar between 2008-09 (5.4%, N = 208,247) and 2015–16 (5.6%, N = 248,669). However, the incidence use of specific services changed during the study period. Specifically, admissions into permanent residential care decreased (from 23.8/1000 people in 2008–09 to 19.6/1000 in 2015–16, at a IRR of 0.84/year, p < 0.001) but increased for transition care (from 4.3/1000 in 2008–09 to 6.6/1000 in 2015–16, at a IRR of 1.57/year, p < 0.001) and home care packages (from 8.04/1000 in 2008–09 to 12.0/1000 per 1000 in 2015–16, at a IRR of 1.52/year, p < 0.001). Between 2008-09 and 2015–16, the greatest changes in IRR were observed in males aged 80–89 years accessing transition care (IRR = 1.68/year, p < 0.001). A higher proportion of people aged between 80-89 years (≥45%), females (≥60%), Australia born (≥ 60%) and English speakers (≥80%) used all the service types.ConclusionsPatterns of service utilisation for aged care services changed over the study period with a decrease in incidence of individuals accessing permanent residential care but increased for other service types. This finding reflects changes in attitudes regarding ageing in place and policies. These findings are helpful to inform key stakeholders on service planning to further improve quality of the aged-care services in Australia.

A pragmatic randomised controlled trial (RCT) and realist evaluation of the interdisciplinary home-bAsed Reablement program (I-HARP) for improving functional independence of community dwelling older people with dementia: an effectiveness-implementation hybrid design

BackgroundA major gap exists internationally in providing support to maintain functional and social independence of older people with dementia living at home. This project evaluates a model of care that integrates evidence-based strategies into a person-centred interdisciplinary rehabilitation package: Interdisciplinary Home-bAsed Reablement Program (I-HARP). Two central aims are: 1) to determine the effectiveness of I-HARP on functional independence, mobility, quality of life and depression among people with dementia, their home environmental safety, carer burden and quality of life, and I-HARP cost-effectiveness; and 2) to evaluate the processes, outcomes and influencing factors of the I-HARP implementation.MethodsI-HARP is a 4-month model of care, integrated in community aged care services and hospital-based community geriatric services, and consists of: 1) 8–12 home visits, tailored to the individual client’s needs, by an occupational therapist, registered nurse, and other allied health staff; 2) minor home modifications/assistive devices to the value of <A$1000 per participant; and 3) three individual carer support sessions. The overarching design is a mixed-methods action research approach, consisting of a multi-centre pragmatic parallel-arm randomised controlled trial (RCT) and realist evaluation, conducted in two phases. Participants include 176 dyads (person aged > 60 years with mild to moderate dementia and his/her carer). During Phase I, I-HARP advisory group is established and training of I-HARP interventionists is completed, and the effectiveness of I-HARP is examined using a pragmatic RCT. Phase II, conducted concurrently with Phase I, focuses on the process evaluation of the I-HARP implementation using a realist approach. Semi-structured interviews with participants and focus groups with I-HARP interventionists and participating site managers will provide insights into the contexts, mechanisms and outcomes of I-HARP.DiscussionI-HARP is being evaluated within the real-world systems of hospital-based and community-based aged care services in Australia. Future directions and strategies for reablement approaches to care for community dwelling people living with dementia, will be developed. The study will provide evidence to inform key stakeholders in their decision making and the use/delivery of the program, as well as influence future systems-thinking and changes for dementia care.Trial registrationAustralian New Zealand Clinical Trial Registry ACTR N12618000600246 (approved 18/04/2018).

Experiences and perceptions of residential and home care services among older lesbian women and gay men in Australia.

The needs of older lesbian and gay people regarding access and use of aged-care services remain underresearched. This paper reports the findings of 33 qualitative interviews with older lesbian women and gay men about their perceptions and experiences of residential aged-care and home-based aged-care services in Australia. The focus of this paper is their preparedness for using aged-care services. The results highlight that participants had a number of concerns related to accessing residential-care services in particular, including perceptions of a lack of inclusivity and concerns of potential for discrimination and hostility, loss of access to community and partners, decreased autonomy and concerns relating to quality of care and the potential for elder abuse. Participants noted a number of strategies they employed in avoiding residential-care services, including the use of home-care services, renovating the home for increased mobility, moving to locations with greater access to outside home-care services, a preference for lesbian/gay-specific housing and residential-care options if available, and the option of voluntary euthanasia to ensure dignity and autonomy. Participants, on the whole, were hopeful that they would never require the use of residential-care services, with some believing that having current good health or the support of friends could prevent this from happening. The findings suggest that older lesbian and gay people have a variety of concerns with aged-care and may need additional support and education to improve their perceptions and experiences of services, whether these are needed presently or in the future.

Trends in Prevalence of Dementia for People Accessing Aged Care Services in Australia.

Studies in some high-income countries have reported a potential decline in the prevalence of dementia. Improvements in cardiovascular health may be contributing to this decline. The objective was to examine trends in prevalence of dementia and survival with dementia for people accessing aged care in Australia. A retrospective study of older people who accessed long-term care 2008-2014 (n = 348,311) and home care 2005-2014 (n = 188,846) in Australia was developed. The age- and sex-standardized prevalence for dementia by year of access to aged care was determined using direct standardization. Generalized linear models were used to determine change in the prevalence of dementia over time and change in 1-year mortality for people who accessed long-term care. The age- and sex-standardized prevalence (95% confidence interval) of dementia declined from 50.0% (49.6, 50.5) in 2008 to 46.6% (46.0, 47.2) in 2014 for people accessing long-term care (absolute change 2008-2014: -3.8 [-4.6, -3.1]) and for people accessing home care from 25.9% (25.0, 26.5) in 2005 to 20.9% (20.2, 21.7) in 2014 (absolute change 2005-2014: -5.2 [-6.2, -4.1]). This decline in dementia occurred in concurrence with a decline in cerebrovascular disease in long-term care but despite the prevalence of hypertension, diabetes, high cholesterol, malnutrition, obesity, depression, and head injury increasing. For people accessing long-term care, 1-year mortality remained stable over time. The decline in prevalence of dementia for people accessing aged care services in Australia is critical to future projection estimates and for planning of services. Further research to determine contributing factors to the decline is needed.

Impact of consumer-directed care on quality of life in the community aged care sector.

All consumer-directed care (CDC) models aim to transfer "choice" and "control" over the allocated funds from the aged care provider to service recipients. This study presents an empirical assessment of the relationships between quality of life for older adults aged ≥65 years receiving community aged care services in Australia under CDC compared with those receiving traditional provider-directed care (PDC). Self-reported quality of life (health status and capabilities) were measured for older adults receiving community aged care services (n = 139) using the EuroQoL five dimensions five-level version and the older people-specific capability index (ICECAP-O) instruments. The relationship between quality of life, mode of service delivery, and other sociodemographic characteristics were examined using descriptive statistical and multivariate regression analyses. The quality of life of individuals receiving CDC and PDC was similar (ICECAP-O: CDC mean 0.74 [SD 0.17], PDC mean 0.78 [SD 0.17]. EuroQoL five dimensions five-level version: CDC mean 0.46 [SD 0.33], PDC mean 0.49 [SD0.27]). In general, individuals in receipt of CDC reported higher levels of capability in the control and independence dimension for the ICECAP-O relative to those receiving PDC. Multivariate regression analysis showed that living alone was associated with higher quality of life (P = 0.01) and higher levels of capability (P = 0.02). Although no discernible differences in overall quality of life were found, higher levels of self-reported control and independence for those in receipt of CDC suggest that the main policy objectives of transferring "choice" and "control" away from the aged care provider and to the individual are being met. Geriatr Gerontol Int 2017; 17: 1399-1405.

Improving care coordination for community-dwelling older Australians: a longitudinal qualitative study.

Objective The aim of the present study was to describe the care transition experiences of older people who transfer between subacute and primary care, and to identify factors that influence these experiences. A further aim of the study was to identify ways to enhance the Geriatric Evaluation and Management (GEM) model of care and improve local coordination of services for older people. Methods The present study was an exploratory, longitudinal case study involving repeat interviews with 19 patients and carers, patient chart audits and three focus groups with service providers. Interview transcripts were coded and synthesised to identify recurring themes. Results Patients and carers experienced care transitions as dislocating and unpredictable within a complex and turbulent service context. The experience was characterised by precarious self-management in the community, floundering with unmet needs and holistic care within the GEM service. Patient and carer attitudes to seeking help, quality and timeliness of communication and information exchange, and system pressure affected care transition experiences. Conclusion Further policy and practice attention, including embedding early intervention and prevention, strengthening links between levels of care by building on existing programs and educative and self-help initiatives for patients and carers is recommended to improve care transition experiences and optimise the impact of the GEM model of care. What is known about the topic? Older people with complex care needs experience frequent care transitions because of fluctuating health and fragmentation of aged care services in Australia. The GEM model of care promotes multidisciplinary, coordinated care to improve care transitions and outcomes for older people with complex care needs. What does this paper add? The present study highlights the crucial role of the GEM service, but found there is a lack of systemised linkages within and across levels of care that disrupts coordinated care and affects care transition experiences. There are underutilised opportunities for early intervention and prevention across the system, including the emergency department and general practice. What are the implications for practitioners? Comprehensive screening, assessment and intervention in primary and acute care, formalised transition processes and enhanced support for patients and carers to access timely, appropriate care is required to achieve quality, coordinated care transitions for older people.

Assessment of sexual health and sexual needs in residential aged care.

To investigate if, when and how assessments regarding residents' sexual health and needs occur within Australian residential aged care facilities. A census of all Australian residential aged care facilities was conducted. A survey developed specifically for the project was posted to all 2766 residential aged care services in Australia. Eight weeks were allowed for the return of surveys. A total of 1094 completed surveys were returned, representing a 39.7% response rate. The type of information most often collected concerned disruptive sexual behaviour, and assessments most frequently occurred following disruptive behaviour. One-quarter of facilities reported having a sexual health/needs assessment form, although only 10 facilities provided evidence of this. Survey responses indicated that sexual health and needs are not routinely assessed in residential aged care, and facilities do not commonly have a dedicated sexual health/needs assessment form to guide them through an assessment process.