Aged Care Research Articles

Social resilience within the carescapes of Asian female migrant aged care workers

Increasingly, Asian female migrants are playing a significant role in meeting Australia’s aged care workforce demand. This article analyses the lived experiences of Asian female aged care workers using the carescape concept, and a theory of agency to understand aged care access and workforce availability. It aims to identify the wider institutional and social structures that influence their agency and contribute to their social resilience as a critical member of the aged care workforce. Qualitative data were used for analysis; specifically, semi-structured interviews which were conducted with 10 Asian female migrant workers from the aged care sector. Analysis reveals that social and institutional structures both challenge and facilitate agency, and thus access to the aged care industry. The findings provide a deeper understanding of agency and highlights the social structures which contribute to developing social support networks and social resilience. Workplace policies and practices which facilitate the agency, adaptation and transformation of this workforce are important to understanding access to the industry and the retention of Asian female migrant aged care workers.

Bolstering agreement with scarce resource allocation policy using education: a post hoc analysis of a randomized controlled trial

BackgroundThe COVID- 19 pandemic prompted rapid development of scarce resource allocation policies (SRAP) in case demand for critical health services eclipsed capacity. We sought to test whether a brief, educational video could improve alignment of participant values and preferences with the tenets of the University of California Health’s SRAP in a post hoc analysis of a randomized controlled trial (RCT) conducted during the pandemic.MethodsAn RCT of an educational video intervention embedded in a longitudinal web-based survey conducted from May to December 2020, analyzed in August 2024. The “explainer” video intervention was approximately 6 min long and provided an overview of the mechanics and ethical principles underpinning the UC Health SRAP, subtitled in six languages. California residents were randomized to view the intervention or not, stratified by age, sex, education, racial identity, and self-reported health care worker status. Non-California residents were assigned to the control group. 1,971 adult participants were enrolled at baseline, and 939 completed follow-up. 770 participants with matched baseline and follow-up responses were analyzed. Self-reported survey assessments of values regarding components of SRAP were scored as the percentage of agreement with the UC Health SRAP as written. Participants responded to items at baseline and follow-up (approximately 10 weeks after baseline), with randomization occurring between administrations.ResultsAfter the intervention, overall agreement improved by a substantial margin of 5.2% (from 3.8% to 6.6%, P <.001) for the intervention group compared to the control group. Significant changes in agreement with SRAP logistics and health factors were also observed in the intervention group relative to the control, while no significant changes were noted for social factors. Differential intervention effects were observed for certain demographic subgroups.ConclusionsA brief educational video effectively explains the complex ethical principles and mechanisms of the SRAP, as well as how to improve the alignment of participant values with the foundational principles of UC Health SRAP. This directly informs practice by providing a framework for educating individuals about the use of these policies during future situations that require crisis standards of care, which can, in turn, enhance agreement and buy-in from affected parties.Trial registrationClinicalTrials.gov registration NCT04373135 (registered 4 May 2020).

Type 1 Diabetes/Hidradenitis Suppurativa Comorbidity—A Population-Based Study

Background: Type 1 diabetes (T1D) and hidradenitis suppurativa (HS) share several metabolic and inflammatory dysfunctions. Prior studies of the potential link between the diseases either lacked validated T1D diagnoses or established only an indirect association. This study sought to determine the odds of HS developing in patients with a validated diagnosis of T1D and to characterize the clinical features of HS/T1D comorbidity. Methods: A population-based nested case-control study was conducted including patients with HS and controls matched 5:1 for age, sex, and primary care clinic. T1D was diagnosed using a specialized algorithm, achieving 90% accuracy. Diagnostic validity was confirmed by diabetes specialists who manually reviewed a random subset of the files. Unadjusted and adjusted odds ratios (OR/aOR) were calculated to determine the odds of incident HS in patients with T1D. Results: The study included 10,919 patients with HS and 53,314 controls. A history of T1D was associated with an elevated odds of new-onset HS (OR 1.80 95% CI (1.30–2.40), p &lt; 0.001), even after adjusting for demographics and metabolic and autoimmune comorbidities (aORs &gt; 1.7, p &lt; 0.001). Patients with HS/T1D comorbidity had higher proportions of autoimmune conditions than patients with HS alone (p &lt; 0.001) and a higher mean Charlson Comorbidity Index score than both patients with HS alone (3.5 vs. 0.9, p &lt; 0.001) and T1D alone (3.5 vs. 2.2, p = 0.004). Conclusions: T1D is associated with higher odds of the subsequent development of HS. Awareness of HS/T1D comorbidity is recommended owing to the elevated burden of metabolic and autoimmune conditions.

Comprehensive analysis of Australia’s aged care system to inform policies for a sustainable future

Comprehensive analysis of Australia’s aged care system to inform policies for a sustainable future

Evidence for improved glucose metrics and perinatal outcomes with continuous glucose monitoring compared to self-monitoring in diabetes during pregnancy.

Evidence for improved glucose metrics and perinatal outcomes with continuous glucose monitoring compared to self-monitoring in diabetes during pregnancy.

Individuals with Cognitive Impairment Entering Long-Term Care: Characteristics and Cumulative Incidence of Dementia after Care Entry.

Individuals with Cognitive Impairment Entering Long-Term Care: Characteristics and Cumulative Incidence of Dementia after Care Entry.

Impact of potentially inappropriate psychotropic medicines on falls among older adults in 23 residential aged care facilities in Australia: a retrospective longitudinal cohort study

ObjectiveFalling is common among older adults in residential aged care facilities (RACFs) and potential inappropriate psychotropic medicines (PIPMs) use may increase the risk of falling. This study aimed to determine...

Advance care planning: empowering older frail people to document their end of life wishes.

ObjectiveTo determine the features that are required to increase uptake of advance care directives (ACDs).MethodsWe conducted a study involving older patients attending aged care outpatient clinics and/or receiving outreach services between March 2021 and December 2022. Patients were assessed using tools related to frailty, end of life and empowerment. If the person agreed to complete an ACD, they were guided through it, and it was subsequently uploaded on the electronic medical record.ResultsOf 170 patients referred to complete an ACD, 47% completed it. These patients had lower Rockwood Clinical Frailty Scale and SPICT (Supportive and Palliative Care Indicators Tool) scores. The Frailty and SPICT tools were easier to use, the PAM (Patient Activation Measure) was difficult to use and assess. Patients did, however, show satisfaction in the process.ConclusionsPatients completing an ACD tended to be a little less frail and less likely to die in the following 12months. Increased uptake of ACD is more likely if the less frail are targeted, and assisted through the process by a health professional at a time and place that suits the person.

Frailty in people with HIV: a geriatric syndrome approach to aging with HIV

Purpose of review Older persons with HIV (OPWH) are at risk of earlier onset of age-related comorbidities and common geriatric syndromes, notably frailty. The purpose of this review is to provide an update on recent developments related to frailty in OPWH, particularly as they relate to common co-occurrence of frailty with other geriatric syndromes which have an adverse impact on health outcomes. Recent findings Recent studies reliably demonstrate that frailty co-occurs with other geriatric syndromes due to common biologic risk factors. They often have an equal or greater impact on mortality and quality of life (QoL) compared to age-related comorbidities. Frailty is potentially reversible and risk factors for progression to or regression from a state of frailty have been identified. Importantly, HIV and Aging care centers have been initiated based on proven geriatric-based principles and frail OPWH should be referred. The role of agism and stigmatization are identified as contributors to states of frailty. Summary Recent findings focus on the important role geriatric syndromes especially frailty play in determining QoL in OPWH and this has led to efforts to operationalize frailty screening methods and to develop appropriate management protocols to limit or delay the impact of frailty on health.

Development of a Predictive Dashboard With Prescriptive Decision Support for Falls Prevention in Residential Aged Care: User-Centered Design Approach

Background Falls are a prevalent and serious health condition among older people in residential aged care facilities, causing significant health and economic burdens. However, the likelihood of future falls can be predicted, and thus, falls can be prevented if appropriate prevention programs are implemented. Current fall prevention programs in residential aged care facilities rely on risk screening tools with suboptimal predictive performance, leading to significant concerns regarding resident safety. Objective This study aimed to develop a predictive, dynamic dashboard to identify residents at risk of falls with associated decision support. This paper provides an overview of the technical process, including the challenges faced and the strategies used to overcome them during the development of the dashboard. Methods A predictive dashboard was co-designed with a major residential aged care partner in New South Wales, Australia. Data from resident profiles, daily medications, fall incidents, and fall risk assessments were used. A dynamic fall risk prediction model and personalized rule-based fall prevention recommendations were embedded in the dashboard. The data ingestion process into the dashboard was designed to mitigate the impact of underlying data system changes. This approach aims to ensure resilience against alterations in the data systems. Results The dashboard was developed using Microsoft Power BI and advanced R programming by linking data silos. It includes dashboard views for those managing facilities and for those caring for residents. Data drill-through functionality was used to navigate through different dashboard views. Resident-level change in daily risk of falling and risk factors and timely evidence-based recommendations were output to prevent falls and enhance prescriptive decision support. Conclusions This study emphasizes the significance of a sustainable dashboard architecture and how to overcome the challenges faced when developing a dashboard amid underlying data system changes. The development process used an iterative dashboard co-design process, ensuring the successful implementation of knowledge into practice. Future research will focus on the implementation and evaluation of the dashboard’s impact on health processes and economic outcomes. International Registered Report Identifier (IRRID) RR2-https://doi.org/10.1136/bmjopen-2021-048657

Exploring and understanding perceptions and definitions of foodservice quality in residential aged care: A scoping review

AbstractAimIdentify and describe research that explores interest‐holder perceptions and definitions of foodservice quality in residential aged care.MethodsThis review follows the Joanna Briggs Institute methodological framework for conducting scoping reviews and was reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews checklist. PubMed, Embase, CINAHL, and Scopus were used to search for peer‐reviewed literature. Grey literature was searched through Google and six Australian government sources. No restrictions were applied to methodology, year, or geographical location published. Findings were synthesised into distinct interest‐holder and foodservice component groups using meta‐synthesis.ResultsA total of 31 eligible texts, including peer‐reviewed (n = 17) and grey literature (n = 14) were included in this review. Texts identifying perceptions (n = 23) were predominantly those of residents (n = 11) while definitions of quality (n = 13) were all described by researchers and experts. Despite some agreement that foodservice quality is associated with how acceptable food or meals are to residents, there is a lack of consensus on what defines quality, with none of the literature addressing quality across the whole foodservice system.ConclusionPublished research and reports that examine the perspectives of interest‐holders in residential aged care provided no consensus on definitions or clear sets of indicators defining foodservice quality. Further research is required to understand the perceptions of foodservice quality in order to guide the development and implementation of specific measures to support assessment and evaluation.

Ageing together and the paradox of negotiating care transitions for informal disability carers in migrant multicultural communities

ABSTRACT This paper examines care transition planning and the experiences of ageing carers who provide care for family members with disability from culturally and racially marginalised migrant (CaRM) backgrounds in Western Sydney. The study was designed as collaborative qualitative research involving family-based in-depth interviews and a validation workshop with nine families with a total of 16 participants: parents (n = 9); adult family members with disability (n = 7). The findings in this paper report only on informal carers (n = 9) and show that ageing informal carers are anxious about the future, stemming from their self-awareness of ageing, ongoing health concerns, and frustration with service systems. Long-term care transition plans include seeking independence for the family member with a disability, continuing living together until the end of life, and relying on normative disability services. The paper argues that ageing informal carers from CaRM backgrounds providing disability care face a growing challenge in negotiating social and healthcare service barriers affecting how they plan for future care. Ongoing advocacy and awareness of disability issues in CaRM communities are essential for prioritising care transition planning, disability rights, and service navigation. Carer support organisations should empower aging carers to address inconsistencies in aged and disability care, considering cultural norms.

From ‘support’ to ‘separate’: residential aged care staff responses to an intimate relationship involving a resident with cognitive impairment

BackgroundIntimate relationships are important throughout life but can be complicated in later years if a person develops cognitive impairment and moves into residential aged care. The aim of this research was to elucidate the ways in which residential aged care staff would intervene in an intimate relationship between residents when a resident has cognitive impairment, and their motivations for intervening.MethodsThis was an exploratory study. Vignette methodology was employed depicting a hypothetical case of a relationship between two residents (one who has cognitive impairment). A national postal survey was sent to all residential aged care facilities in Australia. Thematic analysis was performed on responses (N = 515) to open-ended questions regarding how staff would intervene and motivations for doing so.ResultsThematic analysis identified six key themes emerging from the data related to staff responses: communicating; educating; respecting; monitoring; distracting; and separating. Each of these themes is illustrated by participant quotes. Participants largely did not report motivations for responding in the ways identified.ConclusionsThere is considerable variability in residential aged care staff responses to an intimate relationship between residents when one resident has cognitive impairment. Intimate relationships between residents can be supported or prevented as a result.

Monitoring cross-setting care and outcomes among older people in aged care: a national framework is needed.

Establishing an evidence-based framework to monitor and evaluate quality and safety of care for older people is critical. Despite progress in health system performance monitoring in Australia, slower progress has occurred for the older population accessing aged care services. With an aging population and increasing demands on aged care and healthcare systems, there is growing recognition of the need for more coordinated and integrated care across settings. It is not uncommon for older people accessing aged care to require a range of services administered by different organisations simultaneously (e.g. primary care, home care) and sequentially (e.g. hospitals, residential care). Aged care also represents an increasingly regulated sector, with significant investment in and growing recognition of the value of quality measurement. Accountability for care quality and safety is often shared among providers, with consequent challenges in attributing responsibility. Therefore, the development of a pragmatic national framework to support high-quality, person-centred care for the older population accessing aged care services across care settings is one opportunity for shared responsibility, care monitoring, and quality improvement activities that could lead to better outcomes for this population. The strategy for framework development proposed in this perspective has implications for aged care and healthcare providers, consumers, policy makers, regulators, and academics. Once implemented, this framework has the potential to drive consistent high-quality care to improve health outcomes and wellbeing among older people accessing aged care services.

Challenging aged care stigma through communication: discursive responses to stigmatising discourses about aged care work and implications for workers’ mental health

Occupational stigma can negatively impact aged care workers’ (ACWs) mental health. This mixed-methods study investigates whether ACWs who challenge stigmatising discourses, through communication, experience reduced psychological costs of aged care stigma. We screened 184 ACWs’ discursive responses and tested for differences in ACWs’ mental health between those who challenge stigma and those who do not. A discourse approach was further employed to examine recurring language patterns in ‘challenge’ discursive responses. ACWs (n = 95) who discursively challenged stigmatising discourses reported lower internalised occupational stigma and psychological distress than those who did not challenge stigma (n = 89). These workers chose to infuse positive value into negative evaluations about ACWs and aged care work. Overall, findings suggest that ACWs may spontaneously challenge occupational stigma, through their discursive responses, which may proactively protect their mental health. We offer practical implications for challenging stigma, including developing guidelines, training, and language-based interventions.

Initiation of antipsychotic medication among refugees, non-refugee migrants, second-generation migrants, and Swedish-born adults with incident non-affective psychotic disorders

Abstract Background It is not known if there are differences in antipsychotic initiation between migrants and native-born individuals diagnosed with non-affective psychotic disorder. This study aimed to determine (1) potential differences in initiation rate and type of first antipsychotic medication between refugees, non-refugee migrants, second-generation migrants, and Swedish-born young adults with incident non-affective psychosis and (2) which sociodemographic and clinical factors are associated with initiation. Methods This register-based cohort included 12,960 adults aged 18–35 years, residing in Sweden during 2007–2018, with an incident diagnosis of a non-affective psychotic disorder in inpatient or specialised outpatient care. Sociodemographic and clinical factors associated with antipsychotic initiation were determined using modified Poisson regression models yielding Relative Risk, RRs, and 95% Confidence Intervals, CI. Results Initiation of antipsychotic use was slightly less common among refugees (65.6%) compared to non-refugee migrants (70.2%), second-generation migrants (71.0%), and Swedish-born individuals (71.1%). However, after adjustment for sociodemographic and clinical factors, there was no difference in initiation rates between refugees and Swedish-born individuals (adjusted RR 0.96; 95% CI 0.92-1.00). Olanzapine was most common initial antipsychotic in all groups. However, compared to the Swedish-born, refugees (1.47; 1.10–1.97), non-refugee migrants (1.70; 1.26–2.27) and second-generation migrants (1.43; 1.05–1.97) were more likely to initiate the use with long-acting injectable antipsychotics, and also with first-generation antipsychotics, particularly haloperidol. Sociodemographic factors associated with initiation were similar among refugees and Swedish-born individuals, including younger age, higher education and inpatient care. Conclusion Our finding that migrants were more likely to initiate long-acting antipsychotics suggests that clinical teams anticipate medication non-adherence among migrants.

A Digitally Capable Aged Care Workforce: Demands and Directions for Workforce Education and Development.

As the aged care sector undergoes digital transformation, greater attention is needed to development of digital health capability in its workforce. There are many gaps in our understanding of the current and future impacts of technology on those who perform paid and unpaid aged care work. Research is needed to understand how to make optimal use of both digital resources and human resources for better aged care. In this Viewpoint, we reflect on a workshop held during an international conference that identified shared concepts and concerns to shape further research into workforce capability. Digital technologies and digital data can increase quality of care in a system that operates through partnerships among service providers, service users, and community members. To realize this potential, digital health learning and development are needed in the aged care workforce. As digital dimensions of aged care services expand, the sector needs clearer direction to implement approaches to workforce learning and development. These must be appropriate to support the safe and ethical performance of care work and to increase the satisfaction of those who care and those for whom they care.

The Intersection of Sarcopenia and Musculoskeletal Pain: Addressing Interconnected Challenges in Aging Care

The global aging population faces a growing prevalence of sarcopenia and musculoskeletal (MSK) pain, two interrelated conditions that diminish physical function, quality of life, and independence in older adults. Sarcopenia, characterized by the loss of muscle strength, mass, and function, often coexists with MSK pain, with emerging evidence suggesting that each condition may contribute to the progression of the other. This perspective explores the bidirectional relationship between sarcopenia and MSK pain, highlighting shared mechanisms, including inactivity, cellular aging, chronic inflammation, gender-related hormonal changes, and psychosocial factors such as depression and social isolation, which underlie the mutual exacerbation between conditions. Through a multidisciplinary framework, the article emphasizes integrating care across specialties to address these interconnected conditions. Practical approaches, including comprehensive screening protocols, tailored resistance exercise, and nutritional support, are discussed alongside innovative hybrid care models combining in-person and telemedicine systems to enhance accessibility and continuity of care. A call to action is presented for clinicians, policymakers, and researchers to adopt collaborative strategies, prioritize investment in integrated healthcare, and bridge critical knowledge gaps. By reframing care delivery and advancing multidisciplinary efforts, this perspective aims to effectively address the complex challenges posed by the intersection of sarcopenia and MSK pain in older adults.

How to age right and care(fully) at home? A protocol for a multistage comparative study of ageing in place and hospital at home care across three countries

IntroductionAgeing right care(fully) is a transnational research study which explores and maps an understanding of the care pathways between ageing in place and hospital at home policy and practices for...

Low Back Pain Presentation and Management at the Emergency Department: Differences Between Older Adults Residing in the Community and Aged Care Homes.

In healthcare systems without gatekeeper access to Emergency Departments (ED), the number of people presenting for low back pain (LBP) is increasing substantially. Low back pain presentations at the Emergency Department are rarely caused by serious underlying pathology, and management often deviates from practice guidelines. Older adults (≥ 65 years) constitute approximately 30% of all ED LBP presentations. Little is known about differences in presentation characteristics and ED management between older adults from aged care homes and those living in the community. This study aimed to identify differences in presentation and management between people presenting at the ED for LBP from aged care homes versus those residing in the community. Retrospective observational study of routinely collected healthcare data and chart audits of older adults from aged care homes (N = 64) and age and sex-matched community-dwelling older adults (N = 64) presenting to ED for LBP. Patients from aged care homes presented with more comorbidities (4 vs. 2), analgesic medication (84% vs. 70%) and polypharmacy (86% vs. 41%) and were more commonly admitted for ongoing analgesia or further diagnostic tests. Community-dwelling older adults were more frequently admitted for Allied Health input. ED administration of opiates was high for both groups (81% aged care; 91% community-dwelling). High rates of lumbar spine medical imaging (61% aged care; 50% community-dwelling) resulted in few acute radiographic findings. Older patients presenting to ED for LBP receive similar management regardless of their residential status. Hospital management of both groups does not align with current published recommendations namely in respect to imaging and pain medication.