Aged Care Research Articles

A Longitudinal Study of the Use and Effects of Fall-Risk-Increasing Drugs in Residential Aged Care

ObjectivesFall-risk-increasing drugs (FRIDs)—psychotropics and cardiovascular disease (CVD) drugs—may elevate the risk of falling, with strong evidence observed in psychotropic FRIDs, whereas findings from cardiovascular disease (CVD) FRIDs remain inconclusive. Existing studies on FRIDs and falls are often hampered by methodologic limitations. Leveraging longitudinal observational data, we aimed to determine the long-term patterns of FRID use and their association with falls in residential aged care (RAC) homes. DesignA retrospective longitudinal cohort study. Setting and ParticipantsA total of 4207 permanent residents newly admitted to 27 RAC homes in Sydney, Australia. MethodThe outcomes were incidence of all and injurious falls. We measured exposure to each FRID over 60 months using the Proportion of Days Covered (PDC) metric. We used group-based multitrajectory modeling to determine concurrent usage patterns of psychotropics and CVD FRIDs and applied negative binomial regression to assess their associations with the outcomes. ResultsA total of 83.6% (n = 3516) and 77.3% (n = 3254) residents used psychotropic and CVD FRIDs, respectively. The PDC values ranged from 67.3% (opioids) to 86.9% (antidepressants) for specific psychotropics and 79.0% (α-adrenoceptor antagonists) to 89.6% (β blockers) for CVD FRIDs. We identified 4 groups: group 1, low psychotropics–low CVDs use (16.7%, n = 701); group 2, low psychotropics–high CVDs (25.0%, n = 1054); group 3, high psychotropics–high CVDs (41.0%, n = 1723); and group 4, high psychotropics–low CVDs (17.3%, n = 729). Group 4 had a significantly higher rate of falls than the other groups for both outcomes, including relative to group 3, in which exposure to both FRID classes was high. Conclusions and ImplicationsOur findings reveal concerningly high FRID use in RAC homes and highlight a critical difference in the impact of the 2 major FRID classes on falls. Psychotropics were strongly associated with falls, whereas the studied CVD FRIDs did not elevate risk of falling.

The impact of telehealth care on escalation to emergency care: A systematic review and meta-analysis.

We compared the impact of accessing healthcare (1) by telehealth (via telephone or video) vs face-to-face; and (2) by telephone vs video telehealth care, on escalation to emergency care. We searched Medline, Embase and Cochrane CENTRAL to 24 July 2023; and conducted a citation analysis on 19 September 2023. We included randomised controlled trials. Risk of bias was assessed using Cochrane Tool 2. We calculated risk ratios for dichotomous outcomes and standardised mean difference for continuous outcomes. Ten trials compared telehealth (five telephone, four video, one both) to face-to-face care. Six were overall low, three some concerns and one high risk of bias. There were no differences between telehealth and face-to-face for visits to the emergency department (RR 1.07, 95% CI 0.89 to 1.29), hospitalisations up to 12 months (RR 0.89, 95% CI 0.56 to 1.41), deaths or other adverse events. Costs of care were similar, as were patient satisfaction scores.Six trials compared telephone to video telehealth: three were overall low, two some concerns, and one high risk of bias. There were no differences between telephone and video for visits to the emergency department (RR 0.67, 95% CI 0.41 to 1.12), hospitalisations (RR 1.04, 95% CI 0.73 to 1.48), deaths, other adverse events, costs, or patient satisfaction. Healthcare provider satisfaction was high. Telehealth care - delivered by telephone or by video - may be an appropriate alternative to face-to-face provision of care, as it does not increase the likelihood of escalation of care to the emergency department for patients in primary care, hospital outpatients, post-discharge patients or residents in aged care.

Introducing virtual reality to older adults: A qualitative analysis of a co-design innovation with care staff

Previous studies of Virtual Reality (VR) in aged care settings have demonstrated that the benefits can be multiple, including improved social connection and engagement and reduced social isolation in later life. However, there remains a lack of widespread uptake of VR in aged care facilities. This prompts an important question: Given the potential benefits, why is there such poor engagement in VR by aged care facilities? The aim of this qualitative study is to investigate the experience of introducing VR into an aged care facility. Our innovative approach supported care staff to introduce VR into aged care facilities. Fieldwork diaries and focus group discussions were used to document experiences of introducing VR, including the obstacles, challenges and benefits and the adaptations to aged care environments that were required to accommodate new VR activities. Thematic analysis of the data revealed that VR can be an important medium to support the wellbeing of older residents. However, our findings also indicate that there are significant challenges associated with introducing VR, including substantial costs in time, money and institutional resources and attention. This study concludes that, to be successful, VR requires substantive care and relational resources from both staff and residents that are only visible when paying attention to the contextual adjustments required to introduce the technology to a new setting. This suggests that other research on gerontechnologies would likely also benefit from further attention to the role of the broader social context – including care and relational resources – in ensuring their successful design and implementation.

Practical Implementation of Gerontechnology Smart Products: Product Suitability Assessment

Because of the critical importance to national healthcare of developing and applying smart technologies to address the needs of Taiwan's rapidly aging society, "gerontechnology" is an industry sector that must be promoted to achieve related policy goals. The scope of technologies involved in gerontechnology is broad, with the application of smart technology often the focus of industrial development. The most crucial feature of gerontechnology-related "smart" products is the collection, analysis, and feedback of target data in the application process necessary to facilitate the provision of "precision" aged care. The application of smart technology to meet the rapidly increasing life and care needs of older adults in aging societies is increasingly valued worldwide. However, the practical implementation of smart technology in aged care is still not widespread, and thus represents an urgent problem to be solved. There are many aspects to consider in the practical application of gerontechnology, among which caregivers are the key to practical application, with product suitability being the first concern of caregivers. In this article, a process is proposed to allow caregivers to assess the suitability of gerontechnology smart products in terms of "data sensing and transmission," "indicator identification and analysis," "event prediction and feedback," and "intervention measures." Based on the World Health Organization's concept of implementing research in healthcare, decision-making evaluation indicators for product selection and a product suitability questionnaire for institutional care are proposed with the goal of providing a practical tool for care institutions to assess the suitability of gerontechnology smart products.

My parents are ageing, what the heck do I do?—Understanding Australia's aged care system to support older loved ones at home By C.Wilkinson, See Me Aged Care Consulting Pty Ltd. 2022. $26.91. Kindle edition $13.99. ISBN‐13: 9781922764263

My parents are ageing, what the heck do I do?—Understanding Australia's aged care system to support older loved ones at home By C.Wilkinson, See Me Aged Care Consulting Pty Ltd. 2022. $26.91. Kindle edition $13.99. ISBN‐13: 9781922764263

Chemotherapy in the last 30 days of life, correlation with age and palliative care referral: A 1-year retrospective gastrointestinal program experience at SQCCCRC.

e24038 Background: Chemotherapy in the last days of life can carry unnecessary toxicities to the patient with no significant impact on survival and disease outcome. This is becoming of greater interest with the involvement of palliative care in patient’s management along with the advent of new therapeutic options with progressively increased cost of treatment. Methods: In our retrospective study, we aimed to analyze retrospectively the data of GI tumors treated at SQCCCRC over one year, by looking at the possible factors influencing the time from last treatment to death. We conducted chart review of all death that occurred between January 2023 and December 2023 in the GI cancer program at SQCCCRC. Information on demographics, type of GI cancer, type, intent and route of chemotherapy, line of chemotherapy and referral to palliative care were collected. Results: A total of 65 patients died within the GI cancer program between January 1st, 2023, to dec 31st, 2023. Most (72.7%) of the patients died of disease progression. Intent for chemotherapy was palliative in 90.9% of cases. Chemotherapy was parenteral (Intravenous) for the majority (60%, 38/63) of the patients. From all the recovered deaths, a total of 52 patients (82%) were referred to palliative team before death whereas palliative team was involved in the journey of all patients. 12 deaths out of 65 occurred in ICU. Only 11 out of 65 patients died within last 30 days of treatment: 81.8% of them were under palliative care at the time of death. For this group, the median age at diagnosis was 50 yo. Median age at death was 61 yo. 72.7% were male. Primary site of disease was colon followed by stomach. Median time from diagnosis to palliative referral was 13.5 months. 8 patients died within 3.5 days of referral to palliative care. In the logistic regression models, only age at diagnosis was a significant predictor for receiving chemotherapy in the last 30 days of life (p = 0.019). Older age was associated with lower odds of receiving chemotherapy in this period (OR = 0.94, 95% CI = 0.89-0.99). Referral to palliative chemotherapy was not associated with decreased rate of treatment administration within last 30 days of life. Conclusions: While some real-world data suggested correlation between shifting to palliative care and administration of chemotherapy in the last 30 days of life, this was not the case in our collected sample, and only the age of the patient played a role in the chemotherapy timing before death. Further studies are needed to study the reasons behind and the best way to improve patient’s centered approach.

Reducing Leak and Increasing Comfort of an N95 Filtering Facepiece Respirator for Aged-Care Workers Using a Customized, Soft, and Compliant Mask Frame

Abstract This prospective cohort study examines the quantitative fit-factor and tolerability impact of a novel custom frame designed to fit beneath N95 filtering facepiece respirators (FFRs) in a healthcare setting. Conducted at a medium-sized metropolitan residential aged care facility (RACF) in South Australia, sixty participants underwent quantitative fit testing while wearing institutional-provided N95 FFRs. Utilizing three-dimensional (3D) face scanning with a proprietary iPhone app, personalized frames were created using flexible silicone foam with a rigid plastic interior “backbone” to ensure compliance and comfort. Following the fitting of custom frames, participants underwent repeat quantitative fit testing using the same style and size of N95 FFRs. Results indicate a remarkable improvement, with 81.5% of participants achieving a pass on quantitative fit testing when using their custom frame in conjunction with the N95 FFRs, compared to a baseline pass rate of only 21.7% (odds ratio (OR) 20.9, 95% confidence interval (CI): 8.26, 58.50, p < 0.001 via logistic regression). Additionally, participants reported a 2.4 times higher level of tolerability when wearing the custom frame with their N95 FFRs compared to using FFRs alone (p < 0.001). In conclusion, the study demonstrates that wearing a customized frame device under an N95 FFR significantly enhances the likelihood of achieving a pass on quantitative fitting and offers a substantially more tolerable experience for wearers. These findings highlight the potential of personalized frame devices to improve respiratory protection efficacy and wearer comfort in healthcare settings.

Nurses' attitudes, beliefs and knowledge of sleep health in residential aged care: An integrative literature review.

To identify, synthesize and evaluate primary research on registered nurses' (RN) knowledge, attitudes and beliefs about sleep health and sleep health management of older adults living in residential aged care. Integrative review. Medline, Embase and CINAHL databases from inception to September 2023. Databases were searched using a combination of key words, subject heading terms. All abstracts and full-text articles were screened by two researchers. Qualitative synthesis of the included articles was conducted. Inductive content analysis was used to identify themes and analyse data. A total of 923 abstracts were screened resulting in a final yield of 13 articles. Three themes were identified: (i) RN experience with sleep-disturbed residents, (ii) the emotional burden of sleep disturbances on RN and, (iii) organizational barriers to promoting resident's healthy sleep. Inappropriate administration of benzodiazepines and psychotropic drugs to manage residents' sleep disturbances was a major issue and lack of resources in residential aged care to facilitate sleep. There were concerns on nursing activity that disturbed residents' sleep and striking a balance between facilitating sleep and meeting managerial expectations was challenging. This review identified that nurses' decision-making has an integral role in the management of sleep health in residents in aged care. Whilst evidence-based guidelines for managing sleep in residential aged care are available, there is a lack of translation to practice. Understanding RN perspectives is critical to improving sleep health models of care in residential aged care. This review found that RN are attuned to the implications of sleep disturbance in residential aged care but are constrained by current sleep health models of care. Not applicable.

Liver and Kidney Transplantation in Elderly Patients

Due to an aging population, advances in multiple medical fields, and shifts among indications for surgery, liver and kidney transplantation is increasingly pursued for elderly patients (aged 65 or greater). Elderly patients represent a uniquely vulnerable group, but overall, they appear to have similar outcomes compared to younger patients. As demographics continue to trend to an older median age, physicians and health care systems must be prepared to take care of elderly transplant candidates.

Effective fall prevention exercise in residential aged care: an intervention component analysis from an updated systematic review

ObjectiveThe effect of fall prevention exercise programmes in residential aged care (RAC) is uncertain. This paper reports on an intervention component analysis (ICA) of randomised controlled trials (RCTs), from an...

Reliability of the quality of life-aged care consumers (QOL-ACC) and EQ-5D-5L among older people using aged care services at home

PurposeThe Quality of Life-Aged Care Consumers (QOL-ACC), a valid preference-based instrument, has been rolled out in Australia as part of the National Quality Indicator (QI) program since April 2023 to monitor and benchmark the quality of life of aged care recipients. As the QOL-ACC is being used to collect quality of life data longitudinally as one of the key aged care QI indicators, it is imperative to establish the reliability of the QOL-ACC in aged care settings. Therefore, we aimed to assess the reliability of the QOL-ACC and compare its performance with the EQ-5D-5L.MethodsHome care recipients completed a survey including the QOL-ACC, EQ-5D-5L and two global items for health and quality of life at baseline (T1) and 2 weeks later (T2). Using T1 and T2 data, the Gwet’s AC2 and intra-class correlation coefficient (ICC) were estimated for the dimension levels and overall scores agreements respectively. The standard error of measurement (SEM) and the smallest detectable change (SDC) were also calculated. Sensitivity analyses were conducted for respondents who did not change their response to global item of quality of life and health between T1 and T2.ResultsOf the 83 respondents who completed T1 and T2 surveys, 78 respondents (mean ± SD age, 73.6 ± 5.3 years; 56.4% females) reported either no or one level change in their health and/or quality of life between T1 and T2. Gwet’s AC2 ranged from 0.46 to 0.63 for the QOL-ACC dimensions which were comparable to the EQ-5D-5L dimensions (Gwet’s AC2 ranged from 0.52 to 0.77). The ICC for the QOL-ACC (0.85; 95% CI, 0.77–0.90) was comparable to the EQ-5D-5L (0.83; 95% CI, 0.74–0.88). The SEM for the QOL-ACC (0.08) was slightly smaller than for the EQ-5D-5L (0.11). The SDC for the QOL-ACC and the EQ-5D-5L for individual subjects were 0.22 and 0.30 respectively. Sensitivity analyses stratified by quality of life and health status confirmed the base case results.ConclusionsThe QOL-ACC demonstrated a good test-retest reliability similar to the EQ-5D-5L, supporting its repeated use in aged care settings. Further studies will provide evidence of responsiveness of the QOL-ACC to aged care-specific interventions in aged care settings.

Clustering care pathways of people with alcohol dependence using a data linkage of routine data in Bremen, Germany

BackgroundAlthough many individuals with alcohol dependence (AD) are recognized in the German healthcare system, only a few utilize addiction-specific treatment services. Those who enter treatment are not well characterized regarding their prospective pathways through the highly fragmented German healthcare system. This paper aims to (1) identify typical care pathways of patients with AD and their adherence to treatment guidelines and (2) explore the characteristics of these patients using routine data from different healthcare sectors.MethodsWe linked routinely collected register data of individuals with a documented alcohol-related diagnosis in the federal state of Bremen, Germany, in 2016/2017 and their addiction-specific health care: two statutory health insurance funds (outpatient pharmacotherapy for relapse prevention and inpatient episodes due to AD with and without qualified withdrawal treatment (QWT)), the German Pension Insurance (rehabilitation treatment) and a group of communal hospitals (outpatient addiction care). Individual care pathways of five different daily states of utilized addiction-specific treatment following an index inpatient admission due to AD were analyzed using state sequence analysis and cluster analysis. The follow-up time was 307 days (10 months). Individuals of the clustered pathways were compared concerning current treatment recommendations (1: QWT followed by postacute treatment; 2: time between QWT and rehabilitation). Patients’ characteristics not considered during the cluster analysis (sex, age, nationality, comorbidity, and outpatient addiction care) were then compared using a multinomial logistic regression.ResultsThe analysis of 518 individual sequences resulted in the identification of four pathway clusters differing in their utilization of acute and postacute treatment. Most did not utilize subsequent addiction-specific treatment after their index inpatient episode (n = 276) or had several inpatient episodes or QWT without postacute treatment (n = 205). Two small clusters contained pathways either starting rehabilitation (n = 26) or pharmacotherapy after the index episode (n = 11). Overall, only 9.3% utilized postacute treatment as recommended.ConclusionsA concern besides the generally low utilization of addiction-specific treatment is the implementation of postacute treatments for individuals after QWT.

Exploring the lived experiences and care challenges of formal paid caregivers for people with intellectual disability and dementia.

A greater number of people with intellectual disability are living into older age and are at increased risk of developing conditions such as dementia. Caring for a person with dementia presents several challenges for formal caregivers due to the progressive nature of the disease. An interpretive phenomenological analysis was used to understand the lived experiences of a purposive sample of formal caregivers in caring for people with intellectual disability and dementia. Discussions from 14 individual interviews generated data were analysed. Four key super-ordinate themes emerged which were: (1) recognising early indicators and diagnosis, (2) post diagnostic support, (3) coping with change and (4) need for future development. Themes reflected the experiences, barriers to dementia diagnosis and provide a valuable insight into the challenges faced by formal caregivers in providing aged care services.

Dietitians' perceptions of employment models used in Australian residential aged care facilities.

The qualitative study aimed to explore dietitians' perceptions of employment status and engagement models with residential aged care facilities (RACF) and the impact on work activities and resident care. Dietitians currently working in RACF were recruited through convenience and snowball sampling, including contacting a list of dietitians who had previously consented to be contacted for research. A semi-structured interview guide was developed by the research team, pilot-tested and then used in each individual interview. Data were analysed using constant comparison and reflexive thematic analysis. Thirty-one dietitians (n = 29 female; median age, 39 years) with a range of experience working in different employment status and engagement models in RACF participated in an interview. Five themes were identified: (1) Being an employee allows for better integration and utilisation in the RACF, (2) Contract work creates a scarcity of time, (3) Ad hoc work does not meaningfully address nutrition challenges and may not be good for resident care, (4) Regularly scheduled visits support positive outcomes for residents and (5) Acknowledging many different employment models. Characteristics of engagement models likely affect dietitian work job satisfaction, individual resident care and food service in RACF. Regular dietetic engagement in RACFs is required to support resident-centred evidence-based dietetic practice and to improve residents' nutrition care. There is an opportunity for policy mandates to assist RACFs in regularly engaging a dietitian to ensure all residents have access to timely, high-quality nutrition care.

Understanding the important characteristics of neighbourhoods to facilitate ageing in place and longevity.

This study investigates which local area characteristics, included in the Healthy Ageing/Vulnerable ENvironment (HAVEN) Index, are the strongest factors predicting transition into permanent residential aged care (PRAC) and mortality, and the geographic distribution of these factors. A retrospective cohort study of older individuals living in the community in Adelaide who received their first eligibility assessment for age care services between 2013 and 2015 (n = 16,939) was conducted. The study cohort, from the Registry of Senior Australians (ROSA), was linked by postcode to HAVEN Index items, selected following item response theory (IRT) analysis to determine the strongest local area factors associated with PRAC and mortality. Geospatial mapping of the factors determined the geographic distribution of these significant factors. Fourteen HAVEN Index items were associated with entry into PRAC and mortality. Three area-level items, lower educational attainment, financial housing stress and low levels of volunteering by older people, were risk factors for entry into PRAC and mortality while the remainder of the items identified were different for each outcome. The mapped local area risk factors for each outcome highlighted similar geographical areas of vulnerability. Local area characteristics are associated with entering PRAC and mortality. Our findings can inform area-level responses to make neighbourhoods more age-friendly, potentially allowing more people to age longer in place. Similar analyses, conducted for other areas, could provide evidence to support the widespread development of age-friendly neighbourhoods reducing area-level inequalities in ageing.

‘The Sanctuary’ – developing a human-animal model to promote health in a supported residential aged care setting

Abstract Human-animal relationships are vital for many older persons. Finding ways to include animals in aged care settings can be part of reorienting aged care settings from a solely humancentric focus to a human-animal inclusive one for the 21st century. This case study project report describes the development of an animal inclusive model of care for a Residential Aged Care Facility (RACF) in a regional town in Australia. The model’s primary objective was to facilitate residents’ empowerment through safe engagements with animals as a source of health and wellbeing while incorporating best practise animal-care and husbandry. Exemplars used to inform the model included The Eden AlternativeTM and Care Farms. The Sanctuary model sought to cover several gaps identified in these approaches. These included clear policies and protocols regarding animal welfare, infrastructure needs (animal housing and designated human-animal interaction areas), staffing models, stakeholder engagement approaches (both within the RACF and the local community) and developing sustainable resourcing and financial frameworks. A vision to establish a refuge for both humans and animals was inherent in the design of the Sanctuary model, and to operationalize this vision, policies, resourcing plans and practical processes were formulated informed by multi-species ethical understandings. Regrettably, it was not possible to fully implement the model. However, this case study is presented with the aim of seeking to redress the noted 85% wastage of global health research; a wastage that includes human-animal research knowledge. Insights into opportunities and barriers and experiential knowledge are shared with the aim of facilitating future endeavours to implement parallel visions that embed human and animal inclusive models in residential aged care in the future.

Personal care workers' intention to stay in residential aged care: An integrative review.

To identify key factors that influence personal care workers' (PCW) intention to stay in residential aged care (RAC). PCWs are the 'backbone' of providing direct care in RAC settings. The well-being of older people hinges upon their dedication and commitment; thus, enhancing their intention to stay is a priority to reduce turnover and ensure continuity of care. Six databases were searched for articles focusing on factors influencing PCWs' intention to stay in RAC. Studies were independently assessed for quality using the Joanna Briggs Institute Methodology for systematic review tools. Reporting of the results followed the PRISMA guidelines. Eight articles published between 2010 and 2022 were included. The key issues were categorized as: (a) sociodemographic characteristics; (b) psychological factors; (c) workplace factors and (d) job satisfaction. Older age, being married and immigration status were positively associated with intention to stay. Work stress and burnout contributed towards demotivation, while a supportive and engaging organizational culture that recognized workers' contributions and provided appropriate remuneration and benefits, enhanced job satisfaction and retention. This review affirms the complexity of the decision-making process influencing workers' intention to stay. A comprehensive understanding of the interplay of these factors and the personal and sociocultural challenges faced by PCWs is essential to design strategies to provide support and enhance job satisfaction and retention. This review showed that support from the organization is critical in improving PCWs' intention to stay in aged care. Given the interconnectedness of a range of key factors, decision-makers need to address modifiable factors holistically. Including PCWs in planning retention strategies could be the missing link in tailoring interventions towards workforce retention. Personal, psychological and workplace factors alone and in combination influence personal care workers' intention to stay in residential aged care (RAC). The interrelationships among the factors impacting PCWs' intention to stay are complex, wherein a change in one often influences other factors. Addressing the causes of psychological stress, improving workplace culture and understanding their interrelationships provide a foundation for co-designing strategies to promote intention to stay among PCWs in RAC. The authors have adhered to relevant EQUATOR guidelines PRISMA. This integrative review is conducted with no involvement or contribution from patients or the public.

Adverse Drug Event–Related Hospital Admissions among Australian Aged Care Residents: A Cross-Sectional Study

ObjectivesTo investigate the proportion, characteristics, causality, severity, preventability, and independently associated factors for adverse drug event (ADE)–related admissions in aged care residents admitted to the major public hospitals in Tasmania, Australia. DesignRetrospective cross-sectional study. Setting and ParticipantsResidential aged care facility (RACF) patients aged ≥65 years who had an unplanned admission to one of the 4 Tasmanian public hospitals between July 1, 2018, and June 30, 2021. MethodsWe accessed the medical records of RACF patients. The ADEs were initially identified via chart review and a trigger tool. Hospitalizations attributable to ADEs were then determined by expert consensus. The causality, preventability, and severity of each ADE admission were assessed using standard criteria. ResultsNinety-one residents (18.2%) of 500 randomly selected experienced potential ADE-related hospitalizations. ADEs were considered possible (n = 58, 64%) or definite/probable (n = 33, 36%). The most common ADEs were falls (n = 19, 21%), hypotension (n = 16, 18%), and confusion or delirium (n = 10, 11%). ADEs were frequently associated with renin-angiotensin system inhibitors (n = 43, 47.3%), opioids (n = 43, 47.3%), and diuretics (n = 40, 44%). Most ADEs were of moderate severity (n = 90, 99%) and considered not preventable (n = 60, 66%). Rheumatologic disease [odds ratio (OR) 1.89, 95% CI 1.09-3.30; P = .024] and previous adverse drug reaction (ADR) (OR 12.91, 95% CI 6.84-24.37; P < .001) were associated with ADE hospitalizations. Conclusions and ImplicationsThis study highlights that hospitalization for moderately severe ADEs is common among RACF residents. Opioids and antihypertensives were the common drug classes associated with harm. Rheumatologic disease (due to opioids) and previous ADR were identified as independently associated factors, which may warrant tailored interventions.

EXPERIENCING AGING IN PALLIATIVE CARE: A systematic literature review on the elderly patient's experience

The increase in life expectancy drives the demand for extended care, triggering the phenomenon of aging amid care. Recognizing the relevance of palliative care as an approach that seeks comprehensive provision to foster quality of life in the face of chronic, incurable illnesses, this research aims to investigate the experience of aging in palliative care from the patient's perspective. It is a systematic review encompassing studies targeting elderly individuals in palliative care. The databases used included PubMed, SciELO, Lilacs, and Medline, with descriptors specified by Desh related to aging and palliative care. The final sample consisted of nine articles. The results converged around three recurring themes: the challenges faced by the elderly concerning chronic health demands, the coping strategies they adopt, and their involvement in the palliative care process and decisions related to their health condition. Although providing valuable insights into the experience of aging in palliative care, this study is limited by the scarcity of available research exploring the phenomenon from the patients' perspective. It is crucial to drive more investigations in this field, providing opportunities for patients to express their needs and experiences, aiming to enhance the quality of services and contributing to an ongoing improvement in quality of life and satisfaction with received care.

Australian Residential Aged Care Facilities Managers’ and Nurses’ Experiences In Implementing Telehealth and Social Connection During COVID-19

Introduction: Residential aged care facility (RACF) residents are highly vulnerable to severe infection and death from COVID-19. During the pandemic, telehealth (telephone and video) provided a mechanism to deliver for health care and social support. We examined logistical factors associated with telehealth, reasons for its use and barriers associated with the choice of telehealth. Methods: A mixed method exploratory study. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using a hybrid framework approach; deductive analysis followed by inductive analysis for sub-themes. Results: Participants (n=19) reported an increase in telehealth use during COVID-19. Organisations bought new equipment, predominately tablets; half had internet connectivity difficulties; nurses used personal devices to overcome connectivity issues or inadequate devices and 74% used three or more platforms/software. Few residents had personal digital devices or could connect with family and friends alone. Five key sub-themes emerged from qualitative data. 1. Needing and persisting with telehealth. RACFs had limited video telehealth use before COVID-19. 2. Being dependent on health providers offering telehealth services. Telehealth was used for a broad range of services. However, many health providers did not offer telehealth consultations. 3 Residents living with dementia. Telehealth was suitable for residents with dementia, depending on the disease stage and clinical need. 4. Challenges with implementing telehealth consultations. Most challenges pertained to workflows. 5. Suitability of videoconferencing for social connection. Staff supported residents with video calls which were highly valued. Conclusion: To capitalise on and sustain telehealth activity in RACFs, further guidance and support to overcome operational barriers are required.