Aged Care Research Articles

Enhancing Care for Older Adults and Dementia Patients With Large Language Models: Proceedings of the National Institute on Aging-Artificial Intelligence & Technology Collaboratory for Aging Research Symposium.

Large Language Models (LLMs) stand on the brink of reshaping the field of aging and dementia care, challenging the one-size-fits-all paradigm with their capacity for precision medicine and individualized treatment strategies. The "Large Pre-Trained Models with a Focus on AD/ADRD and Healthy Aging" symposium, organized by the National Institute on Aging and the Johns Hopkins Artificial Intelligence & Technology Collaboratory for Aging Research, served as a platform for exploring this potential. The symposium brought together diverse experts to discuss the integration of LLMs in aging and dementia care. They highlighted the roles LLMs can play in clinical decision support and predictive analytics, while also addressing critical ethical concerns including bias, privacy, and the responsible use of artificial intelligence (AI). The discussions focused on the need to balance technological advancement with ethical considerations in AI deployment. In conclusion, the symposium projected a future where LLMs not only revolutionize healthcare practices but also pose significant challenges that require careful navigation.

Building a culture of safety in Australian residential aged care facilities: protocol for a longitudinal mixed methods research programme

IntroductionThe quality and safety of care within residential aged care facilities (RACFs) have been linked to their organisational culture. However, evidence for understanding and improving culture in this setting is...

Health system regulation—a system ‘as-a-whole’ perspective: what can be learnt from the Australian aged care experiences

Health system regulation—a system ‘as-a-whole’ perspective: what can be learnt from the Australian aged care experiences

A model-based assessment of social isolation practices for COVID-19 outbreak response in residential care facilities

BackgroundResidential aged-care facilities (RACFs, also called long-term care facilities, aged care homes, or nursing homes) have elevated risks of respiratory infection outbreaks and associated disease burden. During the COVID-19 pandemic, social isolation policies were commonly used in these facilities to prevent and mitigate outbreaks. We refer specifically to general isolation policies that were intended to reduce contact between residents, without regard to confirmed infection status. Such policies are controversial because of their association with adverse mental and physical health indicators and there is a lack of modelling that assesses their effectiveness.MethodsIn consultation with the Australian Government Department of Health and Aged Care, we developed an agent-based model of COVID-19 transmission in a structured population, intended to represent the salient characteristics of a residential care environment. Using our model, we generated stochastic ensembles of simulated outbreaks and compared summary statistics of outbreaks simulated under different mitigation conditions. Our study focuses on the marginal impact of general isolation (reducing social contact between residents), regardless of confirmed infection. For a realistic assessment, our model included other generic interventions consistent with the Australian Government’s recommendations released during the COVID-19 pandemic: isolation of confirmed resident cases, furlough (mandatory paid leave) of staff members with confirmed infection, and deployment of personal protective equipment (PPE) after outbreak declaration.ResultsIn the absence of any asymptomatic screening, general isolation of residents to their rooms reduced median cumulative cases by approximately 27%. However, when conducted concurrently with asymptomatic screening and isolation of confirmed cases, general isolation reduced the median number of cumulative infections by only 12% in our simulations.ConclusionsUnder realistic sets of assumptions, our simulations showed that general isolation of residents did not provide substantial benefits beyond those achieved through screening, isolation of confirmed cases, and deployment of PPE. Our results also highlight the importance of effective case isolation, and indicate that asymptomatic screening of residents and staff may be warranted, especially if importation risk from the outside community is high. Our conclusions are sensitive to assumptions about the proportion of total contacts in a facility accounted for by casual interactions between residents.

Evaluation of Factors Affecting the Health-Related Quality of Life in End-Stage Renal Disease Patients Receiving Hemodialysis Treatment in Northern Cyprus.

Introduction Health-related quality of life (HR-QoL) is recognized as an important predictor of mortality and morbidity in end-stage renal disease (ESRD) patients receiving hemodialysis (HD). The goal of this study was to obtain HR-QoL scores using the Kidney Disease and Quality of Life questionnaire (KDQOL-36TM) (RAND Corporation, Santa Monica, CA) and to assess the factors affecting HR-QoL in ESRD patients receiving HD. Methods A multicenter cross-sectional study was performed using the KDQOL-36TM for the assessment of HR-QoL of ESRD patients receiving HD in Northern Cypriotstate hospitals. Alongside KDQOL-36TM scores for assessing HR-QoL, sociodemographic as well as relevant laboratory data were collected. Spearman Correlations and multiple linear regression analyses using the 'stepwise' method were carried out to identify predictors of HR-QoL. Nonparametric tests were used to determine significantly (p<0.05) associated variables. Ethical approvals were received from the Northern Cypriot Ministry of Health and Eastern Mediterranean University Research and Publication Ethics Boards. Results One hundred and thirty-eight participants were recruited in this study, corresponding to 85.1% of the total study population. Participants had a mean age of 66.49 ± 13.35. 65.2% of the participants were males. Participants had low scores on most dimensions of quality of life, namely, Burden of Disease, Physical Component Summary (PCS), and Mental Component Summary (MCS) subscales. Particularly, females, unemployed patients, and patients with more comorbidities had significantly lower scores (p=0.003, p<0.001, and p=0.005, respectively). Spearman correlation analyses revealed multiple significant moderate correlations between sociodemographic data, laboratory variables, and scores. Furthermore, multiple linear regression analysis identified gender (p=0.006), total number of comorbidities (p=0.005), age (p<0.001), and patient care (p=0.019) as significant predictors of KDQOL-36TM scores. Conclusion This study has shown that the quality of life of hemodialysis patients was highly impaired. Gender, current employment status, and presence of comorbidities were all significant independent factors affecting HR-QoL mean scores. Lastly, further studies regarding the implementation of routine HR-QoL surveillance and targeted interventions are required to better understand their potential therapeutic benefits.

Difficulty with mobility among the aged in Ghana: Evidence from Wave 2 of the World Health Organization's Study on Global Ageing and Adult Health.

Globally, the population is rapidly ageing, stemming from a recent decline in mortality, and an increase in life expectancy. About 727 million people globally were aged ≥65 in 2020, and 1 in 6 people will be ≥65 years by 2050. About 7% of Ghana's population was over 60 years in 2010, and projected to be 12% by 2050. However, the aged are confronted with degenerative conditions that translate into difficulty with mobility. The study was conducted to investigate the difficulty with mobility among the aged in Ghana. The study utilised a cross-sectional dataset of the 2014/2015 (wave 2) Study on Global Ageing and Adult Health and included 1,856 participants aged ≥50 years. The survey command was applied to adjust for sampling biases and the design of the study. At 5% alpha level, a chi-square test of independence was conducted to determine the association between dependent and independent variables. At 95% confidence interval and 5% alpha level, three-level multilevel logistic regression models were performed. The fixed-effects were presented in odds ratio and the random effects were presented using the Intra-Class Correlation. All analysis were performed using STATA statistical software version 16.0. Out of the 1,856 participants, 40.3% had difficulty with mobility. Additionally, age (80 and above) [AOR = 3.05, 95%CI = 1.78-5.22], self-reported poor/bad health status [AOR = 2.39, 95%CI = 1.35-4.23], having severe/extreme difficulty performing household activities [AOR = 25.12, 95%CI = 11.49-44.91], experienced severe/extreme bodily pains [AOR = 4.56, 95%CI = 2.16-9.64], severe/extreme sleep problems [AOR = 4.15, 95%CI = 1.68-10.29], and participants with difficulty with sight/vision [AOR = 1.56, 95%CI = 1.16-2.10] had higher odds of difficulty with mobility. The aged in Ghana had relatively higher prevalence (40.3%) of difficulty with mobility which is influenced by demographics, health status, and degeneration associated with ageing. This highlights the need to provide social support and strengthen social capital for the aged in Ghana, especially those with difficulty with vision, experiencing bodily pains and had poor health status. Additionally, the Government and stakeholders should provide assistive devices for the aged and geriatric care including recreational fields and care homes to address the health and physical needs of the aged in Ghana.

Analysis of longitudinal patterns and predictors of medicine use in residential aged care using group-based trajectory modelling: The MEDTRAC-Polypharmacy longitudinal cohort study.

Polypharmacy serves as a quality indicator in residential aged care facilities (RACFs) due to concerns about inappropriate medication use. However, aggregated polypharmacy rates at a single time offer limited value. Longitudinal analysis of polypharmacy patterns provides valuable insights into identifying potential overuse of medicines. We aimed to determine long-term trajectories of polypharmacy (≥9 medicines) and factors associated with each polypharmacy trajectory group. This was a longitudinal cohort study using electronic data from 30 RACFs in New South Wales, Australia. We conducted group-based trajectory modelling to identify and characterize polypharmacy trajectories over 3 years. We evaluated the model fitness using the Bayesian Information Criterion, entropy (with a value of ≥0.8 considered ideal) and several other metrics. The study included 2837 permanent residents (median age = 86 years, 61.7% female and 47.4% had dementia). We identified five polypharmacy trajectory groups: group 1 (no polypharmacy, 46.0%); group 2 (increasing polypharmacy, 9.4%); group 3 (decreasing polypharmacy, 9.2%); group 4 (increasing-then decreasing polypharmacy, 10.0%), and group 5 (persistent polypharmacy, 25.4%). The model showed excellent performance (e.g., entropy = 0.9). Multinomial logistic regressions revealed the profile of each trajectory group (e.g., group 5 residents had higher odds of chronic respiratory disease compared with group 1). Our study identified five polypharmacy trajectory groups, including one with over a quarter of residents following a persistently high trajectory, signalling concerning medication overuse. Quality indicator programs should adopt tailored metrics to monitor diverse polypharmacy trajectory groups, moving beyond the current one-size-fits-all approach and better capturing the evolving dynamics of residents' medication regimens.

Avoidable Hospitalizations in Frail Older Adults: The Role of Sociodemographic, Clinical, and Care-Related Factors

ObjectivesThis study aims to investigate the relationship between frailty and avoidable hospitalization risk, and the moderating role of sociodemographic, clinical, and care-related factors. DesignLongitudinal population-based cohort study. Setting and ParticipantsA total of 3168 community-dwelling individuals, aged ≥60 years, from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). MethodsWe operationalized physical frailty using baseline SNAC-K data (2001-2004). In line with the Swedish Board of Health and Welfare and Association of Local Authorities and Regions, avoidable hospitalizations were considered those that could have been prevented through proper and timely outpatient care and identified through the Swedish National Patient Register. Participants were followed from baseline until first avoidable hospitalization, death, drop out, institutionalization, or maximum 12 (median 7.6) years. The association between frailty and avoidable hospitalization was explored through flexible parametric survival models, with stratified analyses to investigate age, gender, education, civil status, multimorbidity, cognitive status, and informal and formal care as potential modifiers. ResultsThe adjusted 12-year cumulative incidence of avoidable hospitalization was significantly higher for frail persons (cumulative incidence 33.2%, 95% CI 28.9%-38.1%) than for prefrail (cumulative incidence 26.6%, 95% CI 24.5%-29.0%) and nonfrail (cumulative incidence 25.2%, 95% CI 22.5%-28.3%) individuals. In addition, prefrailty [hazard ratio (HR) 1.21, 95% CI 1.00-1.45] and frailty (HR 1.91, 95% CI 1.47-2.50) were associated with increased avoidable hospitalization hazards. Furthermore, the association between frailty and avoidable hospitalization was stronger in older adults aged <78 years (HR 3.12, 95% CI 1.99-4.91) and those with relatively fewer chronic diseases (HR 3.88, 95% CI 1.95-7.72), whereas provision of formal social care (HR 1.15, 95% CI 0.77-1.72) seemed to act as a buffer. Conclusions and ImplicationsOur results indicate that older community-dwelling adults with prefrailty and frailty are at increased risk of experiencing avoidable hospitalizations, highlighting a need for better care of these individuals at the outpatient level. Formal social care services and close monitoring of particularly vulnerable subgroups of frail persons may mitigate this risk.

Reading Between the Lines: An Exploratory Pilot Study of a Co-creation Approach to Life Story Work in Aged Care in Australia.

Life story work (LSW) uses a narrative, reminiscence approach to capturing memories from one's life and has shown positive outcomes for participants. However, LSW in aged care has been criticized for being resource intensive, often involving care staff using pre-determined process and output formats. This pilot study explored participants' lived experiences of a novel co-creation approach to LSW conducted predominantly with university students and older adults in residential aged care and retirement communities, producing multi-modal outputs. Within a 12-month period, 33 LSW projects were completed (21 books, 5 posters, and 7 digital stories). Semi-structured interviews (n = 44) explored participants' lived experience of completing a LSW project. Findings indicate that working with students and adopting a flexible, co-creation approach that empowers participants to make decisions, engage in learning and reflection, and build meaningful relationships can maximize opportunities for transformative impacts, and enable providers to offer a LSW program despite finite resources.

Promoting digital inclusion for enhanced resident wellbeing: an examination of aged residential care facility websites.

Digital inclusion has a positive impact on health and wellbeing through fostering connectivity and access to information. In Aotearoa New Zealand, 4% of older adults live in aged residential care (ARC) facilities and are vulnerable to social isolation. This study explored whether ARC facilities provide opportunities to socially connect online and whether the COVID-19 pandemic affected the provision of these opportunities. Information on technology and internet provision from 558 ARC facilities was extracted from facilities' own or related websites in 2019 and 2021. ARC facilities were categorised according to whether they provided digital devices, internet access and internet-based leisure activities, or made no reference to technology. In 2019, 392 (70%) of 558 ARC facilities publicised availability of internet-based technologies for residents; however, only 46 (8%) mentioned providing access to computer devices. In 2021 (during the pandemic), there was a small increase to 421 (76%) and 54 (10%) of facilities respectively. Facilities mentioning internet-based leisure activities were 63 (11%) in 2019 and 55 (10%) in 2021. Those not referring to technology had reduced from 166 (30%) in 2019 to 137 (24%) in 2021. Few ARC facilities enabled residents to fully access the digital world, even after periods of isolation due to COVID-19. Aged care providers could be more proactive by providing internet access and digital learning opportunities.

COVID-19 infection prevention and control program for aged care providers: a quasi-experimental study of Telegram-based training

ABSTRACT Given the high turnover of care workers in residential aged care facilities, continuous training on infection prevention and control (IPC) remains essential even after the COVID-19 pandemic. This study examined the impact of a Telegram-based training on aged care providers’ IPC knowledge, attitudes, self-efficacy. A two-arm, pre-post quasi-experimental study with repeated measures at week 2 (T1) and week 4 (T2) was conducted for seventy-two (72) participants from 14 residential aged care facilities in Malaysia, with 60 completing the study (30 per arm). All instructional activities and data collection for both groups were delivered through Telegram. The intervention group received a 2-day synchronous workshop (3 h/day) alongside e-materials for a 10-unit IPC module. Primary outcomes were measured using a knowledge test, COVID-19 Elderly Caregiver Questionnaire (attitude component), and an adapted General Self-Efficacy Scale. Telegram’s acceptability was also assessed using an adapted Technology Acceptance Model questionnaire. Results showed that the intervention group had a faster knowledge transfer (91.3%–93.5%; T0-T2 = ∆22.9; p ≤ .002;), higher knowledge scores (∆7.2–16; p ≤ .002; large effect sizes 0.9–1.7), and a small-to-modest increments in self-efficacy (∆13.2; p = .002) and attitude (∆5.2; p = .045). Integrating synchronous sessions into an online program improved knowledge transfer, enhanced self-efficacy and promoted positive attitudes by enabling real-time interpersonal communication and instant feedback. Telegram proved effective for mobile learning in aged care settings with limited resources.

‘Mum Added You’ Managing Transnational Aged Care Arrangements Through Family WhatsApp Groups

ABSTRACTIncreasing global migration and (im)mobilities are affecting the provision of aged care in transnational families. Such families rely on digital communication technologies like WhatsApp to manage and maintain aged care obligations across borders. This study investigates the role of WhatsApp family groups in enabling transnational families to manage transnational aged care from a distance. I draw on interviews with three transnational family constellations with members in the United Kingdom and Zimbabwe. The study finds that WhatsApp family groups create a virtual home where Zimbabwean transnational families can plan, organise and deliver care to their ageing parents. However, managing transnational aged care through WhatsApp family groups can also pose problems, especially for migrants pressured to remit. Furthermore, gendered assumptions of care and asymmetrical power relationships entrenched in families are reinforced. The study contributes to the literature on transnational care and new technologies, providing a Zimbabwean perspective on co‐presence and mediated aged care practices.

The attributable mortality, length of stay, and health care costs of methicillin-resistant Staphylococcus aureus infections in Singapore

ObjectivesWe used a multi-state model, which mitigates time-dependent bias, to estimate the mortality, length of stay (LOS), and costs of methicillin-resistant Staphylococcus aureus (MRSA) infections in Singapore. MethodsWe conducted a retrospective study in a hospital in Singapore from 2018 to 2022. Patients with MRSA infections were matched 1:1:3 to patients with MRSA colonization and patients without MRSA by age, gender, specialty, and intensive care admission, respectively. A multi-state model was used to derive excess LOS and mortality hazard ratios. The attributable cost of infections was estimated in 2022 Singapore dollars (SGDs) from the health care perspective. ResultsWe matched 536 patients with MRSA infections to 536 patients with MRSA colonization, and to 1608 patients without MRSA. The excess LOS due to MRSA infection was 2.11 (95% confidence interval [CI] 2.05-2.17) days compared with MRSA colonization and 3.75 (95% CI 3.69-3.80) days compared with no MRSA, which translated to an excess cost of SGD $1825 and SGD $3238, respectively. Of the different MRSA infection types, pneumonia had the highest mortality risk (hazard ratio 4.13; 95% CI 2.28-7.50) compared with patients without MRSA. ConclusionsMRSA infections increased hospital LOS and health care costs in Singapore. Our estimates can inform future economic analyses of management strategies against MRSA.

Osteopathic health care in aged care facilities: The experience of practitioners in an emerging practice setting.

Residential aged care facilities (RACFs) are an emerging practice setting for osteopaths in Australia. This study explored the experiences of osteopaths working in Australian RACFs, reviewed current trends and challenges and considers future developments. Purposive and snowball sampling were used to recruit osteopaths with experience working in RACFs. This was a qualitative descriptive study derived from verbatim interview transcripts. Data were analysed using a six-step thematic analysis. Eight interviews were conducted during January 2023. Thematic analysis identified common experiences between participants. These included positive aspects of aged care, perceived challenges of working in aged care, exposure to age-specific conditions, benefits of working in multidisciplinary teams and perceived gaps in university education curricula in relation to geriatric populations. Employment in RACFs may offer a satisfying employment experience for osteopaths, albeit hindered by policy and funding inadequacy. The respondents suggested enhancing pre- and postgraduate education to better prepare and encourage the profession to engage in this health service.

Infrastructures of support: Australian young people’s perspectives on caring during the pandemic and future disability and care policy reform

ABSTRACT Today’s young people are critical stakeholders in the future of social care policy and services, but their voices and perspectives are often overlooked in public debate and deliberation on disability services, aged care, and support for family carers. This article reports on a pilot project involving focus groups with young people in the Australian Capital Territory, Australia. Participants included young people with caring roles for family members with disability and chronic illness and young people without lived experience of disability or care. The article explores how young people’s understandings of care were profoundly shaped by their experiences during the COVID-19 pandemic. Lockdowns, health concerns and media coverage heightened their awareness of the diverse ways in which people support each other in families and communities and the systemic issues afflicting the formal care sector. The article draws on the concept of care as critical social and economic infrastructure to frame participants’ proposals for future reform of policy and services. The findings indicate that young people both with and without current care roles want to see significantly more investment in the care and support sectors, and these groups view meaningful engagement with service users as key to improving access to needed supports.

Impact of COVID-19 public health restrictions on fall-related hip fracture hospitalizations: An interrupted time series analysis

PurposeThere is limited evidence regarding the impact of public health restrictions on hip fracture hospitalization by place of fracture occurrence. This study aimed to examine the impact of COVID-19 public health restrictions on fall-related hip fracture hospitalization rates by place of occurrence. MethodsThis retrospective cohort study was conducted using hospitalization data in New South Wales, Australia, between January 2014 and June 2022. Older adults aged ≥65 years admitted to hospital following a fall-related hip fracture. An interrupted time-series analysis using autoregressive integrated moving average models evaluated the impact of public health restrictions on fall-related hip fracture hospitalization by place of fracture occurrence (home/residence, residential aged care facility (RACF), or away from usual residence). ResultsThe mean observed fall-related hip fracture hospitalization rate during COVID-19 public health restrictions (36.3 per 100,000 people per month) was 13.4 % lower than the forecasted rate (41.1 per 100,000 people per month). The mean observed hospitalization rates for fall-related hip fractures at home/residence, at a RACF, and away from the usual residence were 3.8 %, 18.5 %, and 40.1 % lower than the forecasted rates, respectively. Level changes in the fall-related hip fracture hospitalization rates at RACFs and away from usual residences were −0.9 per 100,000 people per month (95 % CI −1.6 to −0.2) and −1.7 per 100,000 people per month (95 % CI −2.5 to −0.9), respectively. ConclusionsThere was a decline in fall-related hip fracture hospitalization rates among older adults, where the fracture occurred at RACFs and away from a person's usual residence during COVID-19 public health restrictions.

Persisting gaps in dementia carer wellbeing and education: A qualitative exploration of dementia carer experiences.

To explore the emotional wellbeing of dementia carers in the lead up to and during transition of a person living with dementia to a residential aged care facility. An interpretative qualitative study. Semi-structured interviews were conducted with informal carers of person living with dementia between February and June 2023. Data were analysed using an inductive thematic approach and resulted in three themes. The majority of carers were adult children (n = 19) and six were wives. Carers lived across metropolitan (n = 20) and regional settings (n = 5) in the most populous state of Australia. Three themes were identified which were attributed to different aspects of the carer role: (1) Carer emotional journey as dementia progresses - impacted by knowledge and lack of support; (2) Questioning decision making-underpinned by knowledge and confidence; and (3) Challenges in re-establishing identity - impacted by ongoing concerns. As dementia progresses carers of person living with dementia consistently reported gaps in knowledge including how to access support. Specifically, this study identified the need for more to be done to help carers to develop the skills needed for their role, including participation in care planning and identifying care preferences for the future. Nurses can play a key role in promoting referral to services that support carers. Findings offer practical solutions to ameliorate carer stress and promote shared decision making. This research was guided by the Consolidated Criteria for Reporting Qualitative Research.

Intestinal microbiology and urinary tract infection associated risk in long-term aged care residents

BackgroundUrinary tract infections (UTI) are the most frequently diagnosed infection in residents of long-term care and are a major risk factor for urosepsis, hospitalisation, and death. Translocation of gut pathobionts into the urinary tract is the presumed cause of most UTIs. While specific gut microbiota characteristics have been linked to UTI risk in younger adults, their relevance in aged care residents remains uncertain.MethodsThe faecal microbiome was assessed in 54 long-term aged care residents with a history of UTIs and 69 residents without a UTI history. Further comparisons were made to microbiome characteristics in 20 younger adults without UTIs. Microbiome characteristics were examined in relation to prior and subsequent UTIs, as well as antibiotic therapy.ResultsIn long-term aged care residents, prior UTI history and exposure to UTI-exclusive antibiotics do not significantly affect microbiome composition or functional capacity. However, exposure to antibiotics unrelated to UTI treatment is associated with distinct microbiota compositional traits. Adjustment for dementia, incontinence, diabetes, and prior antibiotic use finds no microbiota characteristic linked to UTI development. However, prior UTI is identified as a predictor of future UTIs. Comparison with younger adults identifies greater within-participant dispersion in aged care residents, as well as lower microbiota diversity and altered microbiome functional potential.ConclusionsNo association between the gut microbiome and UTI incidence, as has been reported in younger individuals, is evident in long-term aged care residents. Considerable variability in gut microbiome characteristics, relating to high antibiotic exposure and age-related physiological and immunological factors, could mask such a relationship. However, it cannot be discounted that increased UTI risk in the elderly is independent of microbiome-mediated mechanisms.

Associations of mental health with vaccination readiness in informal caregivers and the vaccination status of their care recipients during the Covid-19 pandemic – A cross sectional analysis

IntroductionVaccinations are important for informal caregivers and their care recipients. Mental health problems are common among care givers. The aim of this study was to investigate vaccination readiness in informal caregivers and associations with mental health issues. Associations between vaccination readiness in informal caregivers and the vaccination status of their aged care recipients were examined. MethodsWithin the multicenter prospective registry study ‘Bavarian ambulatory Covid-19 Monitor (BaCoM) ‘, informal caregivers were asked for symptoms of depression (PHQ-9), burden of caretaking (BSFC-s), psychological antecedents of vaccination readiness (5C model) and previous Covid-19 infections of their care recipients. The vaccination status against Covid-19, seasonal influenza and pneumococcal disease was determined via vaccination certificates. Data analysis was performed using ordinal regressions and Mann-Whitney-U tests. ResultsData of n = 91 informal caregivers, associated with n = 84 care recipients were collected. Symptoms of depression were associated with reduced vaccination readiness (Calculation: p = 0.026, OR = 1.18), as well as the perceived burden of caretaking (Confidence: p = 0.006, OR = 0.88). A previous Covid-19 infection of the care recipients was associated with decreased vaccination readiness of informal caregivers (Median (Q1–Q3) Confidence: 5.0 (4.5–6.0) vs. 4.0 (3.0–5.0); Calculation: 5.0 (3.0–6.0) vs. 4.0 (1.0–5.0)). The vaccination status of the care recipients interrelated significantly with vaccination readiness of their informal caregivers (Confidence: p < 0.001; Complacency: p < 0.01; Constraints p < 0.05). No significant interrelations between vaccination readiness and the vaccination status against seasonal influenza or pneumococcal disease occurred. ConclusionMental health issues of informal caregivers seem to be associated with the actual vaccination status against Covid-19 in their care recipients. Target group specific counselling as well as an active involvement of informal caregivers in shared decision-making processes can be of relevance, but even more attention should be paid to the protection of mental health for informal caregivers.Trial registration number: German Register of Clinical Studies DRKS 26039.

Person-centred quality indicators for Australian aged care assessment services: a mixed methods study

BackgroundAged Care Assessment Teams are the assessment component of the Australian aged care system. Their purpose is to undertake needs-based assessments to determine an older person’s eligibility for, and access to Commonwealth-funded aged care services. There are no measures that tell us if the aged care assessment service is of high quality from the perspective of the person being assessed. Quality measures have been developed and introduced in Australian residential aged care facilities. These however, have not considered the perspectives of those living in this setting. Quality measures for home care services have also been recommended.This research aims to address the gap in person-centred quality measures by asking current and future service users of aged care assessment services to vote on the importance of 24 person-centred quality indicators (PC-QIs), that were developed in a previous study using a modified Delphi method approach supported by engagement with a consumer led Advisory Board.MethodsThis mixed methods study used the RAND/UCLA Appropriateness Method to reach consensus on a final set of PC-QIs. Twenty-five community-dwelling older people in Brisbane, Australia, voted on the importance of 24 PC-QIs using a five-point Likert scale. A consensus statement for PC-QI elimination was determined prior to participants voting. Voting was undertaken with participants individually either face-to-face or via telephone, in their homes. To capture any narrative provided by participants regarding each PC-QI, participant voting sessions were audio-recorded and subsequently transcribed verbatim.Quantitative data from participant votes for each PC-QI were calculated and statistically described by median, interquartile range, consensus met, percentile, percentile rank, rank order, median and standard deviation. PC-QIs were then assessed against the consensus statement for elimination and rank ordered according to importance to participants. Content analysis of qualitative data from audio transcriptions was conducted to determine the presence of certain words supporting participant votes for each PC-QI.ResultsNo PC-QIs were eliminated during voting. Variation existed among participants’ ratings of importance for each PC-QI. Final quality domains, their respective title, quality indicator descriptor and supporting qualitative data are presented. Five PC-QIs had a median of five, no votes recorded below four, an interquartile range of zero, and a rank order score of one, two and four, out of a possible ten, indicating they were of highest importance to participants.ConclusionParticipants reached consensus on 24 evidence-based PC-QIs that represent measures of quality of aged care assessment services from the perspectives of current and future service users.