Australian Residential Aged Care Research Articles

Perceived barriers and facilitators to the provision of physiotherapy in residential aged care facilities: A national survey of Australian physiotherapists.

To identify and explore physiotherapists' perceived barriers and facilitators to the provision of physiotherapy in Australian residential aged care facilities (RACFs). A national cross-sectional survey was conducted with physiotherapists who worked in Australian RACFs for at least 50% of their working week. A variety of methods, such as social media, direct contact with aged care providers, and the Australian Physiotherapy Association, were used to advertise the survey. A rigorous design was used to develop the online survey to collect views on barriers and facilitators to provision of physiotherapy in Australian RACFs. Descriptive analysis was conducted using SPSS to analyse participant characteristics. Inductive framework analysis was conducted using NVivo 12 to identify key themes. One hundred and sixty-five qualified and registered physiotherapists (mean age 39.5 years, 74% female) who worked predominantly in Australian RACFs participated in this study. Five themes were identified: individual physiotherapist, collaborations, organisational, RACF community, and public policy. Each had associated barriers and facilitators to provision of physiotherapy as perceived by physiotherapists. Individual, collaborative, and RACF community factors were the main facilitators of physiotherapy in Australian RACFs. Organisational and public policy factors were identified as the main barriers of physiotherapy. This study highlighted what factors are perceived by RACF physiotherapists to facilitate provision of physiotherapy, and what areas of improvement should be considered to potentially provide more effective care in Australian RACFs. Due to the varied responses in this study, further research is warranted to determine the degree of impact of the identified factors.

Improving management of urinary tract infections in residential aged care facilities.

Antimicrobial resistance rates are higherin Australian residential aged care facilities (RACFs) than other community or hospital settings. This is driven by antibiotic overuse and misuse. Urinary tract infection (UTI) is consistently the most common infection treated with antibiotics in Australian RACFs. The aim of this article is to provide an overview of how general practitioners (GPs) can support appropriate UTI management in RACFs following antimicrobial stewardship (AMS) principles. GPs are well placed to improve UTI management in RACFs. In this article, criteria for suspected, proven, recurrent and relapsed UTI are outlined, in addition to key AMS practices for the assessment, prevention, treatment and review of UTIs. Included are recommendations for the judicious use of urine dipstick testing, a widespread and longstanding practice in RACFs, and first-line empirical antibiotic prescribing for suspected UTIs.

The type and scope of physiotherapy is under-utilised in Australian residential aged care facilities: a national, cross-sectional survey of physiotherapists

BackgroundWith an increasingly ageing population in Australia, more older adults who are frail are living in residential aged care facilities (RACFs). The aim of this study was to detail the type, scope, and funding of physiotherapy utilised in Australian RACFs.MethodsRegistered physiotherapists (n = 219, 72% female, mean age (SD) = 38.6 (12.9) years) working in Australian RACFs participated in a nationwide, cross-sectional online survey. The survey was developed iteratively through a review of the literature and clinical guidelines, consensus of final survey items by an expert panel of five senior physiotherapists and aged care managers. Survey questions related to the characteristics of the physiotherapists (e.g., age, gender, employment status), characteristics of the RACFs (e.g., state, remoteness, sector), the type and scope of physiotherapy provided by respondents, and the availability of equipment and certain spaces (e.g., gyms) in the RACFs that respondents worked in. Survey responses were analysed and presented descriptively. Correlation using Spearman’s rho (ρ) and the associated 95% confidence intervals (CI) were used to determine whether the availability of equipment or space at the RACF was associated with the time dedicated to performing non-Aged Care Funding Instrument (ACFI) tasks.ResultsCommon reasons for physiotherapy referral were chronic pain management as per the ACFI framework (89.7%), falls (69.2%), and reduced mobility (35.9%). Rehabilitation or short-term restorative care was provided in only 22.2% of the facilities. The ACFI funded 91.4% of all participants, which limited physiotherapists to low-value chronic pain management including massage and electrical stimulation. Respondents spent 64.5% of their time on ACFI tasks, which equated to 19 h per week. More time was spent on non-ACFI tasks particularly when resistance bands (ρ = 0.28, 95%CI 0.14–0.41) and a dedicated therapy space or gym (ρ = 0.19, 95%CI 0.04–0.33) were available.ConclusionsThe expertise of physiotherapists is currently being under-utilised in Australian RACFs, which may be related to the availability of public funding, equipment, and space for therapy. Therefore, public health policy should address the urgent need for high-value, evidence-based physiotherapy that supports the reablement and independence of older adults living in RACFs.

Cycling Without Age: An Australian residential aged care home experience.

ObjectiveCycling Without Age (CWA) involves taking residents on outdoor trishaw (electric bicycle) rides driven by trained ‘pilots’. This study explored the CWA experience from the perspective of residents and family members, staff and volunteer pilots from a residential aged care home in Queensland, Australia.MethodsA qualitative descriptive design was used. Interviews were conducted with 21 participants. Transcripts were analysed thematically, with the interview questions determining a priori categories followed by coding of central themes.ResultsSeveral themes emerged. For residents, seeing familiar places prompted reminiscences, and being outdoors elicited positive emotions. Family members reported CWA was a novel way to be with their loved one. Enabling residents to have time away from the care home with community contact was rewarding for pilots. Staff noted improvement in residents' mood post‐ride, however, rides needed to be scheduled to fit in with their workflow.ConclusionsCycling Without Age was perceived to offer a unique and meaningful experience, with benefits including sharing stories, being outside, and feeling part of the community.

Barriers and enablers to leisure provision in residential aged care: personal care attendant perspectives

AbstractThis exploratory descriptive study investigated barriers and enablers to the provision of leisure activities for people living in three Australian residential aged care facilities (RACFs) that operated under a household model of care. This research is unique in the international context, as few studies have explored the understandings and experiences of personal care attendants' (PCAs) perceptions of what impacts leisure provision for people living in RACFs. Qualitative data were collected from 17 PCAs via four focus groups. Barriers to leisure provision were identified as PCA–resident ratios, competing demands of the PCA role and a prioritisation of physical care tasks over leisure-related activities. The severity of residents' dementia (cognitive and functional deficits) as well as behavioural and psychological symptoms of dementia were also framed as barriers to participation in and the provision of leisure. Participants identified enablers of leisure provision as related to perceptions of leisure, the experiential knowledge of staff, organisational support and resourcing. The study findings suggest that enhancing leisure provision for people living with dementia will require attention to system issues (i.e. staffing levels, ratios, PCA role demands) as well as PCA knowledge and capability to facilitate person-centred leisure.

Venous thromboembolism risk screening, training and provider awareness in Australian residential aged care facilities.

Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in the geriatric post-surgical population, and its prevention is a public health priority. The aim of this study was to assess the use of VTE risk screening and training protocols, and VTE awareness in the Australian residential aged care sector. A cross-sectional survey was conducted that was directed at facility and policy managers of community aged care facilities with ≥10 residents in two Australian states and territories. Forty-nine of 301 (16.3%) providers responded, representing 249/871 (28.6%) aged care facilities and 20,958/66,121 (31.7%) residents. VTE risk screening protocols were used by 1.2% of facilities (3/249), and 79.5% (198/249) were unaware that VTE is an issue in this population. Only 0.8% (2/249) were aware that risk screening and prophylaxis is required to prevent VTE; none were acting upon this. No facility had specific VTE risk assessment or prevention processes in place. Most residential aged care facilities surveyed do not have VTE risk screening protocols and were unaware of the risk that may be associated with this omission. These results have implications for development and implementation of national and international VTE risk screening guidelines in community care.

Provision of a comprehensive medicines review is associated with lower mortality risk for residents of aged care facilities: a retrospective cohort study.

Backgroundno studies have examined the impact of residential medication management review (RMMR, a 24-year government subsidised comprehensive medicines review program) in Australian residential aged care facilities (RACFs) on hospitalisation or mortality.Objectiveto examine associations between RMMR provision in the 6–12 months after RACF entry and the 12-month risk of hospitalisation and mortality among older Australians in RACFs.Designretrospective cohort study.Subjectsindividuals aged 65–105 years taking at least one medicine, who entered an RACF in three Australian states between 1 January 2012 and 31 December 2015 and spent at least 6 months in the RACF (n = 57,719).MethodsCox regression models estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for associations between RMMR provision and mortality. Adjusted subdistribution hazard ratios were estimated for associations between RMMR provision and next (i) emergency department (ED) presentation or unplanned hospitalisation or (ii) fall-related ED presentation or hospitalisation.Resultsthere were 12,603 (21.8%) individuals who received an RMMR within 6–12 months of RACF entry, of whom 22.2% (95%CI 21.4–22.9) died during follow-up, compared with 23.3% (95%CI 22.9–23.7) of unexposed individuals. RMMR provision was associated with a lower risk of death due to any cause over 12-months (aHR 0.96, 95%CI 0.91–0.99), but was not associated with ED presentations or hospitalisations for unplanned events or falls.Conclusionsprovision of an RMMR in the 6–12 months after RACF entry is associated with a 4.4% lower mortality risk over 12-months but was not associated with changes in hospitalisations for unplanned events or falls.

Occupational therapy in Australian residential aged care facilities: A systematic mapping review.

Australia's population is ageing, resulting in more older adults living in residential aged care facilities. Occupational therapy scope of practice in Australian residential aged care facilities is significantly influenced by the government funding instrument. As the current government funding instrument is administratively inefficient, insufficiently discriminates between residents' care needs and provides perverse incentives, a new funding model is set to be implemented. This creates an opportunity for a review of the current evidence base to support the lobbying of national associations to shape occupational therapy practice. The research question that guided this systematic mapping review was as follows: What is the current state of scholarship about occupational therapy in Australian residential aged care facilities? A search of four databases (CINAHL, Medline, Embase and Scopus) was conducted and 1,617 papers were identified. All papers were screened through a two-phase process: (i) title and abstract review and (ii) full text review, using pre-determined inclusion and exclusion criteria to identify papers relevant to this review. A data extraction tool was designed in Microsoft Excel® and was used to extract data from the included papers. Twelve Australian articles were published between 1986 and 2020, most frequently authored by an occupational therapist. Included articles were classified into four groups: articles including occupational therapists as participants, articles about occupational therapy practice, articles exploring an occupational perspective of residents and articles with limited exploration of occupational therapy. This review identified that there is a dearth of Australian occupational therapy literature. This creates challenges for occupational therapists seeking evidence to guide their practice to optimise resident health and well-being and for national associations seeking to lobby for the profession. Consequently, there is a crucial need to develop the evidence base to support the profession within this practice setting and, ultimately, residents.

Medicines use before and after comprehensive medicines review among residents of long-term care facilities: a retrospective cohort study.

BackgroundResidential Medication Management Review (RMMR) is a subsidized comprehensive medicines review program for individuals in Australian residential aged care facilities (RACFs). This study examined weekly trends in medicines use in the four months before and after an RMMR and among a comparison group of residents who did not receive an RMMR.MethodsThis retrospective cohort study included individuals aged 65 to 105 years who first entered permanent care between 1/1/2012 and 31/12/2016 in South Australia, Victoria, or New South Wales, and were taking at least one medicine. Individuals with an RMMR within 12 months of RACF entry were classified into one of three groups: (i) RMMR within 0 to 3 months, (ii) 3 to 6 months, or (iii) within 6 to 12 months of RACF entry. Individuals without RMMRs were included in the comparison group. Weekly trends in the number of defined daily doses per 1000 days were determined in the four months before and after the RMMR (or assigned index date in the comparison group) for 14 medicine classes.Results113909 individuals from 1979 RACFs were included, of whom 55021 received an RMMR. Across all three periods examined, decreased use of statins and proton pump inhibitors was observed post-RMMR in comparison to those without RMMRs. Decreases in calcium channel blockers, benzodiazepines/zopiclone, and antidepressants were observed following RMMR provision in the 3–6 and 6–12 months after RACF entry. Negligible changes in antipsychotic use were also observed following an RMMR in the 6–12 months after RACF entry by comparison to those without RMMRs. No changes in use of opioids, ACE inhibitors/sartans, beta blockers, loop diuretics, oral anticoagulants, or medicines for osteoporosis, diabetes or the cognitive symptoms of dementia were observed post-RMMR.ConclusionsFor six of the 14 medicine classes investigated, modest changes in weekly trends in use were observed after the provision of an RMMR in the 6–12 months after RACF entry compared to those without RMMRs. Findings suggest that activities such as medicines reconciliation may be prioritized when an RMMR is provided on RACF entry, with deprescribing more likely after an RMMR the longer a resident has been in the RACF.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12877-022-03187-0.

Do clinical practice guidelines for the prevention of pressure ulcers really prevent pressure ulcers? An analysis of the guidelines

This review article aims to analyze sections of the 2012 Australian Wound Management Association, Pan Pacific, Clinical Practice Guideline for the Prevention and Management of Pressure Injury, the “Guide,” mandated for use in all Australian residential aged care facilities to explain why pressure ulcers still occur, I considered two sections of the “Guide:” a) “Assess all patients as soon as possible following admission to service and within a minimum of 8 h;” and b) “Implement a prevention plan – strategies for patients at high risk: Use a high specification foam reactive (constant low pressure) support surface OR consider using an (active alternate pressure) support surface.” Nowhere in the “Guide” is there an explanation for a) “Assessing all patients as soon as possible following admission and within a minimum of 8 h.” Similarly, there is no explanation for why b) “a high specification foam reactive (constant low pressure) support surface” is recommended to prevent pressure ulcers. The evidence for screening “within a minimum of 8 h,” does not consider the speed at which pressure ulcers develop. If the resident is lying in one position for 30 min or more and a “constant low pressure” mattress is used, residents may still develop pressure ulcers because a “constant low pressure” does not relieve pressure.

Dismantling antibiotic infrastructures in residential aged care: The invisible work of antimicrobial stewardship (AMS)

Recent social science scholarship has sought to understand the visible and invisible impacts of how antibiotics are entrenched as infrastructures and put to work as a proxy for higher levels of care (clinical or otherwise) within modern healthcare. Using a qualitative research design, in this paper our aim is to draw attention to less visible aspects of antimicrobial stewardship (AMS) in residential aged care and their implications for nurse-led optimization of antibiotic use in these settings. By developing an account of the perceptions, experiences and practices of staff regarding the ‘on the ground’ work associated with implementing and upholding AMS objectives our study extends research on attempts to dismantle antibiotic infrastructures in Australian residential aged care facilities (RACF). Drawing on a review of relevant policies, empirical data is presented from fifty-six in-depth interviews conducted in 2021 with staff at 8 different RACFs. Interview participants included managers, nurses, and senior and junior personal care assistants. Our results suggest that registered nurses in residential aged care have been tasked with promoting antibiotic optimization and assigned with AMS responsibilities without sufficient authority and resourcing. A host of hidden care work associated with AMS strategies was evident, reinforcing some staff support for empirical antibiotic prescribing as a ‘safety net’ in uncertain clinical cases. We argue that this hidden work occurs where AMS strategies displace the infrastructural role previously performed by antibiotics, exposing structural gaps and pressures. The inability of organisational accounting systems and the broader AMS policy agenda to capture hidden AMS workflows in RACFs has consequences for future resourcing and organisational learning in ways that mean AMS gaps may remain unaddressed. These results support findings that AMS interventions might not be easily accepted by aged care staff in view of associated burdens which are under recognised and under supported in this domain.

A multimodal intervention to optimise antimicrobial use in residential aged care facilities (ENGAGEMENT): protocol for a stepped-wedge cluster randomised trial

BackgroundInappropriate antibiotic use can cause harm and promote antimicrobial resistance, which has been declared a major health challenge by the World Health Organization. In Australian residential aged care facilities (RACFs), the most common indications for antibiotic prescribing are for infections of the urinary tract, respiratory tract and skin and soft tissue. Studies indicate that a high proportion of these prescriptions are non-compliant with best prescribing guidelines. To date, a variety of interventions have been reported to address inappropriate prescribing and overuse of antibiotics but with mixed outcomes. This study aims to identify the impact of a set of sustainable, multimodal interventions in residential aged care targeting three common infection types.MethodsThis protocol details a 20-month stepped-wedge cluster-randomised trial conducted across 18 RACFs (as 18 clusters). A multimodal multi-disciplinary set of interventions, the ‘AMS ENGAGEMENT bundle’, will be tailored to meet the identified needs of participating RACFs. The key elements of the intervention bundle include education for nurses and general practitioners, telehealth support and formation of an antimicrobial stewardship team in each facility. Prior to the randomised sequential introduction of the intervention, each site will act as its own control in relation to usual care processes for antibiotic use and stewardship.The primary outcome for this study will be antibiotic consumption measured using defined daily doses (DDDs). Cluster-level rates will be calculated using total occupied bed numbers within each RACF during the observation period as the denominator. Results will be expressed as rates per 1000 occupied bed days. An economic analysis will be conducted to compare the costs associated with the intervention to that of usual care. A comprehensive process evaluation will be conducted using the REAIM Framework, to enable learnings from the trial to inform sustainable improvements in this field.DiscussionA structured AMS model of care, incorporating targeted interventions to optimise antimicrobial use in the RACF setting, is urgently needed and will be delivered by our trial. The trial will aim to empower clinicians, residents and families by providing a robust AMS programme to improve antibiotic-related health outcomes.Trial registrationUS National Library of Medicine Clinical Trials.gov (NCT04705259). Prospectively registered in 12th of January 2021.

Epidemiology of falls in 25 Australian residential aged care facilities: a retrospective longitudinal cohort study using routinely collected data.

Falls are frequent among older adults and have significant health and economic consequences. There have been few studies on the epidemiology of falls in residential aged care facilities (RACFs). To determine the incidence of falls in RACFs using longitudinal routinely collected incident data over 5 years (July 2014-December 2019). A retrospective cohort study is conducted using fall incident data from 25 RACFs in Sydney, NSW, Australia. Incidents relating to a population of 6163 aged care residents aged ≥65 years were included. Outcome measures were incidents of all falls, injurious falls and falls requiring hospitalization. The risk-adjusted incidence rate (IR) for each outcome indicator for each of the 25 facilities was calculated. A total of 27 878 falls were reported over 3 906 772 resident days (a crude rate of 7.14 incidents per 1000 resident days; 95% confidence interval (CI) 6.81-7.48). Of these, 10 365 (37.2%) were injurious and 2733 (9.8%) required hospitalization. The crude IRs were 2.65 incidents per 1000 resident days (95% CI 2.53-2.78) for injurious falls and 0.70 incidents per 1000 resident days (95% CI 0.66-0.74) for falls requiring hospitalization. The incidence of falls was significantly higher in respite compared to permanent residents for all falls (adjusted IR ratio (aIRR) 1.33; 95% CI 1.18-1.51) and injurious falls (aIRR 1.30; 95% CI 1.14-1.48) and for men compared to women for all outcomes (all falls aIRR 1.69; 95% CI 1.54-1.86; injurious falls aIRR 1.87; 95% CI 1.71-2.04 and falls requiring hospitalization aIRR 1.29; 95% CI 1.12-1.48). The risk-adjusted IRs per 1000 resident days between facilities varied substantially (all falls 0.57-12.93 falls; injurious falls 0.25-4.47 and falls requiring hospitalization 0.10-1.70). Falls are frequent in RACFs, often resulting in injury and hospitalization. The study provides robust and comprehensive information that may help inform future initiatives to minimize the incidence of falls in RACFs.

A qualitative study of senior management perspectives on the leadership skills required in regional and rural Australian residential aged care facilities

BackgroundWith increasing recognition of the quality and safety issues in residential aged care, there is an urgent need to better understand what skills senior managers require to deliver on the spectrum of leadership functions in residential aged care facilities. This qualitative study sought to explore the leadership skills that positively influence the quality of care within Australian residential aged care facilities and better understand the professional development needs of senior managers to positively influence care within these complex environments.MethodsWe conducted semi-structured interviews with 19 senior managers purposively recruited from 14 high-performing non-government residential aged care facilities of varying geographical remoteness in northern Queensland, Australia. Participants held a range of professional roles, including Chief Executive Officer, Director of Nursing and Facility Manager, and had various professional qualifications. We used inductive thematic analysis to identify and categorise senior managers’ perspectives on the leadership skills and related strategies to promote quality of care.ResultsSenior managers reported leadership skills in five major domains: i) communication and relationship management, ii) stewardship, iii) professional development, iv) health care knowledge and v) information technology and finance. Most participants highlighted communication and relationship management skills and responding to regulatory change as influential to residential aged care quality performance. Participants with different professional backgrounds often emphasised different skills.ConclusionsParticipants identified a broad range of skills and strategies required by senior managers in Australian residential aged care facilities. Identifying different skills by differently trained individuals suggests more work is needed to understand and develop sector-specific professional development approaches to better prepare individuals to lead in this complex service environment.

COVID-19 pandemic: end-of-life experience in Australian residential aged care facilities.

BackgroundThe COVID‐19 pandemic has significantly impacted those in residential aged care facilities (RACF). This research was undertaken to explore and better understand the effects of the pandemic on the experience of next‐of‐kin and carers who encountered the death of a loved one who resided within a RACF during the pandemic.AimsTo explore end‐of‐life experiences for residents who die in RACF and their next‐of‐kin/carers during the COVID‐19 pandemic, to identify areas of concern and areas for improvement.MethodsProspective single‐centre mixed methods research was undertaken involving telephone interview with next‐of‐kin or carers of residents who died within 30 days of being referred to Austin Health Residential InReach Service during the ‘second wave’ of COVID‐19 in Melbourne, Australia, in 2020. Qualitative and quantitative data were collected. Qualitative description and aspects of grounded theory were used for analysing qualitative data. Thematic analysis of the interview transcripts used open and axial coding to identify initial themes and then to group these under major themes.ResultsForty‐one telephone interviews were analysed. Major themes identified included: COVID‐19 pandemic, communication and technology, death and dying experience, bereavement and grief, and social supports and external systems.ConclusionsFindings identify the many COVID‐19 pandemic‐related challenges faced by participants and their dying loved one in RACF. Access to palliative care and bereavement support is crucial for dying residents and for grieving that has been made more difficult by the pandemic.

Government-subsidised mental health services are underused in Australian residential aged care facilities

Objective To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access.

Pattern of prescription of psychotropics (antipsychotics, antidepressants and benzodiazepines) in Western Australian residential aged care facilities.

Behavioural and psychological symptoms of dementia are exhibited by up to 90% of residents in aged care facilities and are associated with a risk of inappropriate use of psychotropic drugs. This study examined the prevalence pattern of psychotropic drug use in 409 residents from 11 residential aged care facilities in Western Australia. Sixty-four (n = 64; 15.6%) residents were not prescribed any psychotropic drug, 345 (84.4%) were prescribed at least one psychotropic drug and between 4 and 10% were prescribed high doses, depending on the class of psychotropic. Despite increasing awareness of inappropriate psychotropic drug use in this population, targeted and effective interventions are required to improve psychotropic prescribing practices.

Aged care nurses' perception of unwanted sexual behaviour in Australian residential aged care services.

To explore aged care nurses' awareness and experience of unwanted sexual behaviour (USB) in residential aged care services (RACS). An anonymous online questionnaire was administered to an opportunistic sample of RACS nurses enrolled to complete an e-learning course in Australia. From the 167 participants who expressed interest to enrol, 129 were eligible and 53 returned completed consent forms. 46/53 responded of which most were females (41/45, 91.1%). Few respondents reported resident-resident USB (<35%) or staff-resident USB (<22%) happened once a year. Most respondents had not been informed by a resident of USB (>75%) or had personally reported USB within their internal reporting system (>77%). Respondents were also unaware if their facility had lodged an incident report to the regulator or law enforcement authorities within the past 12months (34/46, 73.9%). Finally, most considered there to be no barriers to reporting USB (35/46, 77.8%). Respondents' awareness and estimates of USB directed at residents were much lower than known national prevalence rates. This lack of awareness could be a substantive barrier to recognition and optimal management of this form of abuse.

How does antibiotic use in Australian residential aged care compare globally?: A systematic review and meta-analysis

Introduction: Inappropriate antibiotic use in residential aged care (RAC) is a concern globally. The World Health Organization recommends surveillance of antibiotic use as part of its strategy to curb antimicrobial resistance. A number of recent programs have been initiated to monitor antibiotic use in RAC; however, a global comparison of estimates from these is not available. We aimed to analyse the international literature to summarise antibiotic use in RAC by region, including for Australia.Methods: We conducted a systematic review, meta-analysis and meta-regression of key indicators of antibiotic use in RAC. Random effects meta-analyses with subgroups by region were conducted. Meta-regression compared use in regions (providing odds ratios [OR]), while adjusting for year of data.Results: Ninety articles reporting antibiotic use across 38 countries were included. Meta-analyses and meta-regression were conducted for point prevalence (n=123 estimates) and 12-month period prevalence (n=19 estimates) of antibiotic use. Data reported for other measures of antibiotic use (e.g. days of therapy/1000 resident days; defined daily doses/1000 resident days) precluded meta-analysis and were summarised narratively. People living in RAC in Australia had higher odds of using an antibiotic on a single day and over 12-months compared to other regions (e.g. Eastern Europe, Western Europe, Asia and the British Isles). Point estimates and odds ratios with 95% confidence intervals will be presented.Conclusion: Antibiotic use in RAC in Australia is higher compared to some regions. There is a need for targeted antimicrobial stewardship programs in RAC to reduce unnecessary antibiotic use in this population. Introduction: Inappropriate antibiotic use in residential aged care (RAC) is a concern globally. The World Health Organization recommends surveillance of antibiotic use as part of its strategy to curb antimicrobial resistance. A number of recent programs have been initiated to monitor antibiotic use in RAC; however, a global comparison of estimates from these is not available. We aimed to analyse the international literature to summarise antibiotic use in RAC by region, including for Australia. Methods: We conducted a systematic review, meta-analysis and meta-regression of key indicators of antibiotic use in RAC. Random effects meta-analyses with subgroups by region were conducted. Meta-regression compared use in regions (providing odds ratios [OR]), while adjusting for year of data. Results: Ninety articles reporting antibiotic use across 38 countries were included. Meta-analyses and meta-regression were conducted for point prevalence (n=123 estimates) and 12-month period prevalence (n=19 estimates) of antibiotic use. Data reported for other measures of antibiotic use (e.g. days of therapy/1000 resident days; defined daily doses/1000 resident days) precluded meta-analysis and were summarised narratively. People living in RAC in Australia had higher odds of using an antibiotic on a single day and over 12-months compared to other regions (e.g. Eastern Europe, Western Europe, Asia and the British Isles). Point estimates and odds ratios with 95% confidence intervals will be presented. Conclusion: Antibiotic use in RAC in Australia is higher compared to some regions. There is a need for targeted antimicrobial stewardship programs in RAC to reduce unnecessary antibiotic use in this population.

Australian infection control practitioners’ practice and educational needs in aged care settings

Introduction: Healthcare-associated infections are serious and significant complications present across healthcare services, including residential & aged care facilities (RACFs). Although ensuring high quality personal and clinical care delivered to those residing in these facilities is a high national priority, there is a paucity of evidence about outbreaks, governance and education programs held for healthcare workers within Australian residential aged care facilities. This study aims to examine the scope of practice of infection control practitioners (ICPs) within Australian residential aged care facilities and the types of infection prevention and control education and training delivered.