People In Residential Aged Care Facilities Research Articles

Deprescribing for older people living in residential aged care facilities: Pharmacist recommendations, doctor acceptance and implementation

BackgroundDeprescribing is an intervention to address the high prevalence of inappropriate polypharmacy in older people living in residential aged care facilities (RACFs). Many deprescribing interventions are complex and involve several stages including initial pharmacist recommendation, subsequent acceptance of the recommendations by a prescriber and the patient, and then actual implementation. ObjectivesThis study aimed to investigate pharmacist deprescribing recommendations for residents within RACFs, general practitioner (GP) acceptance, and the actual implementation of the accepted recommendations at 12-month. MethodsThe intervention occurred as part of a randomised controlled trial and comprised a pharmacist-led medication review using an evidence-based algorithm, with the focus on identifying medications to potentially deprescribe. Consent to participate was obtained from residents (or surrogate decision-makers), RACF nursing staff and the resident's GP. Deprescribing recommendations were reviewed by GPs before implementation as part of the intervention and control arms of the trial, although control group participants continued to receive their usual medications in a blinded manner. ResultsThere were 303 participants enrolled in the study, and 77% (941/1222) of deprescribing recommendations suggested by the pharmacists were accepted by GPs. Of the recommendations accepted by GPs, 74% (692/ 941) were successfully implemented at the end of the follow-up visit at 12 months. The most common reason for deprescribing was because medications were no longer needed (42%, 513/ 1231). ConclusionPharmacist-led deprescribing recommendations arising from an algorithm-based medication review are acceptable to doctors and can have a significant impact on reducing the number of inappropriate medications consumed by older people in RACFs. Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12613001204730

Polypharmacy and medicine regimens in older adults in residential aged care

ObjectiveTo describe medicines regimens used by older people living in residential aged care facilities (RACFs). Materials and methodsThis cross-sectional study presents baseline data from a randomised controlled trial in seventeen Australian RACFs that recruited residents aged 65 years and older at the participating facilities. The main outcome measures were to evaluation of medicines utilisation, including the number of medicines, medicine regimen complexity, potential under-prescribing and high-risk prescribing (prescribing cascades, anticholinergic or sedative medicines or other potentially inappropriate medicines) with data analysed descriptively. ResultsMedicines regimens were analysed for 303 residents (76% female) with a mean age of 85.0 ± 7.5 years, of whom the majority were living with dementia (72%). Residents were prescribed an average of 10.3 ± 4.5 regular medicines daily. Most participants (85%) had highly complex regimens. Most residents (92%) were exposed to polypharmacy (five or more medicines). Nearly all, 302 (98%) residents had at least one marker of potentially suboptimal prescribing. At least one instance of potential under-prescribing was identified in 86% of residents. At least one instance of high-risk prescribing was identified in 81% of residents including 16% of participants with at least one potential prescribing cascade. Conclusion(s)Potentially suboptimal prescribing affected almost all residents in this study, and most had highly complex medicines regimens. If generalisable, these findings indicate most older people in RACFs may be at risk of medicines-related harm from suboptimal prescribing, in addition to the burden of administration of complex medicines regimens for facility staff and residents.

Preparing dental graduates to provide care for frail and care-dependent older patients: An educational intervention

Introduction: Australia’s population is living longer and retaining more of their dentition. While the demand for oral health services in residential aged-care facilities increases, there is a call for further inclusion of gerodontology in the undergraduate dental curriculum. This qualitative study explored the attitude of dental students to providing oral health care to older people using a pilot gerodontology curriculum as an intervention during a final-year clinical placement in Hobart, Tasmania.Methods: Focus groups with undergraduate dental students on clinical placement were conducted in 2018 prior to and after implementation of a pilot gerodontology curriculum. The qualitative data was thematically analysed.Results: Two focus groups were conducted with a total of 18 dental students. The main themes included: applied practical learning in aged care, unpreparedness for managing frail older patients, lack of confidence with the process of gaining consent from people with dementia, barriers to providing care to older people and interactions with residents and staff of residential aged-care facilities. Conclusions: This study highlighted the barriers for dental students providing care to older people. There is a need to evaluate how gerodontology is currently taught in the undergraduate dental curriculum to better prepare the dental workforce to respond effectively and more confidently to the growing population of dentate older people in residential aged-care facilities.

Pharmacist-led interventions to reduce adverse drug events in older people living in residential aged care facilities: A systematic review.

We aimed to investigate the efficacy and effectiveness of pharmacist-led interventions to reduce adverse drug events (ADEs) in older people living in residential aged care facilities (RACFs). We systematically searched MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials and PsycINFO from their inceptions to July 2020. We investigated experimental study designs that employed a control group, or quasi-experimental studies conducted in RACFs. We screened 3826 records and included 23 studies. We found seven single-component and 16 multicomponent pharmacist-led interventions to reduce ADEs in older people living in RACFs. The most frequent single-component pharmacist-led intervention was medication review. Medication review and education provision to healthcare professionals were the most common components in many pharmacist-led multicomponent interventions. Thirteen studies (56%) showed no effect, whereas ten studies (43%) reported significant reductions in ADEs following pharmacist-led interventions either as a sole intervention or as a part of a multi-component intervention. Many interventions focused on reducing the incidence of falls (39%). This systematic review suggests that pharmacist-led interventions have the potential to reduce the incidence of ADEs in older people living in RACFs. Medication review and educational programmes, particularly academic detailing, either as a single component or as part of multicomponent interventions were the most common approaches to reducing drug-related harm in older people living in RACFs. The lack of a positive association between interventions and ADE in many studies suggests that targeted and tailored pharmacist-led interventions are required to reduce ADEs in older people in RACFs.

Treatment for osteoporosis in Australian residential aged care facilities: consensus recommendations for fracture prevention

Older people living in residential aged care facilities (RACFs) are at considerably higher risk of suffering fractures than older people living in the community. When admitted to RACFs, patients should be assessed for fracture risk to ensure early implementation of effective fracture prevention measures. Routine or regular determination of calcium and phosphate serum levels in institutionalised older people is not indicated. Opinion is divided about the value of routine measurements of serum concentrations of 25-hydroxyvitamin D, parathyroid hormone and bone turnover markers. The non-pharmacological approach to fracture prevention includes multifactorial programs of falls prevention and the use of hip protectors. Vitamin D supplementation is recommended for all patients in RACFs. Dietary calcium intake should be optimised (1200-1500 mg per day is recommended) and supplementation offered to those with inadequate intake. The decision to prescribe calcium supplements should be guided by patients' tolerance, whether or not they have a history of kidney stones, and emerging data about its cardiovascular safety. Bisphosphonates are the first-choice pharmacological agents for fracture prevention in older persons at high risk. Intravenous administration is as efficient as oral and has the significant advantage of better adherence. Use of strontium ranelate has not been tested on people in RACFs, but evidence in the "old-old" (those aged 75 years and older) suggests it could be a therapeutic option for fracture prevention in this setting. In general, teriparatide should not be considered as a first-line treatment for fracture prevention, particularly for people in RACFs.

Descriptive, exploratory study of the role of nursing assistants in Australian residential aged care facilities: The example of pain management

This study explored the experiences of nursing assistants (NAs) who work with older people in residential aged care facilities (RACFs), to ascertain their role in Australian RACFs. Experiences with pain management were used as an example to explore their work role. A descriptive, exploratory qualitative approach was used to examine NAs' experiences. Participants included six NAs from three RACFs in regional Western Australia. In-depth interviews focused on the NAs' experiences of providing care to older people in RACFs and in particular their experiences providing pain management for residents. The role of NAs often extends beyond their scope of practice. NAs describe making clinical decisions, initiating clinical care and advocating for residents. NAs represent a majority of the staff in Australian RACFs and they have a significant role in clinical care. There is a need to ensure that NAs are adequately prepared and supported in their role.