Residential Aged Care Services Research Articles

Evaluation of an Infection surveillance program in residential aged care facilities in Victoria, Australia.

Infection surveillance is a key element of infection prevention and control activities in the aged care sector. In 2017, a standardised infection surveillance program was established for public residential aged care services in Victoria, Australia. This program will soon be expanded to a national level for all Australian residential aged care facilities. It has not been evaluated since its inception. The current study aimed to evaluate the Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre Aged Care Infection Indicator Program (ACIIP), to understand its performance and functionality. A mixed methods evaluation was performed using the Updated Guidelines for Evaluating Public Health Surveillance Systems developed by the United States Centers for Disease Control and Prevention as a framework. VICNISS staff who coordinate and manage the ACIIP were invited to participate in interviews. Residential aged care staff who use the program were invited to participate in a survey. Document analysis was also performed. Four VICNISS staff participated in the interviews and 38 aged care staff participated in the survey. The ACIIP is stable and able to be adapted quickly to changing definitions for infections. Users found the system relatively easy to use but have difficulties after the long intervals between data entry year on year. VICNISS staff provide expert guidance which benefits users. Users appreciated the benefit of participating and many use the data for improving local practice. The ACIIP is a usessful state-wide infection surveillance program for aged care. Further development of data validation, IT system capacity and models for education and user support will be required to support future scalability.

Job satisfaction and regulation in the aged care sector: staff perspectives

BackgroundThe quality of care provided in residential aged care facilities is largely dependent on the job satisfaction of employees and the organisational framework and systems that they provide care in. This study aimed to explore aged care staff perceptions of job satisfaction, regulation of the sector and the Royal Commission into Aged Care Quality and Safety.MethodsA cross-sectional survey conducted in 2019-early 2020 with staff employed in various roles at residential aged care services in Australia. The study specific survey collected views and experiences about working in the aged care sector as well as information about their role.ResultsA total of 167 aged care staff completed the survey of which 71% worked in a direct care role. Most participants indicated they thought they were doing a worthwhile and important job (98%), were proud to work in the sector (94%) and found the job personally rewarding (94%). However, participants also reported feeling emotionally drained by the work (37%) and fatigued by having to face a day of work (30%). 72% of participants felt the Royal Commission would lead to improvements in the care provided to residents.ConclusionAged care staff have an overall positive feeling towards their work. Additional support including increasing skills to deliver high-quality care, creating a supportive work environment to reduce job stressors and changes to the way the sector is regulated, are likely to lead to improved care.

An evaluation of influenza, pneumococcal and herpes zoster vaccination coverage in Australian aged care residents, 2018 to 2022.

For older persons, vaccination mitigates the harmful impact of vaccine preventable infections. Our study objectives were to evaluate in the Victorian public sector residential aged care services (PSRACS) (1) the existence of local vaccination policies and admission assessment practices, (2) the current documented status of resident influenza, pneumococcal and herpes zoster vaccination uptake and (3) changes in documented resident vaccination uptake over time. Standardised data were annually reported by all PSRACS between 2018 and 2022. The influenza, pneumococcal and herpes zoster vaccination status of each resident was classified as vaccinated, declined, contraindicated or unknown. Annual trends in vaccination status were assessed using Spearman's correlation. In 2022, most PSRACS reported an influenza immunisation policy existed (87.1%) and new residents were assessed for their influenza vaccination status (97.2%); fewer PSRACS reported the same for pneumococcal disease (73.1% and 78.9%) and herpes zoster (69.3% and 75.6%). The median resident influenza, pneumococcal and herpes zoster (70-79 years old) vaccination uptake was 86.8%, 32.8% and 19.3% respectively. The median unknown status was 6.9%, 63.0% and 76.0% respectively. Statistical evidence of an increase in annual uptake was observed for the herpes zoster (all resident) surveillance module (rs=0.900, p=0.037). Our study showed local influenza vaccination policies and practices exist and influenza vaccination uptake was consistently high. Pneumococcal and herpes zoster vaccination uptake were lower. Quality improvement strategies that at least determine the status of those residents classified as unknown are required.

Unsafe care inresidential settings forolder adults: a content analysis ofaccreditation reports.

Residents of aged care services can experience safety incidents resulting in preventable serious harm. Accreditation is a commonly used strategy to improve the quality of care; however, narrative information within accreditation reports is not generally analysed as a source of safety information to inform learning. In Australia, the Aged Care Quality and Safety Commission (ACQSC), the sector regulator, undertakes over 500 accreditation assessments of residential aged care services against eight national standards every year. From these assessments, the Aged Care Quality and Safety Commission generates detailed Site Audit Reports. In over one-third (37%) of Site Audit Reports, standards relating to Personal and Clinical Care (Standard 3) are not being met. The aim of this study was to identify the types of resident Safety Risks that relate to Personal and Clinical Care Standards not being met during accreditation or re-accreditation. These data could inform priority setting at policy, regulatory, and service levels. An analytical framework was developed based on the World Health Organization's International Classification for Patient Safety and other fields including Clinical Issue (the issue related to the incident impacting the resident, e.g. wound/skin or pain). Information relating to safety incidents in the Site Audit Reports was extracted, and a content analysis undertaken using the analytical framework. Clinical Issue and the International Classification for Patient Safety-based classification were combined to describe a clinically intuitive category ('Safety Risks') to describe ways in which residents could experience unsafe care, e.g. diagnosis/assessment of pain. The resulting data were descriptively analysed. The analysis included 65 Site Audit Reports that were undertaken between September 2020 and March 2021. There were 2267 incidents identified and classified into 274 types of resident Safety Risks. The 12 most frequently occurring Safety Risks account for only 32.3% of all incidents. Relatively frequently occurring Safety Risks were organisation management of infection control; diagnosis/assessment of pain, restraint, resident behaviours, and falls; and multiple stages of wounds/skin management, e.g. diagnosis/assessment, documentation, treatment, and deterioration. The analysis has shown that accreditation reports contain valuable data that may inform prioritization of resident Safety Risks in the Australian residential aged care sector. A large number of low-frequency resident Safety Risks were detected in the accreditation reports. To address these, organizations may use implementation science approaches to facilitate evidence-based strategies to improve the quality of care delivered to residents. Improving the aged care workforces' clinical skills base may address some of the Safety Risks associated with diagnosis/assessment and wound management.

Historical Trends and Future Projections of Demand for Permanent Residential Aged Care for Older People in Australia, 2008–2052

ObjectivesTo examine the historical trends and predict the future rates and total volumes of permanent residential aged care (PRAC) service utilization in Australia. DesignA population-based repeated cross-sectional and projection study of non-indigenous older people (≥65 years) accessing PRAC in Australia was conducted. Setting and ParticipantsPublicly available aged care admissions from the Australian Institute of Health and Welfare and population estimates from the Australian Bureau of Statistics were used. MethodsHistorical incidence rates (per 1000 people), incidence rate ratios (IRRs) and 95% CIs of PRAC admission from 2008–2009 to 2020–2021 were estimated using negative binomial regression models. The future incidence and prediction intervals (PIs) of PRAC admission between 2021–2022 and 2051–2052 were projected using a generalized additive model-negative binomial regression. All estimates were adjusted or standardized by sex and age. ResultsBetween 2008–2009 and 2020–2021, the adjusted admission to PRAC decreased (from 23.6/1000 people to 15.7/1000 people with an IRR = 0.97/year, 95% CI 0.97–0.98). The projected PRAC admission rate will decrease to 12.1/1000 (95%PI 10.8–13.3) by 2037–2038 and 9.0/1000 (95%PI 7.6–10.4) by 2051–2052. The projected volume of PRAC admission will be 73,988 (95%PI 65,960–81,425) at its highest point in 2037–2038 and 64,579 (95%PI 54,258–74,543) in 2051–2052. Conclusions and ImplicationsThe utilization of PRAC has decreased in the past decade, and a predicted decrease in PRAC use in future years is estimated. However, the volume of PRAC utilization will still increase for the next 15 years (until 2037–2038) due to our increasingly older population. These findings can inform service planning of PRAC access in Australia.

“Building the plane while flying it” Reflections on pandemic preparedness and response; an organisational case study

BackgroundThe COVID-19 pandemic provided a unique opportunity to learn about acute health organisations experiences implementing a pandemic response plan in real-time. This study was conducted to explore organisational leader’s perspectives and experience activating a COVID-19 pandemic response plan in their health service and the impact of this on service provision, clinicians, and consumers.MethodsThis study was conducted at a large metropolitan health service in Australia that provides acute, subacute, and residential aged care services. Semi-structured interviews were conducted with 12 key participants from the COVID-19 leadership team between November-January 2021/2022. A semi-structured interview guide was developed to explore how the health service developed a clinical governance structure, policy and procedures and experience when operationalising each element within the Hierarchy of Controls Framework. Thematic analysis was used to code data and identify themes. A cross-sectional survey of frontline healthcare workers on the impacts and perceptions of infection control practices during the COVID-19 pandemic, was also completed in 2021 with 559 responses.ResultsTwelve organisational leaders completed the semi-structured interviews. Key themes that emerged were: (1) Building the plane while flying it, (2) A unified communications strategy, (3) Clinicians fear ‘my job is going to kill me’, (4) Personal Protective Equipment (PPE) supply and demand, and (5) Maintaining a workforce. When surveyed, front-line healthcare workers responded positively overall about the health services pandemic response, in terms of communication, access to PPE, education, training, and availability of resources to provide a safe environment.ConclusionHealth service organisations were required to respond rapidly to meet service needs, including implementing a pandemic plan, developing a command structure and strategies to communicate and address the workforce needs. This study provides important insights for consideration when health service leaders are responding to future pandemics. Future pandemic plans should include detailed guidance for acute and long-term care providers in relation to organisational responsibilities, supply chain logistics and workforce preparation.

Evidence for the external validity of the Consumer Choice Index Six Dimension (CCI-6D) for people living in residential aged care with dementia

Abstract The large proportion of people living in residential aged care services with dementia necessitates that any instrument used to measure quality of care is meaningful and practical to be completed by this group. This study assessed the external validity of using the Consumer Choice Index Six Dimension (CCI-6D) instrument to assess quality of care in a large sample of people living in residential aged care, including those with dementia. We applied the CCI-6D with 446 residents along with a range of measures of clinical and functional status and a measure of dementia-specific quality of life, the Quality of Life in Alzheimer's Disease (QOL-AD). Resident's cognitive abilities ranged from no evidence of cognitive impairment through to severe dementia. A high proportion of participants reported they felt very at home in their own room (82%, N = 367), while a lower proportion reported they could undertake meaningful activities that made them feel valued often (37%, N = 163). We identified moderate correlations between quality of care and quality of life, as measured through the QOL-AD utility score. Those with moderate dementia were significantly more likely to report poorer quality of care than those with no or mild dementia. This study provides further evidence for the use of the CCI-6D instrument to assess quality of care from the perspective of the individual receiving care even among those with living with dementia. Residents living with moderate dementia reported lower quality of care than those living with mild or without dementia, indicating the risks of poor care quality among this group.

Medication-Related Complaints in Residential Aged Care.

Complaints reflect a person's or family's experience within the aged care system and provide important insight into community expectations and consumer priorities. Crucially, when aggregated, complaints data can serve to indicate problematic trends in care provision. Our objective was to characterize the areas of medication management most frequently complained about in Australian residential aged care services from 1 July 2019 to 30 June 2020. A total of 1134 complaint issues specifically referenced medication use. Using content analysis, with a dedicated coding framework, we found that 45% of these complaints related to medicine administration processes. Three categories received nearly two thirds of all complaints: (1) not receiving medication at the right time; (2) inadequate medication management systems; and (3) chemical restraint. Half of the complaints described an indication for use. These were, in order of frequency: 'pain management', 'sedation', and 'infectious disease/infection control'. Only 13% of medication-related complaints referred to a specific pharmacological agent. Opioids were the most common medication class referred to in the complaint dataset, followed by psychotropics and insulin. When compared to complaint data composition overall, a higher proportion of anonymous complaints were made about medication use. Residents were significantly less likely to lodge complaints about medication management, probably due to limited engagement in this part of clinical care provision.

Aged and Health Care Service Utilization by Older Australians Receiving Home Care Packages.

To examine the (1) cohort of individuals living at home with Home Care Packages (HCPs) in 2016, (2) their access to other aged care services after HCP commencement, and (3) their hospital and ambulance service utilization. A cross-sectional study was conducted using integrated aged care and health care data contained within the National Historical Cohort of the Registry of Senior Australians. This study included people who accessed HCP between January 1, 2016 and December 31,2016. The access to permanent residential aged care, transition care, respite care, hospital and ambulance services among Australian HCP recipients ≥65years old in 2016 was evaluated. Descriptive statistics were employed. In 2016, 84,681 individuals received HCPs, of which 68.4% (n= 57,942) accessed HCP levels 1‒2, 26.0% (n= 22,057) accessed HCP levels 3‒4, and 5.5% (n= 4682) accessed both care levels within the year. Of the individuals receiving HCP, 34.0% (n= 27,787) started services that year and 16.7% (n= 14,117) moved to permanent residential aged care, 18.4% (n= 15,592) used respite care and 5.8% (n= 4937) used transition care that year. Emergency department (ED) presentations [43.6%, 95% confidence interval (CI) 43.3‒44.0] were the most common hospital encounters, followed by inpatient hospitalizations for any reason (43.3%, 95% CI 42.9‒43.7), and unplanned hospitalizations (38%, 95% CI 37.6‒38.3). Forty-four percent (44.5%, 95% CI 43.9‒45.0) of individuals utilized ambulance services. ED presentations, hospitalization for any reason, and unplanned hospitalizations were more common in individuals receiving HCP levels 3‒4 compared with those accessing HCP levels 1‒2. HCP recipients in Australia have frequent hospitalizations, including ED presentations. In addition, almost 1 in 5 access respite care and 16.7% transition to permanent residential care each year. As the population accessing HCP is increasing, adequate support for these individuals to live well at home and avoid health events that lead to hospitalizations are necessary.

Public health service board members' understanding of care quality in residential aged care services.

ObjectiveThe objective of this study was to explore how health service boards understand care quality for older people living in public sector residential aged care services.MethodsSemi-structured interviews were undertaken with board members from six Victorian public health services responsible for the governance of 15 residential aged care services comprising over 850 beds. Transcripts were thematically analysed.ResultsEleven board members were interviewed. While committed to their governance and monitoring role, analysis suggests board members have a limited understanding of the residential aged care environment. They rarely visit and the information they receive about residential aged care is primarily clinical data (quality indicators) as well as sub-committee and staff reports. In addition to quality indicator data and reports, accreditation and complaints are used to measure care quality.ConclusionBoard members vary in their understanding of care quality in residential aged care settings. The exclusive focus on clinical indicators and accreditation as measures of quality reinforces this understanding. Visiting residential aged care services would provide understanding of the care environment and context for the information they receive. The provision of other metrics, such as consumer advocacy reports and residents' and families' experiences of care, would further assist board members to monitor care quality in these settings.

In Australian hospitals and residential aged care facilities, how do we train nursing and direct care staff to assist patients and residents to move? A national survey.

ObjectiveNursing workplace injuries related to staff-assisted patient/resident movement occur frequently, however, little is known about the programs that aim to prevent these injuries. The objectives of this study were to: (i) describe how Australian hospitals and residential aged care services provide manual handling training to staff and the impact of the coronavirus disease 2019 (COVID-19) pandemic on training; (ii) report issues relating to manual handling; (iii) explore the inclusion of dynamic risk assessment; and (iv) describe the barriers and potential improvements.MethodUsing a cross-sectional design, an online 20-min survey was distributed by email, social media, and snowballing to Australian hospitals and residential aged care services.ResultsRespondents were from 75 services across Australia, with a combined 73 000 staff who assist patients/residents to mobilise. Most services provide staff manual handling training on commencement (85%; n = 63/74), then annually (88% n = 65/74). Since the COVID-19 pandemic, training was less frequent, shorter in duration, and with greater online content. Respondents reported issues with staff injuries (63% n = 41), patient/resident falls (52% n = 34), and patient/resident inactivity (69% n = 45). Dynamic risk assessment was missing in part or in whole from most programs (92% n = 67/73), despite a belief that this may reduce staff injuries (93% n = 68/73), patient/resident falls (81% n = 59/73) and inactivity (92% n = 67/73). Barriers included insufficient staff and time, and improvements included giving residents a say in how they move and greater access to allied health.ConclusionMost Australian health and aged care services provide clinical staff with regular manual handling training for staff-assisted patient/resident movement, however, issues with staff injuries, as well as patient/resident falls and inactivity, remain. While there was a belief that dynamic in-the-moment risk assessment during staff-assisted patient/resident movement may improve staff and resident/patient safety, it was missing from most manual handling programs.

Using the Theoretical Framework of Acceptability to understand the acceptability of e-training for nurse led prevention of unwanted sexual behaviour in Australia’s residential aged care services

Objective: The aim of this study was to evaluate the acceptability of one specific e-training (intervention) for prevention of unwanted sexual behaviour in Australia’s residential aged care services using the Theoretical Framework of Acceptability. Background: Aged care staff are of fundamental importance in unwanted sexual behaviour incident management and prevention. The research team developed and implemented an evidence-informed intervention designed to increase awareness, promote collaborative practice, and improve prevention and management of such incidents in aged care. Current acceptability of training on this topic is yet to be studied despite it being recognised as a key factor for successful implementation and translation into practice. Study design and methods: This is a qualitative, cross-sectional study employing semi-structured telephone interviews with actively working enrolled and registered aged care nurses who had completed the intervention. Acceptability of the intervention was measured with the Theoretical Framework of Acceptability. Of the 36 participants that signed the consent form, 18 completed interviews. One participant was excluded from analysis as they did not complete all modules of the intervention. Results: Analysis revealed favourable evaluation in all seven domains of the Theoretical Framework of Acceptability, finding high acceptability of the intervention amongst all participants. The intervention aligned with participant’s values and the content was perceived to fill a knowledge gap. This is showcased in participants unanimous belief that it would be helpful for all front-line aged care staff to receive the intervention frequently. Although participants showcased high acceptability of the intervention, participants recommended that sexuality content be included before detailing unwanted sexual behaviour, and that this content inclusion may increase awareness and understanding of unwanted sexual behaviour. Conclusion: Participants reported this e-training to be highly acceptable. They believed it has potential to improve attitudes and awareness of incidents in aged care. However, favourable results may reflect a personal interest with the topic, for example, the content aligned with their personal values, experience, and beliefs. More research is needed to understand both the acceptability and the efficacy of the training short and long-term. Implications for research, policy, and practice: This study indicates that larger scale national staff training on this topic is possible and considered necessary by the sample. Future national policy should explore the inclusion of this topic in the curriculum standards. Future research should focus on evaluating the efficacy of the training in changing attitudes, awareness and influencing professional practice. What is already known about the topic? Known prevalence of unwanted sexual behaviour in aged care suggests most nursing staff will be required, at some stage, to provide care to a resident who has been a target, or exhibitor of unwanted sexual behaviour. Previous studies of this pilot intervention indicate that it provides a useful model and curriculum of specific topics to guide development of training on unwanted sexual behaviour initiatives nationally and internationally. Acceptability of healthcare interventions is a critical measure in facilitating their implementation and in this instance, capacity of the aged care workforce to be trained on unwanted sexual behaviour. What this paper adds E-training about prevention of unwanted sexual behaviour is acceptable to aged care nurses. E-training filled an existing program gap in education provision and addressed current staff knowledge deficits that aged care nurses perceived as important for better resident care and reducing work related stress. Lack of prior learning about intimacy and sexuality hampered optimal learning about prevention of unwanted sexual behaviour.

Frailty change based on minimally important difference in nursing home residents: FIRST cohort study findings.

Frailty is common among residential aged care services (RACS) residents; however, little is known about how frailty changes over time in this population. This study aimed to estimate minimally important difference (MID) in frailty to then describe: frailty change over 12 months; and factors associated with worsening frailty. Prospective cohort study across 12 RACS sites of a single aged care organisation in South Australia (n = 548 residents, mean age 87.7 ± 7.2years, 72.6% female). Frailty was measured using a frailty index (FI) with 12 months between baseline and follow-up. MID was calculated cross-sectionally (anchor-based using self-reported health, and ½SD for distribution-based). Between-person MID for the FI was identified as 0.037 (anchor-based) and 0.063 (distribution-based). Using the conservative value of 0.063 as the basis for change, 32.3% (n = 177) of residents remained stable, 13.7% (n = 75) improved, 33.0% (n = 181) worsened and 21.0% (n = 115) died over 12 months. In a multivariable analysis, significant predictors of the dichotomous outcome of worsening and death at 12 months were: being malnourished (odds ratio (OR) = 2.15, 95% confidence interval (CI) = 1.23, 3.75), at risk of malnutrition (OR = 1.98, 95%CI = 1.34, 2.91) and diabetes (OR = 1.61, 95%CI = 1.06, 2.42) compared to those who remained stable or improved. A 6.3% change in frailty for RACS residents is a conservative MID. Frailty is dynamic in RACS residents, and stability or improvement was possible even for the most-frail. Treatments such as nutritional interventions, exercise and diabetes management are likely to benefit frailty.

Design and rationale of the Western Sydney Clinical Frailty Registry: A prospective observational long-term clinical cohort study

BackgroundFrail older adults are frequently admitted to hospital with complex care needs, however little is known about their clinical profile, inpatient management or outcomes. Aims(i) To establish a baseline clinical profile of patients with frailty; (ii) To obtain a representative cross-sectional view of patients with frailty and their acute inpatient clinical management; (iii) To determine the rate and clinical outcomes of frailty among hospitalised patients. MethodsThe study will be conducted in a Western Sydney tertiary teaching hospital (Blacktown and Mount Druitt Hospital), serving a large socio-economically diverse, multi-cultural community. A long-term, prospective observational clinical cohort of patients who are admitted under Rehabilitation and Aged Care Services over the next 5-year period (2020–25) will be conducted. Frailty will be assessed using the Clinical Frailty Scale, and the FI-ED frailty instrument, performance will be assessed using the Australian-modified Karnofsky Performance Status (AKPS). Participants will be followed-up at 3, 6, and 12 months by telephone, following their index hospitalisation. Outcomes of interest include all-cause rehospitalisation (including emergency department presentation), mortality and admission to residential aged care service over the period of 12 months. Data Linkage endpoint assessment will be undertaken at 1, 2, and 5 years. DiscussionFrailty is an emergent area of clinical and research interest. It is an important prognostic indicator of mortality, rehospitalisation and institutionalisation. ConclusionThis study will provide longitudinal data to demonstrate short, mid, or long-term outcomes of hospitalised frail older adults. Data will be used to inform future studies and quality improvement activities. ImpactIt is envisioned that the registry will act as a spine project for future multi-disciplinary research opportunities including interventional studies, data linkage studies and quality improvement projects, thus enabling robust medium – long term examination of outcomes of interest, such as mortality, rehospitalisation and admission to residential aged care within this area of growing concern. There are plans to engage more disciplines in the registry's research capacity-building endeavours and we have identified the need for greater consumer engagement and public involvement. The sustainability of the registry needs to be considered within the context of ongoing research funding and making better use of these data for continuous quality improvement. Registry registrationThe registry was registered with the Australian Register of Clinical Registries (Australian Commission on Safety and Quality in Healthcare) on 3rd August 2020.(Australian Commission on Safety and Quality in Healthcare, 2020) Reference ACSQHC-ARCR-095. Available via https://www.safetyandquality.gov.au/australian-register-clinical-registries

Characterising trauma-informed aged care: An appreciative inquiry approach.

While Trauma-informed care (TIC) has the potential to improve the quality of aged and dementia care, the challenge remains in translating the principles of TIC into practice. This study aimed to characterise what trauma-informed aged care looks like in practice, by learning from an aged care service acknowledged as delivering trauma-informed aged care effectively. We conducted an appreciative inquiry study within a residential aged care service catering for veterans and others with trauma histories. Observation of care behaviours, interviews with staff and residents, and organisational policy mapping were used to identify elements that maximised care safety and accessibility for trauma survivors. Data were analysed and triangulated using a framework analysis approach. The aged care provider embedded the principles of TIC into its staff training (i) to promote understanding of how trauma may affect experiences in care, and (ii) to adapt care when appropriate to promote safety. The service promoted a calm atmosphere where residents could make choices and felt safe. Uniforms and signage provided consistency, clarity, and transparency for residents. Staff behaviours demonstrated respect, fostered trust, and anticipated needs without unnecessarily imposing care. Staff consistently offered choices, used residents' names, sought permission before providing care, and offered reassurance. Staff reported high morale with a commitment to delivering high quality care, and feedback to management. Effective communication promoted information sharing and trust among staff. Trauma-informed practice was facilitated through organisational policy, a dignified environment, and thoughtful staff behaviour creating safety, choice, and control for residents.

Review article: Roles of activities of daily living and frailty assessments for residents of residential aged care services in emergency department transfers: A scoping review.

Residents from residential aged care services (RACS) (i.e. nursing homes) many of whom are frail or disabled, are frequently transferred to ED for treatment of acute episodes of illness or injury. This review scoped the research related to the ways in which frailty or activities of daily living (ADL) measures are used for clinical purposes, either prior to the transfer of patients to ED or in ED themselves. A search for original studies up to June 2021 that included participants aged 65 years or over was conducted across four databases. Abstracts were first reviewed, leading to full text screening and article selection. Thirty-four studies were included in the scoping review. Most of the ADL and frailty assessments were conducted in residential aged care settings. In seven studies, ADL or frailty assessments in the aged care setting contributed to reduced transfer rates to ED. No results were found that associated the assessment of ADL or frailty with decisions related to treatment in the ED. A single ED study involved specialist emergency nursing in an ED as an intervention which included frailty assessment and led to decreased hospitalisation. This scoping review confirms an opportunity for further research into the ways frailty and ADL assessments are used for decision making in relation to the transfer of frail older people to ED, including how these assessments influence their treatment.

Nutrition and diabetes self-management in aged care: Exploring community-dwelling older adults' expectations.

To explore the diabetes self-management expectations of older adults with diabetes, not yet accessing residential aged care services. Admission to residential aged care (RAC) can create many interruptions to usual food choices and diabetes self-management, and we know little about the concerns of the emerging ageing population. This is a qualitative study employing focus groups and inductive thematic analysis involving 18 older adults with diabetes between the ages of 60 and 88, living in their own homes within an Australian city. Focus groups were recruited on a sequential basis and progressively analysed using an inductive process until data saturation was reached. Focus groups were digitally recorded and transcribed verbatim for thematic analysis. Three key themes were generated: autonomy, individualised dietary management and the food service system. Older adults speculated that they would want a collaborative approach to maintain their health in ageing and to self-manage their diabetes while feasible. Participants wanted autonomy over food choices, flexible meal timings and quality meals. There was a significant anxiety that aged care staff and existing food service systems in RAC could not support these preferences. Community-dwelling older adults with diabetes would highly value aged care services that facilitated autonomy, individualised nutrition support and flexibility, but feared this will not be feasible. The introduction of new diabetes and RAC guidelines may require an implementation plan to include the full food service system, from staff education to meal preparation, ordering and service.

Ethical Design and Use of Robotic Care of the Elderly

The Australian Royal Commission into Aged Care Quality and Safety acknowledged understaffing and substandard care in residential aged care and home care services, and recommendations were made that that the Australian Government should promote assistive technology within aged care. Robotic care assistants can provide care and companionship for the elderly—both in their own homes and within health and aged care institutions. Although more research is required into their use, studies indicate benefits, including enabling the elderly to live independently at home, assistance with medication and monitoring of safety. Nevertheless, there are inherent ethical challenges in the use of robots as carers, including loss of privacy, unwarranted restrictions on autonomy, lack of dignity, deception, and the exacerbation of loneliness. Ethics by design can counter these issues in development of robotics and clinical ethics committees have been put forward as a way of dealing with the ethical use of robotic care in healthcare institutions. In this paper I outline the ethical challenges of robotic care assistants and how these may be mediated in their design and use.

Sarcopenia risk in nursing home residents using SARC-F: FIRST study findings.

Sarcopenia is a common disorder of loss of muscle mass and function among older adults; however, few studies have examined screening instruments for sarcopenia risk in residential aged care services (RACS). The aims of this study were to measure sarcopenia risk in RACS residents using the SARC-F, describe factors associated with sarcopenia risk and examine the predictive validity of the SARC-F for 12-month mortality. This was a prospective cohort study carried out in South Australian RACS across 12 sites. In total, 541 residents (mean age 87.7 [7.3] years, 72.6% women) were included in the study. Sarcopenia risk was measured using a modified SARC-F (≥4 point cut point). We identified 89.5% (n=484) of residents at risk of sarcopenia. Significant (P > 0.05) predictors of sarcopenia risk in multivariable analysis included the presence of diabetes (relative risk [RR]=1.08), classification as most-frail (RR=1.06) and smaller Nursing Home Life Space Diameter (NHLSD) score (RR=0.99). Mortality was observed in 20.9% (n=113) of residents over a 12-month follow-up. Classification as at-risk of sarcopenia was a significant predictor of 12-month mortality; however, it had a poor area under the receiver operator curve (0.56), and a low positive predictive value (23.1%). The best performing cut-point of ≥7 also had poor discriminative ability (under the receiver operator curve=0.66, positive predictive value=30.8%). Sarcopenia risk is extremely common among RACS residents and its presence is a significant contributor to 12-month mortality. Low discriminative ability for the SARC-F was noted across multiple cut-off scores for predicting mortality at 12months. Diabetes management and promoting physical activity and nutrition among RACS residents are likely to influence sarcopenia risk positively. Geriatr Gerontol Int 2022; 22: 206-212.

Prevalence of Eye Conditions, Utilization of Eye Health Care Services, and Ophthalmic Medications After Entering Residential Aged Care in Australia.

PurposeThis study aims to evaluate the burden and trends of eye diseases, utilisation of eye health care services, and ophthalmic medications among older people living in residential aged care facilities in Australia.MethodsA cross-sectional study was conducted using data from the Registry of Senior Australians. Individuals aged ≥65 years who entered permanent residential aged care facilities between 2008 and 2015 were included. The prevalence (95% confidence interval [CI]) of eye diseases by year, eye health care services, and ophthalmic medication use within a year of entry into the service were evaluated. Poisson regression models estimated adjusted rate of change using prevalence ratio (PR) by age, sex, state, and frailty scores.ResultsOf the 409,186 people studied, 43.6% (N = 178,367) had an eye condition. Of the total cohort, 32.9% (N = 134,566) had chronic eye conditions and 19.7% (N = 80,661) had an acute eye condition. Common chronic eye conditions were glaucoma (13.6%, N = 55,830), cataract (8%, (N = 32,779), blindness (4.5%, N = 18,856), and poor vision (10.3%, N = 42,245). Prevalence of any eye condition (2008: 42.7%, 95% CI = 42.2%–43.2% and 2015: 41.2%, 95% CI = 40.8–41.6%, PR = 0.99, 95% CI = 0.99–0.99, P < 0.001), acute eye conditions (2008: 19.8%, 95% CI = 19.4%–20.2% and 2015: 17.4%, 95% CI = 17.1%–17.6%, PR = 0.97, 95% CI = 0.97–0.98, P < 0.001), and blindness (2008: 5.2%, 95% CI = 5.0%–5.4% and 2015: 3.7%, 95% CI = 3.5%–3.9%, PR = 0.93, 95% CI = 0.93–0.94, p < 0.001). decreased over the study period. The prevalence of glaucoma (2008: 13.5%, 95% CI = 13.2%–13.8% and 2015: 13.8%, 95% CI = 13.5%–13.7%; PR = 1.01, 95% CI = 0.99–1.10, P < 0.001) and cataract (2008: 7.4%, 95% CI = 7.2%–7.7% and 2015: 8.5%, 95% CI = 8.3%–8.7%, PR = 1.00, 95% CI = 1.00–1.01, P < 0.001) remained stable or slightly increased. Overall, 46.4% (N = 82,769) of individuals with eye conditions, accessed at least one eye health service within the first year of entering residential care and 70.5% (N = 125,673) used at least one ophthalmic medication. Optometric services (41.7%, N = 74,358) were the most used eye health care services and anti-infective eye drops (37.2%, N = 66,331) were the most commonly dispensed medications.ConclusionsThe prevalence of blindness among older Australian using residential aged care services decreased over the study period. However, the burden of eye diseases remained high between 2008 and 2015, whereas the use of eye health care services was disproportionately low. This study provides evidence of a significant need for eye health care services for older people with an eye disease in residential aged care facilities.Translational RelevanceFour in ten long term aged care residents in Australia had at least one eye condition over the study period, indicating potential for a high eye health care needs in aged care settings.