People In Residential Aged Care Research Articles

Nurse-led multidisciplinary initiatives to improve outcomes and reduce hospital admissions for older adults: The Care coordination through Emergency Department, Residential Aged Care and Primary Health Collaboration project.

This article describes the Care coordination through Emergency Department, Residential Aged Care and Primary Health Collaboration (CEDRiC) project. CEDRiC is designed to improve the health outcomes for older people with an acute illness. It attempts this via enhanced primary care in residential aged care facilities, focused and streamlined care in the emergency department and enhanced intersectoral communication and referral. Implementing this approach has the potential to decrease inappropriate hospital admissions while improving care for older people in residential aged care and community settings. This article discusses an innovative way of caring for older adults in an ageing population utilising the existing evidence. A formal evaluation is currently underway.

There is more to life than risk avoidance – elderly people’s experiences of falls, fall-injuries and compliant flooring

ABSTRACTPurpose: Falls are the most common cause of injury in all ages and are especially difficult to prevent among residential care residents. Compliant flooring that absorbs energy generated within the fall, has been proposed as a measure to prevent fall-injury, however little is known regarding the implementation aspects in clinical settings. The aim of this study is to explore the experiences of falls, the risk of fall-injury, prevention in general and specifically compliant flooring as an injury preventative measure amongst frail elderly people living in a residential care facility with compliant flooring. Through this, generate a theory that further explains the underlying barriers of active prevention amongst elderly people.Method: We used the grounded theory method and conducted semi-structured in-depth interviews with eight elderly people in residential care (data collected between February and December 2017).Results: The identified categories were Falling as a part of life, Fearing the consequences and A wish to prevent falls and injuries. Through the results it was clear that There is more to life than risk avoidance, permeated the interviews, therefore forming the grounded theory. The interviewees viewed falls as something common and normal, and were uninterested in focusing on the risk of falls. Although they wanted to prevent falls, it was often difficult to integrate preventative measures into their everyday life. They embraced the idea of an injury-reducing compliant flooring, however their main interests lay elsewhere, preferring to focus on social interaction and issues concerning daily activities.Conclusions: The theory generated in this paper proposes explanations on the obstacles of implementing fall prevention measures in an elderly frail population. The findings give insights as to why interest and compliance for active fall prevention measures are low. We conclude that complaint flooring, from the perspective of the residents, can work well in residential care.

Access to food choices by older people in residential aged care: An integrative review

BackgroundThere is increasing concern regarding autonomy and quality of life for older people living in residential aged care. Failure to provide food choices and suitable dining environments has been reported to negatively impact their nutritional status, undermining their sense of autonomy and quality of life. AimThis paper presents an integrative review of studies on food choices in residential aged care and explores the relationships between food choices, autonomy and quality of life. MethodsSearch of nine databases CINAHL, PubMed, Scopus, PsycINFO, ProQuest, Cochrane, Embase, AMED, and Social Science Citation Index, identified nine primary articles. The Critical Appraisal Skill Program tool was used to examine the quality of these articles. FindingsThree key themes were identified: (1) Prevalence of food choices and catering for residents’ preference; (2) Importance of food choices to nutritional status; (3) Impact of food choices on autonomy and quality of life. The importance of increasing staff awareness and a need to develop aged care regulation to ensure adequate food choices provided. DiscussionThe importance of increasing staff awareness regarding the interrelatedness of respecting older people’s food choices, autonomy and quality of life is identified. The needs of determining aged care regulation and accreditation standards were also highlighted. ConclusionFailure to provide satisfying food choices impacts older people’s quality of life. However, the strength of the relationships between food choices, autonomy and quality of life requires further study.

Palliative care in residential aged care: An overview.

To measure how care needs, health and length of stay in permanent residential aged care differs by assessed need for palliative care. On entry into permanent residential aged care, people's care needs and health conditions are assessed on the Aged Care Funding Instrument. Data for the period 2008-2009 and 2015-2016 were analysed for trends in care needs, health conditions, length of stay and separation reason across assessed need for palliative care. Assessed care needs have increased for all people in residential aged care over this period, and people appraised for palliative care were more likely to be rated 'high' in need for support in activities of daily living. People appraised for palliative care had a higher prevalence of cancer and shorter length of stays. Palliative care appraisal is associated with increased complexity in assessed care needs, different profiles of health and shorter length of stays in permanent residential aged care.

‘I’d rather die happy’: residents’ experiences with food regulations, risk and food choice in residential aged care. A qualitative study

Background: Food regulations exist to protect older people in residential aged care, leading to the restriction of potentially hazardous foods. The impacts of malnutrition, resident centred care and the importance of maintaining individual autonomy for older people are well documented. By contrast, there is scant literature describing residents’ perceptions of food regulations and food risks in the residential aged care setting. Aims: The aim of this study is to explore resident perceptions of food choice and food restrictions in residential aged care. Methods: Using a qualitative, hermeneutic phenomenological design, semi-structured interviews were conducted with six participants recruited from two residential aged care facilities. Interviews were audio-taped, transcribed verbatim and thematically analysed. Results: The following key themes emerged in this study: participants were largely unaware of food regulations and risks, yet expressed the desire to make their own choices. Participants provided contradictory accounts of their experiences with food in residential aged care, which emphasises the ongoing challenge of meeting individual preferences. Conclusion: These themes warrant further investigation, particularly in relation to the impact of food regulations on food choice and the meaning of risk to older people in residential aged care. This research provides new insight into the perceptions of residents regarding their individual autonomy and independence against legislated risk minimization strategies.Impact statementThis article raises the issue of risk taking and food choices from the perspective of residents in a residential aged care facility.

Ethics, intimacy and sexuality in aged care.

To analyse the accounts of staff, family and residents to advance ethical insights into intimacy and sexuality in residential care. Discourses of ageing readily construct people in residential aged care as postsexual, vulnerable and at risk of sexual exploitation, and therefore, expressions of intimacy and sexuality may be responded to as deviant and inherently risky. Staff may manage decision-making tacitly, without recourse to policies and education. The proof-of-concept study used a discursive methodology, identifying discourses that shape diverse meanings of intimacy, sexuality and ageing. Data analysis involved thematic analysis. Semi-structured interviews were conducted with four participants in 2015 as part of a mixed-methods study. This article reports on the qualitative data. Four themes were identified in the data analysis: mediated intimate relationships and everyday ethics; self-referential morality; knowing the person then and now; and juggling ethical priorities. Data indicated that participants used their personal moral compass to inform their decision-making, without any related policies and applied ethics and communication education. As a result, staff described moral uncertainty and moral distress. Staff indicated that there were tensions in terms of the role of proxy decision-makers, as there were situations where staff believed they were more aware of residents' current wishes and cognitive capabilities than family members. Staff, families and residents routinely address intimacy and sexuality in aged care. Ethically informed education and policies may enhance the role of staff as advocates, ensuring older people living in RAC are as at home and autonomous as possible.

Streamlining care of older people in residential aged care: Nurse practitioner candidate and emergency department care coordination

Streamlining care of older people in residential aged care: Nurse practitioner candidate and emergency department care coordination

Vitamin D response of older people in residential aged care to sunlight-derived ultraviolet radiation.

The aim of this study was to determine the vitamin D response to sunlight ultraviolet radiation in older people. Increases in vitamin D depended on the season of exposure, but the changes were small. Natural sun exposure is not a practical intervention for vitamin D deficiency in this population. The purpose of this study is to measure the ultraviolet radiation (UVR) exposure of those in residential aged care in an earlier trial of sunlight exposure and to determine its effect on their vitamin D response. Attendance data, demographic, clinical and biochemical variables for 248 participants were used for a secondary analysis of a previous cluster randomized trial of sunlight exposure and falls. The ambient solar UV Index data were used to calculate the participants' UVR dose. Multiple linear regression was used to test if UVR exposure over 6 months, as measured by the standard erythemal dose (SED), was a predictor of vitamin D response, controlling for age, gender, BMI, calcium intake, baseline vitamin D and season of exposure. The median 25-hydroxyvitamin D (25OHD) was 32.4 nmol/L at baseline and 34.6 nmol/L at 6 months (p = 0.35). The significant predictors of 25OHD at 6 months were UVR exposures in spring-summer (coefficient = 0.105, 95 % confidence interval (CI) 0.001-0.209, p = 0.05) and autumn-winter (coefficient = 0.056, 95 % CI 0.005-0.107, p = 0.03) and baseline vitamin D (adjusted coefficient = 0.594, 95 % CI 0.465-0.724, p = 0.00). In those starting sunlight sessions in spring, an increase of 1 unit in log SED was associated with 11 % increase in 25OHD. Natural UVR exposure can increase 25OHD levels in older people in residential care, but depends on the season of exposure. However, due to inadequate sun exposure, 25OHD did not reach optimal levels. Nevertheless, where sun exposure is encouraged in this group, the focus for the start of exposure should be in the months of spring or autumn, as this timing was associated with a vitamin D response.

Nursing practice in nutritional care: a comparison between a residential aged care setting and a hospital setting

To explore the similarities and differences in the nursing practice in nutritional care between a residential aged care setting and a hospital setting. Despite being preventable and treatable, undernutrition remains a problem for many older people in residential aged care and hospital settings. Nurses have a crucial role in assisting people who are unable to eat independently and are uniquely positioned to implement solutions that will lead to better nutritional care. During 2007-2010, an action research study was conducted, underpinned by the principles of the participatory world view to address undernutrition in a residential aged care setting and a hospital setting. The multimethod approach of data and between-method triangulation were used to collect and analyse qualitative non-participant observations and action research group data. Non-participant observations and action research group data were qualitatively analysed using the Analytic Hierarchy. How nurses chose to participate in the provision of nutritional care and assert their autonomy when changing practice to nutritional care affected the quality of the resident/patient mealtime experience. Operational efficiency influenced the choices that nurses made about the type of intervention to implement to improve nursing practice in nutritional care. Nurses required management approval to change practice in nutritional care. The reasons for undernutrition are multifactorial and more research is needed to investigate the organizational structures and processes that affect the delivery of nutritional care across role functions, how these affect the continuity of care and the nurses' role in defining the culture around resident/patient mealtimes.

Interviewing Older People in Residential Aged Care About Sexuality: Difficulties and Challenges

Sexuality is a sensitive topic that can be awkward and difficult to research qualitatively. When the research participants are older people living in residential aged care, some of whom have dementia, the process can be even more challenging. In this article, we outline the difficulties encountered in conducting face-to-face qualitative interviews with older people in residential aged care as part of a research project on sexuality conducted in the states of Victoria and Queensland, Australia. We explore issues surrounding ethics and recruitment and considerations for accessing residents with cognitive impairment, difficulties with the interview process, and the collection of meaningful data from participants. We provide advice and recommendations for future researchers on how to potentially minimize problems associated with conducting qualitative face-to-face interviews on sexuality with older people in residential aged care.

Mobility has a non-linear association with falls risk among people in residential aged care: an observational study

What is the association between mobility and falls risk for people living in residential aged care? Can the Physical Mobility Scale discriminate between residents at risk of falling and those not at risk? Prospective longitudinal observational study. Six residential aged care facilities in Australia. Eighty-seven high- and low-level care permanent residents. The primary outcome measure was the number of falls in the six months after the initial mobility assessment. Mobility of all participants was assessed using the Physical Mobility Scale, which includes nine mobility items assessed on a 0-5 scale yielding a total score out of 45. During the six-month study period, 131 falls were reported. Residents with mild mobility impairment (Physical Mobility Scale total score 28-36) had the highest fall risk (hazard ratio = 1.98, 95% CI 1.30 to 3.03). Residents with fully dependent mobility (Physical Mobility Scale total score 0-9) had the lowest risk for falls (HR=0.05, 95% CI 0.01 to 0.32). Aged care residents with mild mobility impairment are at increased risk of falls and are an appropriate target for falls prevention strategies. Although improving the mobility of residents with moderate to severe mobility impairment may enhance their independence and reduce their burden on staff, paradoxically this may also increase their risk of falls. When these residents improve enough to progress into a higher category of mobility, physiotherapists should be aware that this may increase the risk of falls and should consider instituting appropriate falls prevention strategies.

Seeking Meaning: Making Art and the Experience of Spirituality in Dementia Care

How do people find meaning in the experience of dementia? Can people living with dementia be supported in meaningful activities that may alleviate depression and increase their sense of well-being? Many programs are offered for people in residential aged care, but little is known about the effectiveness of these programs. This article reports on the qualitative component of a study engaging 15 older adults with dementia and depression in a program of person-centered art making. The weekly facilitated study groups met over an 18-month period, with a three-month follow up. The importance of engagement in the process of art making is emphasised.

Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial

Sophisticated approaches are needed to improve the quality of care for elderly people living in residential care facilities. We determined the effects of multidisciplinary integrated care on the quality of care and quality of life for elderly people in residential care facilities. We performed a cluster randomized controlled trial involving 10 residential care facilities in the Netherlands that included 340 participating residents with physical or cognitive disabilities. Five of the facilities applied multidisciplinary integrated care, and five provided usual care. The intervention, inspired by the disease management model, consisted of a geriatric assessment of functional health every three months. The assessment included use of the Long-term Care Facility version of the Resident Assessment Instrument by trained nurse-assistants to guide the design of an individualized care plan; discussion of outcomes and care priorities with the family physician, the resident and his or her family; and monthly multidisciplinary meetings with the nurse-assistant, family physician, psychologist and geriatrician to discuss residents with complex needs. The primary outcome was the sum score of 32 risk-adjusted quality-of-care indicators. Compared with the facilities that provided usual care, the intervention facilities had a significantly higher sum score of the 32 quality-of-care indicators (mean difference - 6.7, p = 0.009; a medium effect size of 0.72). They also had significantly higher scores for 11 of the 32 indicators of good care in the areas of communication, delirium, behaviour, continence, pain and use of antipsychotic agents. Multidisciplinary integrated care resulted in improved quality of care for elderly people in residential care facilities compared with usual care. www.controlled-trials.com trial register no. ISRCTN11076857.

Reclaiming time for nursing practice in nutritional care: outcomes of implementing Protected Mealtimes in a residential aged care setting

To improve nutritional care and the mealtime experience of older people in a residential aged care setting by assisting nurses to create change to their practice and to the mealtime environment. Despite being preventable and treatable, inadequate nutrition remains a problem for many older people in residential aged care and tertiary health care settings. Nevertheless, many organisations are uniquely positioned to implement solutions that will lead to better care. The study used a qualitative, action research approach, grounded in the participatory worldview. The multimethod approach of data and between-method triangulation were chosen to assist in understanding the multidimensional issues associated with resident mealtimes and the provision of nutritional care. The collection of non-participant observations was informed by aspects of the Developmental Research Sequence. Action group meetings and non-participant observations were qualitatively analysed using the Analytic Hierarchy. Protected Mealtimes was tailored for the residential aged care unit. The most significant change involved the transformation of system processes by creating the space in nurses' busy schedules and thus reclaiming time for nurses to reconnect with nutritional care. Fixed role boundaries were made flexible by assisting individuals to understand and extend their roles in nutritional care. Most importantly, sustainability of Protected Mealtimes was achieved and long-term changes around nutritional care continued to be resident focused. This study demonstrates that lasting changes to nursing practice in nutritional care can be achieved by applying the principles of a participatory worldview and action research. CHANGE is challenging to achieve in complex health care organisations. This study bridges the gap between theory and practice and has shown that nurses can create change by employing a participatory worldview and action research as part of their toolkit for problem solving.

An instrument to assess nurses’ and care assistants’ self-efficacy to provide a palliative approach to older people in residential aged care: A validation study

ObjectiveThis study investigated the psychometric properties of the ‘Palliative care self-efficacy scale’, an instrument designed to assess clinicians’ degree of confidence in engaging in patient and family interactions at the end-of-life. DesignThe instrument was administered to 405 aged care professionals employed in nine aged care facilities. Exploratory factor analysis and internal consistency statistics were undertaken. ResultsA two-factor solution of the ‘Palliative care self-efficacy scale’ was extracted with factor loadings above the 0.4 cutoff. Cronbach's alpha of the scale and subscales ranged from 0.87 to 0.92. The ‘Palliative care self-efficacy scale’ demonstrates good validity and reliability. ConclusionsThe ‘Palliative care self-efficacy scale’ can be a useful tool in assessing and monitoring clinicians’ perceived capacity to provide a palliative approach. Further evaluation in other samples and settings is required.

Young people in aged care: progress of the current national program

The aim of this paper is to examine the progress and effect of the current 5-year $244 million National Young People in Residential Aged Care program on the reduction of young people in aged care. Semi-structured telephone interviews with 20 service providers, 10 advocacy organisations and 6 public servants across Australia actively involved in the implementation of the program. The development of new accommodation options has been slow. The 5-year program aims to move 689 young people out of nursing homes; in the first 4 years of the initiative only 139 people had moved out. The lives of those who have been helped by the program have been enormously improved. This study highlights the challenges of achieving a long-term reduction in the number of young people in residential aged care, including the challenge of achieving systemic change to prevent new admissions. Implications. The accommodation options currently being developed for this target group will soon be at capacity. Without sustained investment in developing alternative accommodation options and resources to implement systemic change ~250 people under 50 are likely to continue to be admitted to aged care each year in Australia.

Eine differenzierte Darstellung der Kostenstelle Pflege bei stationären Altenhilfeeinrichtungen

The cost centre „care“ within the residential care for elderly people comprises of the following basics: care, medicalattendance care, social care and indirect care. Within the scope of a documentation analysis, two institutions forresidential care of elderly people in the North of Bavaria/Germany, comprising 273 patients were investigated in theyear 2005. The information about the quantity and duration of the respective performance within these care processeswere of relevancy here. The high total cost share of the cost centre “care” underlines the research activities.The actually rendered performances within the care treatment and in the social care field were registered in quantityby means of a performance evaluation throughout the cover period 2005. The data of the indirect care could begathered by means of a secondary analysis and of the actual-working hours. The quantity and time of the basic careperformances could be appointed as a result of the available data aswell as of the instructions stipulated in the Code of Social Law XI.The results of this research project are very extensive. The resultsof these four investigated performance types and of the investigatedperiod concerning basic care performances are representedin this article. A central result is the percentual distribution of thefour investigated performance types of the cost centre “care.” Furthermore,an answer could be found concerning the questionabout the performed minutes in the area basic care per care leveland per patient.The systematic registration of data and hours could not alwaysbe fully completed because the available documentation wasincomplete.The objective of this investigation was to gather an overallview as close as possible about the cost centre “care” together withits various performance types. The results of this investigation enablea precise consideration of the cost center “care.” Another objectiveof the research activities is to complete the cost centre accountingwithin the residential care of elderly, and to develop anew cost unit accounting based on this collected data.

Effectiveness of multifaceted fall-prevention programs for the elderly in residential care

Background:Unintentional falls are particularly prevalent among older people and constitute a public health concern. Not much is known about the implications of multifaceted intervention programs implemented in residential care settings.Objectives:To...

Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial

Objective To assess the effectiveness of an activity programme in improving function, quality of life, and falls in older people in residential care.Design Cluster randomised controlled trial with one year...

Promoting quality care for older people in meal management: whose responsibility is it?

Objective: To examine the role of registered nurses and allied health workers in meal management, assessment, safe environment and care planning for older people in residential aged care. Primary Argument: Nurses and carers are often the first to observe and put into place strategies to prevent choking in residents with swallowing difficulties. Coroners’ reports have raised issues with regard to the role of the registered nurse, resident autonomy and the effectiveness of speech pathologist assessments in avoiding incidents that compromise resident’s health and well being. Conclusions: In residential aged care the role of the registered nurse involves managing a complex environment. In the area of meal management, nurses are struggling to have their knowledge and expertise recognised. Nurses need to develop strategies to articulate and demonstrate their contribution to meal management in order to promote their knowledge and skills. Nurses must actively continue to develop their body of knowledge through research; otherwise ‘expert’ knowledge will be accessed from elsewhere. This paper will outline a number of areas for future development and research which focuses on the needs of older people and staff in this area.