Rural Aged Care Facilities Research Articles

Personalised music for residents with dementia in an Australian rural aged-care setting.

Personalised music reportedly has a positive effect on behaviour and mood in people living with dementia. This intervention has not been conducted in low-resourced or rural aged-care settings. We evaluated the effect of a non-therapist-led personalised music listening intervention on residents with dementia and workplace culture in a rural aged-care facility in South Australia. Qualitative pilot study. Rural aged-care home in South Australia. Ten residents with dementia and 15 aged-care staff participated in this study. Ten residents participated in an 8-week music program. Four focus groups were conducted with aged-care staff post-intervention. A thematic analysis was used to identify emerging themes. Personalised music positively influenced resident's behaviour and well-being, social interaction and the workplace environment and culture, and served as a useful tool for personalised care. Three themes emerged: quality of life, personalised care and better aged-care environment. Personalised music positively influenced resident's behaviour and well-being, social interaction and the workplace environment and culture, and served as a useful tool for personalised care. Personalised music program is an effective, low-cost intervention to improve quality of life and personalised care of residents living with dementia, staff well-being, and a workplace and culture in low-resourced or rural aged-care settings.

Person-centered, non-pharmacological intervention in reducing psychotropic medications use among residents with dementia in Australian rural aged care homes

BackgroundHigh rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention.MethodsOur larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n = 31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.ResultsThe median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n = 27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medications, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control.ConclusionsOur findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data.Trial registrationANZCTR, ACTRN12618000263291. Registered on 20th February 2018.

Improving eye care in residential aged care facilities using the Residential Ocular Care (ROC) model: study protocol for a multicentered, prospective, customized, and cluster randomized controlled trial in Australia

BackgroundOlder adults in residential aged care facilities have unnecessarily high levels of vision impairment (VI) which are largely treatable or correctable. However, no current comprehensive eye health service model exists in this setting in Australia. We aimed to determine the clinical, person-centered, and economic effectiveness of a novel eye care model, the Residential Ocular Care (ROC).Methods/designThis protocol describes a multicentered, prospective, randomized controlled trial. A total of 395 participants with distance vision < 6/12 (0.30 LogMAR) and/or near vision N8 (1.00 M) or worse will be recruited from 38 urban and rural aged care facilities across Victoria, Australia. Aged care facilities will be randomized (1:1) to one of two parallel groups. Participants in the ROC group will receive a comprehensive and tailored eye care pathway that includes, as necessary, refraction and spectacle provision, cataract surgery, low vision rehabilitation, and/or a referral to an ophthalmologist for funded treatment. Usual care participants will be referred for an evaluation to the eye care service associated with the facility or an eye care provider of their choice. The primary outcome will be presenting near and distance vision assessed at the two- and six-month follow-up visits, post baseline. Secondary outcomes will include vision-specific quality of life, mobility, falls, depression, and eye care utilization at two and six months. An incremental cost-effectiveness analysis will also be undertaken.DiscussionThe ROC study is the first multicentered, prospective, customized, and cluster randomized controlled trial in Australia to determine the effectiveness of a comprehensive and tailored eye care model for people residing in aged care facilities. Results from this trial will assist health and social care planners in implementing similar innovative models of care for this growing segment of the population in Australia and elsewhere.Trial registrationAustralian and New Zealand Clinical Trials Registry, ACTRN12615000587505. Registered on 4 June 2015 – retrospectively registered.

Managing chronic diseases in rural aged care facilities using point-of-care testing systems

Chronic health conditions represent a significant challenge to global health. By 2020, they will account for 73% of all deaths and 60% of the global burden of disease. The main contributing conditions include: cancer; cardiovascular disease which mainly includes heart disease and stroke; and diabetes. Chronic disease management (CDM) has been a significant focus for many countries worldwide. CDM is characterised by a systematic and coordinated approach from various stakeholders to provide patient-centred care. Successful CDM is dependent on many aspects of health care. These include coordinated care between various organisations; using the best available evidence; support for self-management; and regular review and follow up. Regular reviews of patients with chronic diseases are essential for effective disease management. Reviewing data concerning patients’ perspectives of their diabetes management, together with contributions from other members of the healthcare team such as diabetes educators and nurses, will provide critical information to clinicians. Such reviews assist clinicians to set clear goals to improve patients’ chronic disease management and prevent complications.

Barriers to managing behavioural and psychological symptoms of dementia: Staff perceptions

Residential aged care facilities are increasingly using pharmacological methods of managing BPSD such as antipsychotics, despite little evidence of effectiveness and high rates of adverse effects. Nonpharmacological approaches to management of behavioural and psychological symptoms of dementia (BPSD) have not been widely implemented in residential aged care, despite reported effectiveness of these strategies. Residential aged care staff opinions on the effectiveness of non-pharmacological approaches to dementia care and any limitations to their use are not well documented. This is the qualitative arm of a broader research project. A 43-point questionnaire was distributed to 6 rural aged care facilities to explore nurses' perceptions of the limitations of five commonly employed non pharmacological and pharmacological interventions in managing BPSD. Staff reported that some non-pharmacological methods of managing BPSD were not the role of nursing staff. This suggests that other interventions such as increased staffing levels would not be effective in facilitating non pharmacological approaches to managing BPSD.

Diabetes management in Australian rural aged care facilities: A cross--sectional audit.

There is gap in the literature regarding the current practice of diabetes management of the elderly in Australia and its compliance with available Australian diabetes practice guidelines. The aims of this study were to describe the pharmacological management of elderly residents with diabetes living in aged care facilities and to identify areas for improvement in the current management as recommended by the current diabetes management guidelines in Australia. Residents with diabetes from three rural aged care facilities were identified by nursing staff. A cross-sectional medical record audit was carried out to obtain data of residents diagnosed with diabetes. Thirty-four medical records were audited from three aged care facilities.Data including demographics, medical histories and medications were collected and analysed. This study had two key findings; Firstly, it showed that about a third of residents with type 2 diabetes are managed with diet only. Secondly, of the residents who are managed with medications, less than half of those audited (41%) were managed according to the current diabetes guidelines in terms of pharmacological treatment which included anti- hypertensive, lipid lowering and anti- platelet therapies. Of those patients with a history of CVD, all were receiving an antihypertensive medication, 71% were not managed for their lipids and 20% were not on any prophylactic anti- platelet therapy. Management of patients with diabetes living in rural aged care facilities is inconsistent with the current management guidelines. Educational interventions targeting health professionals and patients might be beneficial to increase compliance with the current diabetes guidelines.

Using mixed methods to develop and implement a work sampling tool in residential aged care

AbstractDespite chronic workforce problems associated with recruitment and retention of care staff in rural residential aged care facilities, there are few research studies that provide methodological guidance on how to investigate care practices. Developing an understanding of workflow and work practices is core to providing solutions in an environment of complexity and change. Based on the authors’ experiences, the purpose of this paper is to document an embedded mixed methods design providing an example of how to best capture the multi-focused work practices in residential aged care. Detail is provided on the development and implementation of a work sampling tool, along with the collection of qualitative contextual data. Processes and challenges involved are highlighted to offer a way forward for future research.

The management of behavioural problems associated with dementia in rural aged care

In Australia 60-80% of all residents in aged care facilities have a cognitive impairment related to dementia with this figure predicted to increase. The associated behavioural and psychological disorders associated with dementia frequently result in the prescription of antipsychotic drugs to assist in limiting disruptive or concerning unmet needs behaviour. Antipsychotic prescription rates in aged care facilities are estimated to be as high as 80% despite the well known adverse effects in this population. Person centred care approaches to management of behavioural and psychological symptoms of dementia (BPSD) has not been widely implemented despite its reported effectiveness. Other interventions aimed at reducing antipsychotic use in aged care has been limited and the barriers to the use of non pharmacological strategies are poorly researched. In this study a 43 point questionnaire was distributed to 6 rural aged care facilities to assess nurses' knowledge of non pharmacological and pharmacological interventions, and the frequency, perceived barriers and efficacy of both strategies. Resources and information bases utilised in behaviour management was also explored. The results indicated that staff have a good knowledge of possible underlying causes of BPSD, but a poor understanding of appropriate methods of management and resources available to assist them. Time constraints were frequently cited by respondents as problematic in managing behavioural problems. The results of this study suggest the need for utilisation of tools to assist nurses to identify target behaviours, implementation of appropriate management and access to the resources available.

A review of pharmacist recommendations in an aged care facility

The aim of this study was to analyse the types of and rationale for the clinical recommendations made by the pharmacist in a rural aged care facility to improve patient safety. The classes of drugs associated with the pharmacist's recommendations were also identified. A related aim was to determine their degree of acceptance by medical practitioners. A retrospective, cross-sectional study design was used to review 56 aged care residents' case notes over a 12-month period. The main outcome measures included: the types of and reasons for recommendations made by the pharmacist; classes of drugs associated with the pharmacist's recommendations; and the implementation rate of the pharmacist's recommendations by the medical practitioner. A total of 196 recommendations were made by the pharmacist to the residents' existing medications. The main types of recommendations were alteration to residents' monitoring (49%), discontinuation of drug treatment (19%) followed by initiation of drug treatment (17%). The main reasons for the recommendations were to reduce potential side-effects (45%), symptom control (32%) and to increase drug efficacy (19%). Analysis of medical practitioners' case notes estimated that 70% of the pharmacist's recommendations were being implemented by the residents' medical practitioner. This case notes analysis reinforces the importance of doctor-pharmacist collaboration in the management of residents' medications in aged care facilities.

Reducing and/or minimising physical restraint in a high care, rural aged care facility

Background This report takes you through a journey of implementing evidence-based best practice guidelines in relation to physical restraint in an aged care facility. It describes the processes involved in making changes to an existing system, introducing evidence-based guidelines and collaboratively achieving compliance with best practice. The project formed part of a combined initiative between the Joanna Briggs Institute and the Commonwealth Department of Health and Ageing, called the Aged Care Clinical Fellowship Program. The Joanna Briggs Institute Practical Application of Clinical Evidence System, an online audit-based tool that includes an action research process Getting Research Into Practice was used to facilitate audit data collection and analysis. This report demonstrates that effective clinical leadership and evidence-based research, combined with a strategy of audit, feedback and re-audit, can become an effective change agent to improve clinical practice in residential aged care facilities. Aims/objectives The aims of this project were to increase staff knowledge and awareness of restraints, improve practices in restraint assessment and usage, reduce or minimise the amount and type of restraints used and ensure the least restrictive device possible was utilised in a rural aged care facility. Methods A system of audit, feedback and re-audit was performed using the Joanna Briggs Institute Practical Application of Clinical Evidence System software. This was completed in a series of stages over a period of 6 months. The first stage was to apply defining characteristics to each of the evidence-based audit criteria to determine compliance. A team of staff was set up to assist with the project. An initial audit was conducted, followed by a situational analysis of the findings. From this an action plan for improvement using Getting Research Into Practice was developed. The action plan was then implemented and the criteria re-audited and reviewed. Results The initial audit confirmed non-compliance as expected in two criteria. All criteria showed improvement in the re-audit. Those criteria with the least compliance in the initial audit showed the most improvement in the re-audit. Conclusion Effective change processes can be achieved when there is an identified reason or need for change, and when staff are aware of that need. With clinical leadership and education attitudes, fears and myths can be dispelled and improved performance will come out.

Reducing and/or minimising physical restraint in a high care, rural aged care facility

Reducing and/or minimising physical restraint in a high care, rural aged care facility

Detecting depression in the aged: Is there concordance between screening tools and the perceptions of nursing home staff and residents? A pilot study in a rural aged care facility

Recognition of depression in the elderly is exacerbated in rural and remote regions by a lack of mental health specialists. In nursing homes, screening tools have been advocated to circumvent the variable reliability of both nursing staff and residents in recognising depression. Debate concerning the utility of screening tools abounds. Previous research has neglected concordance between screening tools, nursing staff and residents in recognising depression. The present study aimed to determine if there was a significant difference in the proportion of depressed residents identified by recognition sources, and assessed the level of chance corrected agreement between sources. One hundred and two residents of aged care facilities in Wagga Wagga, Australia, mean age of 85.19 +/- 7.09 years. Residents were interviewed within their residential aged care facility. Cross-sectional, between-subjects design. Residents, nursing staff, Geriatric Depression Scale (GDS-12R) and Hamilton Depression Rating Scale. Hamilton Depression Rating Scale and nursing staff professional opinion were not significantly different; however, both measures were significantly different to the resident measures (GDS-12R and resident opinion). Kappa statistic analysis of outcome measures revealed, at best, no more than a moderate level of chance corrected agreement between said sources. It is tentatively argued that the different sources might correspond to qualitatively different 'depression' constructs, and that health professionals who are concerned with depression in the elderly be aware of the disparity between, and subsequently consider, a variety of recognition sources.

Development of a self‐sustaining speech pathology service for residents in rural aged care facilities

Objective: The literature suggests that approximately 90% of residents in aged care facilities have communication difficulties and between 40 and 60% of residents experience dysphasia. The ability of residents to attend outpatient clinics or private consultation, especially in a rural setting, is severely restricted. In an attempt to address this service gap a speech pathology service for residents in rural aged care facilities was developed and trialed over a 12‐month period. Method: Thirty aged care facilities in the Northern Rivers Area of New South Wales (NSW) agreed to participate in the trial. Results and Conclusion: An analysis of the first 9 months of data collected showed 331 resident consultations, 94 general practitioner (GP) consultations, and 111 education sessions showed that the quality of life of residents was greatly improved. As well, the skills, knowledge and the overall provision of service provided by GPs, nursing and allied health staff to residents of aged care facilities was greatly enhanced. The speech pathology service also proved to be financially self‐sustainable and was able to generate income for: (i) GPs through improved access to Enhanced Primary Care (EPC) funding; and (ii) aged care facilities through significant movements within the Resident Classification Scale.

User satisfaction with allied health services delivered to residential facilities via videoconferencing.

We have investigated the role of videoconferencing in allied health service provision to high-care clients in rural residential facilities. Videoconferencing equipment was set up at a rural aged-care facility and a metropolitan allied health centre; ISDN transmission at 384 kbit/s was used to link the equipment. Twelve residents were assessed by both videoconference and face to face across five allied health disciplines (a total of 120 assessments). User satisfaction was measured using questionnaires and focus groups. Face-to-face assessment took significantly longer than videoconferencing assessment. However, the mean satisfaction ratings for face-to-face assessments were higher than for videoconferencing and the majority of the staff preferred the face-to-face format. Videoconferencing was particularly useful for consultations and the initial stages of the assessment process. A number of issues relating to the videoconferencing equipment, to the environment in which assessments were performed and to the clients themselves need to be addressed in order for this form of service delivery to be effective.