Examining trajectories of hospital readmission in older adults hospitalised with hip fracture from residential aged care and the community

Abstract Background Hip fracture risk is higher for older adults living in residential aged care facilities (RACF) and their health outcomes worse compared to older adults living in the community. Pre-hip fracture residential status is not well recorded within hospital records, necessitating linkage of hospital and residential aged care data to better ascertain residential location pre-fracture. Aim To examine temporal trends, characteristics and health outcomes following a fall-related hip fracture hospitalisation of people living in RACFs to those living in the community. Method A retrospective analysis of fall-related hip fracture hospitalisations of people aged ≥65 years during 2008-2013 in New South Wales, Australia. Linked hospitalisation and RACF data were examined. Negative binomial regression examined the significance of hospitalisation temporal trends. Results There were 28,897 hip fracture hospitalisations and 32.5% were living in RACFs at time of fracture. The hospitalisation rate was 2,180 per 100,000 (95%CI: 2,097.0-2,263.7) for RACF residents and 390 per 100,000 (95%CI 384.8-395.8) for the community-living. Over 5 years, the hospitalisation rate for RACF residents declined by 2.9% annually (95%CI: -4.3 to -1.5). Hospital treatment cost for hip fractures was $958.5 million. Compared to older people living in the community, a higher proportion of RACF residents were aged ≥90 years (36.1% vs 17.2%), were female (75.3% vs 71.8%), had >1 Charlson comorbidity (37.6% vs 35.6%), and had dementia (58.2% vs 14.4%). RACF residents had fewer in-hospital rehabilitation episodes (18.7% vs 60.9%) and a higher proportion of unplanned readmissions (10.6% vs 9.1%) and in-hospital mortality (5.9% vs 3.3%) compared to older people living in the community. Conclusions RACF residents are a vulnerable cohort of older people who experience worse health outcomes and survival post-hip fracture than older people living in the community. Whether access to individualised hip fracture rehabilitation for RACF residents could improve health outcomes should be examined.

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The prevalence, reporting, and treatment of anxiety among older adults in nursing homes and other residential aged care facilities

Journal of Affective Disorders ◽

10.1016/j.jad.2017.11.029 ◽

2018 ◽

Vol 227 ◽

pp. 416-423 ◽

Cited By ~ 3

Author(s):

Alexandra S. Creighton ◽

Tanya E. Davison ◽

David W. Kissane

Keyword(s):

Older Adults ◽

Nursing Homes ◽

Aged Care ◽

Residential Aged Care ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

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Virtual reality intervention to improve apathy in residential aged care: protocol for a multisite non-randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-046030 ◽

2021 ◽

Vol 11 (2) ◽

pp. e046030

Author(s):

Dimitrios Saredakis ◽

Hannah A D Keage ◽

Megan Corlis ◽

Tobias Loetscher

Keyword(s):

Older Adults ◽

Virtual Reality ◽

Passive Control ◽

Aged Care ◽

Residential Aged Care ◽

Laptop Computer ◽

Reminiscence Therapy ◽

Increased Risk ◽

Secondary Outcomes

IntroductionApathy is a prevalent neuropsychiatric symptom for older adults residing in aged care. Left untreated, apathy has been associated with accelerated cognitive decline and increased risk of mortality. Reminiscence therapy is commonly used in aged care and has demonstrated to reduce apathy. Traditional methods of reminiscence use physical objects and more recently technology including tablets and laptop computers have demonstrated potential. Virtual reality (VR) has successfully been used to treat psychological disorders; however, there is little evidence on using VR for behavioural symptoms such as apathy in older adults. Using VR to deliver reminiscence therapy provides an immersive experience, and readily available applications provide access to a large range of content allowing easier delivery of therapy over traditional forms of therapy. This study aims to identify changes in apathy after a reminiscence therapy intervention using head-mounted displays (HMDs).Methods and analysisParticipants will be allocated to one of three groups; reminiscence therapy using VR; an active control using a laptop computer or physical items and a passive control. A total of 45 participants will be recruited from residential aged care (15 in each group). The three groups will be compared at baseline and follow-up. The primary outcome is apathy, and secondary outcomes include cognition and depression. Side effects from using HMDs will also be examined in the VR group. Primary and secondary outcomes at baseline and follow-up will be analysed using linear mixed modelling.Ethics and disseminationEthics approval was obtained from the University of South Australia Human Research Ethics Committee. The results from this study will be disseminated through manuscript publications and national/international conferences.Trial registration numberACTRN12619001510134.

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Identifying the Association Between Older Adults' Characteristics and Their Health-Related Outcomes in a Transition Care Setting: A Retrospective Audit

Frontiers in Public Health ◽

10.3389/fpubh.2021.688640 ◽

2021 ◽

Vol 9 ◽

Author(s):

Jo-Aine Hang ◽

Jacqueline Francis-Coad ◽

Chiara Naseri ◽

Angela Jacques ◽

Nicholas Waldron ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Care Service ◽

Aged Care ◽

Functional Improvement ◽

Residential Aged Care ◽

Discharge Destination ◽

Transition Care ◽

Retrospective Audit ◽

Health Related

Introduction: Continued evaluation of Transition Care Programs (TCP) is essential to improving older adults' outcomes and can guide which older adults may benefit from undertaking TCP. The aim of this study was to audit a transition care service to identify the association between the characteristics of older adults undertaking a facility-based TCP and (i) discharge destination and (ii) functional improvement.Materials and methods: An audit (n = 169) of older adults aged 60 years and above who completed a facility-based TCP in Australia was conducted. Outcomes audited were performance of activities of daily living (ADL) measured using the Modified Barthel Index (MBI) and discharge destination. Data were analyzed using logistic regression and linear mixed modeling.Results: Older adults [mean age 84.2 (±8.3) years] had a median TCP stay of 38 days. Fifty-four older adults (32.0%) were discharged home, 20 (11.8%) were readmitted to hospital and 93 (55%) were admitted to permanent residential aged care. Having no cognitive impairment [OR = 0.41 (95% CI 0.18-0.93)], being independent with ADL at admission [OR = 0.41 (95% CI 0.16-1.00)] and a pre-planned team goal of home discharge [OR = 24.98 (95% CI 5.47-114.15)] was significantly associated with discharge home. Cases discharged home showed greater improvement in functional ability [MBI 21.3 points (95% CI 17.0-25.6)] compared to cases discharged to other destinations [MBI 9.6 points (95% CI 6.5-12.7)].Conclusion: Auditing a facility-based TCP identified that older adults who were independent in ADL and had good cognitive levels were more likely to be discharged home. Older adults with cognitive impairment also made clinically significant functional improvements.

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Characteristics of Cognitive Behavioral Therapy for Older Adults Living in Residential Care: Protocol for a Systematic Review (Preprint)

10.2196/preprints.9902 ◽

2018 ◽

Author(s):

Phoebe Chan ◽

Sunil Bhar ◽

Tanya E. Davison ◽

Colleen Doyle ◽

Bob G. Knight ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Cognitive Behavioral Therapy ◽

Residential Care ◽

Behavioral Therapy ◽

Late Life ◽

Aged Care ◽

Residential Aged Care ◽

Late Life Depression ◽

Residential Settings

BACKGROUND The prevalence rates of depressive and anxiety disorders are high in residential aged care settings. Older adults in such settings might be prone to these disorders because of losses associated with transitioning to residential care, uncertainty about the future, as well as a decline in personal autonomy, health, and cognition. Cognitive behavioral therapy (CBT) is efficacious in treating late-life depression and anxiety. However, there remains a dearth of studies examining CBT in residential settings compared with community settings. Typically, older adults living in residential settings have higher care needs than those living in the community. To date, no systematic reviews have been conducted on the content and the delivery characteristics of CBT for older adults living in residential aged care settings. OBJECTIVE The objective of this paper is to describe the systematic review protocol on the characteristics of CBT for depression and/or anxiety for older adults living in residential aged care settings. METHODS This protocol was developed in compliance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Studies that fulfill the inclusion criteria will be identified by systematically searching relevant electronic databases, reference lists, and citation indexes. In addition, the PRISMA flowchart will be used to record the selection process. A pilot-tested data collection form will be used to extract and record data from the included studies. Two reviewers will be involved in screening the titles and abstracts of retrieved records, screening the full text of potentially relevant reports, and extracting data. Then, the delivery and content characteristics of different CBT programs of the included studies, where available, will be summarized in a table. Furthermore, the Downs and Black checklist will be used to assess the methodological quality of the included studies. RESULTS Systematic searches will commence in May 2018, and data extraction is expected to commence in July 2018. Data analyses and writing will happen in October 2018. CONCLUSIONS In this section, the limitations of the systematic review will be outlined. Clinical implications for treating late-life depression and/or anxiety, and implications for residential care facilities will be discussed. CLINICALTRIAL PROSPERO 42017080113; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=80113 (Archived by WebCite at http://www.webcitation.org/70dV4Qf54) REGISTERED REPORT IDENTIFIER RR1-10.2196/9902

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Trajectories of Hospital Readmission After A Fall Injury for Older Adults Living in Aged Care or The Community

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1476 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Rebecca Mitchell ◽

Brian Draper ◽

Jacqueline Close ◽

Lara Harvey ◽

Henry Brodaty ◽

...

Keyword(s):

Older Adults ◽

Hospital Readmission ◽

Hospital Admissions ◽

Group Membership ◽

Hospital Readmissions ◽

Care Facility ◽

Aged Care ◽

Community Living ◽

Fall Injury ◽

Trajectory Group

IntroductionFall injuries are one of the leading causes of hospitalisation for adults aged ≥65 years. Distinguishing key characteristics of older adults who are either living in aged care or in the community who have multiple hospital readmissions after a fall injury may inform targeted approaches to the prevention of hospital readmissions. Objectives and ApproachTo examine trajectories of hospital readmission of older adults living in aged care or the community after a fall injury hospitalisation and to identify factors predictive of trajectory group membership. A group-based trajectory analysis of hospital readmissions of adults aged ≥65 years who had a fall injury hospitalisation during 2008-09 in New South Wales, Australia was conducted. Linked hospitalisation and aged care data were examined for a 5 year period to 2013. Group-based trajectory models were derived based on number of subsequent readmissions following the index admission. Multinominal logistic regression examined predictors of trajectory group membership. ResultsThere were 24,729 fall injury hospitalisations; 78.8% of fallers were living in the community and 21.2% in aged care. Five distinct trajectory groups were identified for community-living (i.e. Moderate-declining, Chronic, Low-constant, Low-declining, and High users) and four trajectory groups for aged care residents (i.e. Low, Moderate-declining, Moderate-chronic, and High users). Key predictors of trajectory group membership for both community-living and aged care residents were age group, number of comorbidities, and dementia status. For aged care residents, depression, assistance with activities of daily living, and number of subsequent fall injury admissions were also predictors of group membership, with time to move to an aged care facility a predictor of group membership for community-living. Conclusion / ImplicationsIdentifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living individuals to remain as long as possible within their own residence.

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DOMICILIARY SERVICES IMPROVE ACCESS TO DENTAL CARE FOR FUNCTIONALLY DEPENDENT OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.1825 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S492-S492

Author(s):

Mathew A Lim ◽

Gelsomina L Borromeo

Keyword(s):

Older Adults ◽

Health Care ◽

Oral Health ◽

Aged Care ◽

Residential Aged Care ◽

Care Needs ◽

Dental Services ◽

Unique Challenge ◽

Care Facilities ◽

Aged Care Facilities

Abstract There is growing evidence demonstrating links between oral diseases and general health. The increased retention of teeth among functionally-dependent older adults presents a unique challenge in maintaining the oral health of these individuals from basic oral hygiene to accessing dental services. The results of our cross-sectional study demonstrate the important role domiciliary dental services play in reducing the barriers to accessing oral health care in this cohort. In our study, most individuals treated by domiciliary services lived in residential aged care facilities and were significantly older than those treated by hospital and community-based dental services dedicated to the specialized care of individuals with additional health care needs. A significantly higher number of those receiving domiciliary care were unable to self-consent for treatment compared to those managed in other settings. 27.4% of these patients had a diagnosis of dementia. More than half (56.9%) of patients treated by domiciliary services received some form of treatment with almost half (48.1%) of these requiring a dental extraction. Only two of these patients were not diagnosed with a chronic condition known to affect oral health (dementia, Parkinson’s disease, diabetes mellitus, arthritis, stroke, osteoporosis). 23.7% of domiciliary appointments were used for denture fabrication. The results depict the worrying level of unmet treatment need in residents of aged care facilities. However, they also demonstrate the potential for domiciliary dental services to play a role in developing partnerships between carers and oral health professionals to improve the oral health of functionally-dependent older adults.

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Older adults’ understandings and perspectives on frailty in community and residential aged care: an interpretive description

BMJ Open ◽

10.1136/bmjopen-2019-035339 ◽

2020 ◽

Vol 10 (3) ◽

pp. e035339 ◽

Cited By ~ 4

Author(s):

Mandy Archibald ◽

Michael Lawless ◽

Rachel C Ambagtsheer ◽

Alison Kitson

Keyword(s):

Older Adults ◽

Older Persons ◽

South Australia ◽

Care Facility ◽

Health Behaviours ◽

Aged Care ◽

Residential Aged Care ◽

Care Group ◽

Static State ◽

Consumer Perspective

ObjectivesDespite growing interest in frailty as a significant public health challenge, comparatively little is known about how older adults perceive and experience frailty, limiting the effectiveness of strategies to improve frailty management and prevention. The objective of this study was to understand how older people, including frail older persons in residential aged care, perceive and understand frailty through an interpretive–descriptive qualitative study.SettingAged care facility, community-based university for older persons and an aged care auxiliary care group in a large metropolitan centre in South Australia.Participants39 non-frail, prefrail, frail and very frail South Australian older adults.MethodsSeven focus groups were conducted. Participants completed one of two frailty instruments depending on setting and indicated whether they self-identified as frail. Data were analysed inductively and thematically by two independent investigators.ResultsFrailty was described according to three schemas of (1) the old and frail: a static state near the end of life; (2) frailty at any age: a disability model; and (3) frailty as a loss of independence: control, actions and identity. In addition, a theme was identifying linking mindset, cognition and emotion to frailty. The term frailty was viewed negatively and was often implicated with personal choice. There was little correlation between frailty assessments and whether participants self-identified as frail.ConclusionsAside from a disability model, views of frailty as unmodifiable permeated older persons’ diverse perspectives on frailty and are likely to impact health behaviours. To our knowledge, this is among the largest qualitative studies examining consumer perceptions of frailty and contributes a clinically relevant schema linking age, prevention and modifiability from a consumer perspective.

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