Life expectancy of older people living in aged care facilities after a hip fracture

Abstract Little is known about life expectancy in nursing home residents with hip fracture. We assessed life expectancy of 240 residents of residential aged care facilities who were aged more than 70 years old and experienced recent hip fracture treated with surgery. 149 deaths occurred over a mean follow-up of 1.2 years. Being female (coefficient (β) = 0.86, 95% confidence interval (CI): 0.39, 1.34; p = 0.0004) was associated with longer life expectancy. Increased age was associated with shorter life expectancy (β=-0.06, 95% CI: -0.10 to -0.02, p = 0.0043). Relative to severe cognitive impairment, normal or mild-cognitive impairment (β = 1.18, 95% CI: 0.05 to 2.31, p = 0.0414) and moderate cognitive impairment (β = 0.56, 95% CI: 0.07 to 1.04, p = 0.0237) were associated with longer life expectancy. Mortality rate within three months after hip fracture was 118 cases per 100 person-years while the mortality rate for the whole study period was 51.3 deaths per 100 person-years. For females with hip fracture, life expectancy was 8.2 years at 70 years of age; 4.8 years at 80 years of age; and 2.8 years at 90 years of age. For males with hip fracture, life expectancy was 3.8 years, 2.2 years and 1.3 years at 70, 80 and 90 years of age, respectively.

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Remodelling Aged Living to Reduce Stigma

10.26686/wgtn.14865036 ◽

2021 ◽

Author(s):

Georgia Reece

Keyword(s):

Social Isolation ◽

Care Facility ◽

The Elderly ◽

Aged Care ◽

Facility Design ◽

Community Based ◽

Aged Care Facility ◽

Iterative Design ◽

Care Facilities ◽

Aged Care Facilities

This thesis investigates whether community-based architectural strategies can be used in aged care facility design to reduce the stigma of social isolation. New Zealand has a growing population, with an increasing number of people needing assistance from aged care facilities. However, the elderly resist moving into aged care facilities because of fears of marginalisation, social isolation and associated stigma. Stigma creates outcomes of discrimination towards marginalised individuals, resulting in negative projections on these people and consequent social exclusion. There are two main aims of this research. The first aim was to understand the relationship between stigma and architecture and stigma and aged care facilities. To achieve this aim, stigma and various strategies for addressing that stigma in aged care facilities were defined based on contemporary literature on this subject and analyses of relevant built precedents. The second aim was to develop, a contemporary aged care facility that demonstrates potential strategies for reducing stigma. This aim was achieved by developing criteria that respond to iterative design exercises and contemporary research in the fields of aged care facilities, architecture and stigma. An iterative design process, continually tested these criteria against literature and precedent reviews, was carried out to arrive at a coherent design and more refined set of criteria. Research conclusions showed that community-based architectural strategies can be used to reduce the stigma of social isolation in aged care facility design. This resulted in the outcome of a community-based model and criteria that can be applied to the design of aged care facilities and will resultantly provide residents with a purposive role and inclusion within society.

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Views of Greenery and Psychological Well-Being in Residential Aged Care Facilities: Longitudinal Associations

HERD Health Environments Research & Design Journal ◽

10.1177/19375867211059757 ◽

2021 ◽

pp. 193758672110597

Author(s):

Takemi Sugiyama ◽

Alison Carver ◽

Masaaki Sugiyama ◽

Alanna Lorenzon ◽

Tanya E. Davison

Keyword(s):

Well Being ◽

Aged Care ◽

Residential Aged Care ◽

Psychological Well Being ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities ◽

Objectively Measured

Objectives: This study examined associations of objectively measured views of greenery in residential aged care facilities (RACFs) with changes in multiple psychological well-being measures among residents who were newly admitted to RACFs. Methods: Data were collected from 52 residents (mean age: 84, 73% women) of 13 RACFs, located in Melbourne, Australia. The outcomes were changes in depression, stress, anxiety, and quality of life (QoL) between baseline and 8-week follow-up. The exposure measures were the amount and presence of greenery visible from participant’s bedroom and common areas (lounge, dining). Greenery was categorized as being either within or beyond the RACF perimeter. Results: Regression analyses found that greenery visible from participant’s bedroom was not associated with any outcomes. The amount of greenery visible from common areas within the RACF perimeter was adversely related to stress, unexpectedly: Each additional 1 m2 of greenery was associated with a greater increase in stress ( b = 0.05; 95% CI [0.07, 0.94]). However, greenery visible from common areas beyond the perimeter contributed favorably to stress and QoL. The presence of such greenery was associated with a lower increase in stress ( b = −3.99; 95% CI [−7.75, −0.23]; reference: no greenery), and a 1 m2 increment was associated with a greater increase in QoL ( b = 0.07; 95% CI [0.02, 0.11]). Conclusion: Views of greenery outside of the RACF from lounge and dining areas may be protective against residents’ stress increase and improve their QoL. Locating residents in areas with such outdoor views may prevent their psychological condition from worsening.

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Integrating pharmacists into aged care facilities to improve the quality use of medicine (PiRACF Study): Protocol for a cluster randomised controlled trial

10.21203/rs.3.rs-38456/v1 ◽

2020 ◽

Author(s):

sam kosari ◽

Jane Koerner ◽

Mark Naunton ◽

Gregory M Peterson ◽

Ibrahim Haider ◽

...

Keyword(s):

Controlled Trial ◽

Medication Management ◽

Care Facility ◽

Cluster Randomised Controlled Trial ◽

Aged Care ◽

Residential Aged Care ◽

Aged Care Facility ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

Abstract BackgroundMedication management in residential aged care facilities is an ongoing concern. Numerous studies have reported high rates of inappropriate prescribing and medication use in aged care facilities, which contribute to residents’ adverse health outcomes. There is a need for new models of care that enhance inter-disciplinary collaboration between residential aged care facility staff and healthcare professionals, to improve medication management. Pilot research has demonstrated the feasibility and benefits of integrating a pharmacist into the aged care facility team to improve the quality use of medicines. This protocol describes the design and methods for a cluster randomised controlled trial to evaluate the outcomes and conduct economic evaluation of a service model where on-site pharmacists are integrated into residential aged care facility healthcare teams to improve medication management.MethodsIntervention aged care facilities will employ on-site pharmacists to work as part of their healthcare teams. Pharmacists will assume responsibility for medication management, and collaborate with facility nurses, prescribers, community pharmacists, residents and families to improve the quality use of medicines. The intervention will last for 12 months. Aged care facilities in the control group will continue usual care. The target sample size is 1,188 residents from a minimum of 13 aged care facilities. The primary outcome is the appropriateness of prescribing, measured by the proportion of residents who are prescribed at least one potentially inappropriate medicine according to the 2019 Beers Criteria. Secondary outcomes include hospital and Emergency Department presentations, fall rates, prevalence and dose of antipsychotics and benzodiazepines, Anticholinergic Cognitive Burden Score, staff influenza vaccination rate, time spent on medication rounds, appropriateness of dose form modification and completeness of resident’s allergy and adverse drug reaction documentation. A cost-consequence and cost-effectiveness analysis will be embedded in the trial.DiscussionThe results of this study will provide information on clinical and economic outcomes of a model that integrates on-site pharmacists into Australian residential aged care facilities. The results will provide policymakers with recommendations relevant to further implementation of this model.Trial registrationACTRN: ACTRN12620000430932, retrospectively registered with ANZCTR on 1 April 2020. Available from https://www.anzctr.org.au/TrialSearch.aspx#&&conditionCode=&dateOfRegistrationFrom=&interventionDescription=&interventionCodeOperator=OR&primarySponsorType=&gender=&distance=&postcode=&pageSize=20&ageGroup=&recruitmentCountryOperator=OR&recruitmentRegion=&ethicsReview=&countryOfRecruitment=&registry=&searchTxt=ACTRN12620000430932&studyType=&allocationToIntervention=&dateOfRegistrationTo=&recruitmentStatus=&interventionCode=&healthCondition=&healthyVolunteers=&page=1&conditionCategory=&fundingSource=&trialStartDateTo=&trialStartDateFrom=&phase=

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Remodelling Aged Living to Reduce Stigma

10.26686/wgtn.14865036.v1 ◽

2021 ◽

Author(s):

Georgia Reece

Keyword(s):

Social Isolation ◽

Care Facility ◽

The Elderly ◽

Aged Care ◽

Facility Design ◽

Community Based ◽

Aged Care Facility ◽

Iterative Design ◽

Care Facilities ◽

Aged Care Facilities

This thesis investigates whether community-based architectural strategies can be used in aged care facility design to reduce the stigma of social isolation. New Zealand has a growing population, with an increasing number of people needing assistance from aged care facilities. However, the elderly resist moving into aged care facilities because of fears of marginalisation, social isolation and associated stigma. Stigma creates outcomes of discrimination towards marginalised individuals, resulting in negative projections on these people and consequent social exclusion. There are two main aims of this research. The first aim was to understand the relationship between stigma and architecture and stigma and aged care facilities. To achieve this aim, stigma and various strategies for addressing that stigma in aged care facilities were defined based on contemporary literature on this subject and analyses of relevant built precedents. The second aim was to develop, a contemporary aged care facility that demonstrates potential strategies for reducing stigma. This aim was achieved by developing criteria that respond to iterative design exercises and contemporary research in the fields of aged care facilities, architecture and stigma. An iterative design process, continually tested these criteria against literature and precedent reviews, was carried out to arrive at a coherent design and more refined set of criteria. Research conclusions showed that community-based architectural strategies can be used to reduce the stigma of social isolation in aged care facility design. This resulted in the outcome of a community-based model and criteria that can be applied to the design of aged care facilities and will resultantly provide residents with a purposive role and inclusion within society.

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The Public's Perceptions of a Cafe within the Social and Physical Context of a Residential Aged Care Facility

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2018.1815 ◽

2018 ◽

Author(s):

Alexa Andrew

Keyword(s):

Residential Care ◽

Local Community ◽

Care Facility ◽

Aged Care ◽

Qualitative Inquiry ◽

Residential Aged Care ◽

Research Project ◽

The Public ◽

Care Facilities ◽

Aged Care Facilities

Background: The publics’ perceptions of aged care residential facilities (ACRF’s) are generally derogatory in nature; with terms such as the ‘end of the road’ or ‘the last resort’ being used to describe them. The institutional design and nature of the traditional ‘nursing home’ has contributed to such a perception. However, more contemporary models of residential aged care facilities are encompassing design features which aim to enhance the physical and social environment and therefore the lives of the older people residing within them. Purpose: This research reports on the inclusion of a café in the foyer of an aged care residential which is open to the public. Members of the public who use the café were interviewed. Methods: This research project utilised qualitative inquiry of a descriptive nature. Data was gathered through semi-structured interviews; seven participants were interviewed. Data analysis to establish themes utilised coding. Findings: The perceptions of members of the public who use the café is presented according to three major themes; place and purpose, people and relationships and community exposure and perceptions. The café is perceived, by the participants of this research project, as a place to go in the local community which was appreciated for its familiarity, pleasant surroundings and the quality of its service. Interactions between staff and residents were observed as caring and participants reflected that the staff were personally invested in their work. Visiting this café has challenged the notion that ACRF’s are closed off institutional places and the environment was described as open and inviting. The interaction between the community and the ACRF was discussed the benefits for the residents and for themselves were identified. Participants described a developing affiliation and connection between the facility and themselves and this prompted reflection about their own future residential needs. Conclusion: This café has opened a door between the ACRF and the local community. Members of the public who visit the café are able to observe, interact and make connections within the residential care environment. Perceptions about the nature of aged care facilities have been challenged and reflection about future residential care needs has occurred.

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Residential aged care facility clinical placements for undergraduate paramedic students: An evaluation of the Australian experience

Australasian Journal of Paramedicine ◽

10.33151/ajp.12.2.144 ◽

2015 ◽

Vol 12 (2) ◽

Cited By ~ 2

Author(s):

Brigit Stratton ◽

Emma Lea ◽

Marguerite Bramble ◽

Claire Eccleston ◽

Mike McCall ◽

...

Keyword(s):

Care Facility ◽

Aged Care ◽

Clinical Placement ◽

Residential Aged Care ◽

Clinical Placements ◽

Palliative Approach ◽

People With Dementia ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

IntroductionThis paper presents an evaluation of the pilot aged care clinical placement undertaken by undergraduate paramedic students in the university-based Wicking Dementia Research and Education Centre’s Teaching Aged Care Facilities Program. The objective is to examine the learning experiences of students taking part in the first paramedic student clinical placement in Tasmania to be situated in the residential aged care environment. The students’ interactions with residents with dementia and with older people requiring a palliative approach to care are discussed, as key strategies to enhance paramedic student learning.MethodTwenty-one final year undergraduate paramedic students completed a 5-day (40 hour) clinical placement in September/October 2011, in two participating residential aged care facilities in Tasmania, Australia. Qualitative data were obtained from weekly feedback meetings with students, which were audio-recorded, transcribed, and subjected to content analysis. Quantitative data from pre and post-placement questionnaires were collected and descriptive analyses performed.ResultsThe data showed that students enjoyed interaction with residents and that this built their communication skills, particularly with residents with dementia. Students also learnt about the importance of a palliative approach to care and improved their knowledge of dementia.ConclusionA supported placement program for paramedic students in residential aged care facilitates student learning in a number of areas, particularly around working with people with dementia, which is likely to enhance student readiness for the graduate paramedic role.

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More action needed: Psychotropic prescribing in Australian residential aged care

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867418758919 ◽

2018 ◽

Vol 53 (2) ◽

pp. 136-147 ◽

Cited By ~ 17

Author(s):

Juanita Westbury ◽

Peter Gee ◽

Tristan Ling ◽

Alex Kitsos ◽

Gregory Peterson

Keyword(s):

New South ◽

Care Facility ◽

Aged Care ◽

Residential Aged Care ◽

Aged Care Facility ◽

South Wales ◽

Residential Aged Care Facility ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

Objective: For at least two decades, concerns have been raised about inappropriate psychotropic prescribing in Australian residential aged care facilities, due to their modest therapeutic benefit and increased risk of falls and mortality. To date, the majority of prevalence data has been collected in Sydney exclusively and it is not known if recent initiatives to promote appropriate psychotropic prescribing have impacted utilisation. Thus, we aimed to comprehensively analyse psychotropic use in a large national sample of residential aged care facility residents. Method: A cross-sectional, retrospective cohort study of residents from 150 residential aged care facilities distributed nationally during April 2014–October 2015. Antipsychotic, anxiolytic/hypnotic and antidepressant utilisation was assessed, along with anticonvulsant and anti-dementia drug use. Negative binomial regression analysis was used to examine variation in psychotropic use. Results: Full psychotropic prescribing data was available from 11,368 residents. Nearly two-thirds (61%) were taking psychotropic agents regularly, with over 41% prescribed antidepressants, 22% antipsychotics and 22% of residents taking benzodiazepines. Over 30% and 11% were charted for ‘prn’ (as required) benzodiazepines and antipsychotics, respectively. More than 16% of the residents were taking sedating antidepressants, predominantly mirtazapine. South Australian residents were more likely to be taking benzodiazepines ( p < 0.05) and residents from New South Wales/Australian Capital Territory less likely to be taking them ( p < 0.01), after adjustment for rurality and size of residential aged care facility. Residents located in New South Wales/Australian Capital Territory were also significantly less likely to take antidepressants ( p < 0.01), as were residents from outer regional residential aged care facilities ( p < 0.01). Antipsychotic use was not associated with State, rurality or residential aged care facility size. Conclusion: Regular antipsychotic use appears to have decreased in residential aged care facilities but benzodiazepine prevalence is higher, particularly in South Australian residential aged care facilities. Sedating antidepressant and ‘prn’ psychotropic prescribing is widespread. Effective interventions to reduce the continued reliance on psychotropic management, in conjunction with active promotion of non-pharmacological strategies, are urgently required.

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Rehabilitation in Residential Aged Care Facilities: Barriers and Facilitators in a Dementia Context

Australian Journal of Rehabilitation Counselling ◽

10.1017/jrc.2013.5 ◽

2013 ◽

Vol 19 (1) ◽

pp. 57-63 ◽

Cited By ~ 1

Author(s):

Leander K. Mitchell ◽

Nancy A. Pachana

Keyword(s):

Care Facility ◽

Aged Care ◽

Communication Process ◽

Residential Aged Care ◽

Open Communication ◽

Aged Care Facility ◽

Potential Barriers ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

This review of the literature sought to highlight key barriers to the implementation of rehabilitation-based interventions in an aged care facility context. It then identifies how such barriers might be actively countered with a view to facilitating rehabilitation-based strategies within such contexts. Key barriers identified included staffing issues, heterogeneity of residents, and the potential complexity behind establishing appropriate forms of rehabilitation for the residents. The most successful facilitators identified included training, the provision of appropriate support, and an open communication process. Having an awareness and an appreciation of potential barriers to the use of rehabilitation interventions in aged care facilities provides the opportunity to actively plan around them, thereby increasing and improving their use.

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Optimising specialist geriatric medicine services by telehealth

Journal of Telemedicine and Telecare ◽

10.1177/1357633x211041859 ◽

2021 ◽

Vol 27 (10) ◽

pp. 674-679

Author(s):

Helen M Haydon ◽

Liam J Caffery ◽

Centaine L Snoswell ◽

Emma E Thomas ◽

Monica Taylor ◽

...

Keyword(s):

Geriatric Medicine ◽

Care Facility ◽

Aged Care ◽

Systematic Evaluation ◽

Residential Aged Care ◽

Specialist Care ◽

Care Facilities ◽

Service Activity ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

Telehealth can effectively increase access to specialist care and reduce the need for travel. The Geri-Connect service was established in 2017 to support people living in residential aged care facilities in regional Victoria, Australia. Using the Model for the Assessment of Telemedicine, an evaluation of the Geri-Connect service identified service activity patterns and factors associated with uptake. Service activity from 2017 to 2020 and 10 semi-structured, key stakeholder interviews were captured and analysed. Between 2017 and 2020, video consultations were provided to 53 residential aged care facilities. Sustained growth (over 178%) and strong stakeholder acceptance highlight the effectiveness of this telegeriatric service. Four recommendations provide opportunities to further enhance service delivery including: implementation of an integrated health information system; systematic evaluation of service impact on stakeholders and residents, auditing and subsequent provision of targeted training; and regular auditing of software and hardware. Additionally, the need to augment fixed room hardware with mobile telehealth systems would increase access for residents with mobility problems. Dedicated personnel of the centralised team are best suited to implementing the recommendations. Whilst the provision of routine telehealth services into residential aged care facilities is challenging, the Geri-Connect service demonstrates that telehealth can be effectively provided to residential aged care facility residents needing specialist geriatric care.

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