Public sector residential aged care: identifying novel associations between quality indicators and other demographic and health-related factors

2014 ◽  
Vol 38 (3) ◽  
pp. 325 ◽  
Author(s):  
Kirsten J. Moore ◽  
Colleen J. Doyle ◽  
Trisha L. Dunning ◽  
Ann T. Hague ◽  
Lucas A. Lloyd ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Cognitive Impairment ◽  
Adverse Events ◽  
Regression Models ◽  
Aged Care ◽  
Residential Aged Care ◽  
Risk Of Falling ◽  
Related Factors ◽  
Health Related

Objective To explore associations among quality indicators (QI; e.g. pressure ulcers, falls and/or fractures, physical restraint, use of multiple medications, unplanned weight loss) of the Victorian Public Sector Residential Aged Care Services (VPSRACS) with other demographic and health-related factors. Methods Data for 380 residents over a 3-month period were extracted retrospectively from client databases at four VPSRAC facilities. Results Four significant logistic regression models were developed. The strongest models related to falls and polypharmacy. Significant associations for these models included the following: (1) residents with a higher body mass index were 6% less likely (95% confidence interval (CI) 1%–11%) to fall, whereas high levels of cognitive impairment increased the risk of falling by 8% (95% CI 2%–14%); (2) being ambulant with a gait aid more than doubled the risk of falling compared with non-ambulant residents (95% CI 19%–546%); and (3) higher cognitive impairment was associated with a 6% (95% CI 1%–11%) reduction in the likelihood of polypharmacy. Conclusions Identification of significant relationships between the VPSRACS QI and other demographic and health-related factors is a preliminary step towards a more in-depth understanding of the factors that influence the QI and predict adverse events. What is known about the topic? Currently, the VPSRACS report on five QI. Previous research has shown associations between several of these indicators, but not all. What does this paper add? This paper examines associations between the five VPSRAC QI as well as other key demographic and health-related factors. Novel findings from regression analyses included an increased risk of falls associated with recommended body mass index and using gait aids, but no association between pressure ulcers and the Norton score. Regression models for other QI were limited by the small occurrences of the QI. However, significant associations were identified indicating that residents using a gait aid had a lower level of unplanned weight loss and residents with polypharmacy had higher unplanned weight loss. What are the implications for practitioners? This paper reinforces the value of collecting VPSRAC QI data to enable facilities to consider how these variables could impact on care quality and to proactively plan to reduce the risk of adverse events. Although QI data can be used to benchmark with other settings, this paper shows how QI data can be used to inform practice within a facility and help identify patient-related factors that may warrant further investigation.

Corrigendum to: Public sector residential aged care: identifying novel associations between quality indicators and other demographic and health-related factors

2015 ◽  
Vol 39 (1) ◽  
pp. 120
Author(s):  
Kirsten J. Moore ◽  
Colleen J. Doyle ◽  
Trisha L. Dunning ◽  
Ann T. Hague ◽  
Lucas A. Lloyd ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Cognitive Impairment ◽  
Adverse Events ◽  
Regression Models ◽  
Aged Care ◽  
Residential Aged Care ◽  
Risk Of Falling ◽  
Related Factors ◽  
Health Related

Objective To explore associations among quality indicators (QI; e.g. pressure ulcers, falls and/or fractures, physical restraint, use of multiple medications, unplanned weight loss) of the Victorian Public Sector Residential Aged Care Services (VPSRACS) with other demographic and health-related factors. Methods Data for 380 residents over a 3-month period were extracted retrospectively from client databases at four VPSRAC facilities. Results Four significant logistic regression models were developed. The strongest models related to falls and polypharmacy. Significant associations for these models included the following: (1) residents with a higher body mass index were 6% less likely (95% confidence interval (CI) 1%–11%) to fall, whereas high levels of cognitive impairment increased the risk of falling by 8% (95% CI 2%–14%); (2) being ambulant with a gait aid more than doubled the risk of falling compared with non-ambulant residents (95% CI 19%–546%); and (3) higher cognitive impairment was associated with a 6% (95% CI 1%–11%) reduction in the likelihood of polypharmacy. Conclusions Identification of significant relationships between the VPSRACS QI and other demographic and health-related factors is a preliminary step towards a more in-depth understanding of the factors that influence the QI and predict adverse events. What is known about the topic? Currently, the VPSRACS report on five QI. Previous research has shown associations between several of these indicators, but not all. What does this paper add? This paper examines associations between the five VPSRAC QI as well as other key demographic and health-related factors. Novel findings from regression analyses included an increased risk of falls associated with recommended body mass index and using gait aids, but no association between pressure ulcers and the Norton score. Regression models for other QI were limited by the small occurrences of the QI. However, significant associations were identified indicating that residents using a gait aid had a lower level of unplanned weight loss and residents with polypharmacy had higher unplanned weight loss. What are the implications for practitioners? This paper reinforces the value of collecting VPSRAC QI data to enable facilities to consider how these variables could impact on care quality and to proactively plan to reduce the risk of adverse events. Although QI data can be used to benchmark with other settings, this paper shows how QI data can be used to inform practice within a facility and help identify patient-related factors that may warrant further investigation.

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

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.

Dementia in Aboriginal people in Residential Aged Care Facilities in Alice Springs: A Descriptive Study

2019 ◽  
Vol 20 (2) ◽  
pp. 171-179
Author(s):  
Bruce Hocking ◽  
Michael Lowe ◽  
Tricia Nagel ◽  
Caroline Phillips ◽  
Melissa Lindeman ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Aboriginal People ◽  
Aged Care ◽  
Residential Aged Care ◽  
Aboriginal Populations ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Clinical File

AbstractBackground:A high prevalence of dementia among Aboriginal and Torres Strait Islanders has been reported but knowledge of underlying causes and associations remains limited.Objective:To identify the prevalence of factors that may be associated with the categories of Major neurocognitive disorders (Major NCDs) in Aboriginal people living in residential aged care facilities in Alice Springs in the Northern Territory (NT).Design and Setting:This descriptive cross-sectional study analysed clinical file and cognitive assessment data of participants who were identified as having cognitive impairment between January and June 2016.Method:Screening for the presence of cognitive impairment using the Kimberley Indigenous Cognitive Assessment (KICA) was undertaken and 58 of 84 Aboriginal people were admitted to the study. Using a clinical file audit, diagnoses of Major NCDs consistent with the DSM-5 classification were made and the prevalence of factors possibly associated with these diagnoses described.Results:Fifty of the 58 participants were diagnosed with a Major NCD. The most frequent diagnoses were Major NCD due to vascular disease (30%), Major NCD due to Alzheimer’s Disease (26%) and Major NCD due to brain injury (20%). Hypertension, Type 2 Diabetes Mellitus and alcohol misuse were commonly reported together with hypothyroidism, hypoglycaemia and vitamin D deficiency.Conclusion(s):This study identified possible associations with Major NCDs in this population as well as a different spread of Major NCD diagnoses to previous studies in Aboriginal populations. There is a need for further research to understand the causes of dementia in Australian Aboriginal people and to use this information to appropriately tailor treatment and prevention programmes.

Use of Metformin for Weight Management in Children and Adolescents With Obesity in the Clinical Setting

2018 ◽  
Vol 57 (14) ◽  
pp. 1677-1685 ◽  
Author(s):  
Kathryn E. Kyler ◽  
Rachel B. Kadakia ◽  
Hannah L. Palac ◽  
Soyang Kwon ◽  
Adolfo J. Ariza ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Weight Loss ◽  
Linear Regression ◽  
Weight Management ◽  
Clinical Setting ◽  
Regression Models ◽  
Obese Patients ◽  
Z Score ◽  
Linear Regression Models ◽  
Anthropometric Measures

Use of metformin for weight loss for children in a clinical setting has not been well described; therefore, we aimed to identify characteristics of obese patients prescribed metformin in a clinical setting and evaluate changes in anthropometric measures. Records of obese patients aged 10 to 18 years without diabetes attending an academic endocrinology practice from 2009 to 2013 were reviewed. Analyses assessed changes in anthropometric measures (weight, body mass index [BMI], and BMI z-score) over 12 months between those prescribed metformin (n = 49) and those not prescribed metformin (n = 142). Outcomes were standardized before using multivariable linear regression models. Patients prescribed metformin were significantly older, more often female, and had larger baseline anthropometric measures (all P < .05). In the models, subjects prescribed metformin had significantly less gain in standardized weight, BMI, and BMI z-score over 6 and 12 months (all P < .05). Metformin may be a useful weight management aid in children in a clinical setting.

scholarly journals Life Expectancy of Older People Living in Aged Care Facilities after a Hip Fracture

2020 ◽  
Author(s):  
Enwu Liu ◽  
Maggie Killington ◽  
Ian Cameron ◽  
Raymond Li ◽  
Susan Kurrle ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Hip Fracture ◽  
Mortality Rate ◽  
Life Expectancy ◽  
Nursing Home Residents ◽  
Aged Care ◽  
Residential Aged Care ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities

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.

scholarly journals Association Between Body Mass Index, Its Change And Cognitive Impairment Among Chinese Older Adults: A Community-Based, 9-Year Prospective Cohort Study

2021 ◽  
Author(s):  
Shanshan Wu ◽  
Xiaozhen Lv ◽  
Jie Shen ◽  
Hui Chen ◽  
Yuan Ma ◽  
...  
Keyword(s):  
Older Adults ◽  
Body Mass Index ◽  
Weight Loss ◽  
Cohort Study ◽  
Cognitive Impairment ◽  
Prospective Cohort ◽  
Community Based ◽  
Chinese Older Adults ◽  
Large Weight Loss ◽  
Increased Risk

Abstract Objective To examine the association of baseline body mass index (BMI) and BMI change with cognitive impairment among older adults in China. Methods The study included data from the Chinese Longitudinal Healthy Longevity Study, a national community-based prospective cohort study from 2002-2018. Baseline BMI and BMI change measurements were available for 12,027 adults aged older than 65 years. Cognitive impairment was defined as Chinese version of the Mini Mental State Examination score less than 18. Multivariable Cox proportional hazard model was used.Results Among 12027 participants (mean age was 81.23 years old and 47.48% were male), the proportion of underweight, normal, overweight and obese at baseline was 33.87%, 51.39%, 11.39% and 3.34%, respectively. During an average of 5.9 years’ follow-up, 3086 participants (4.35 per 100 person-years) with incident cognitive impairment were identified. Compared with normal weight group, adjusted hazard ratio (AHR) for cognitive impairment was 0.86 (95% CI 0.75-0.99) among overweight group, whereas corresponding AHR was 1.02 (95% CI 0.94-1.10) in underweight and 1.01 (95% CI 0.80-1.28) in obese. Large weight loss (<-10%) was significantly associated with an increased risk of cognitive impairment (AHR, 1.42, 95% CI 1.29-1.56), compared to stable weight status group (-5%~5%). In the restricted cubic spline models, BMI change showed a L-shaped association with cognitive impairment. Conclusions BMI-defined overweight is associated with a reduced risk of cognitive impairment among Chinese older adults, while large weight loss is associated with increased risk. More attention should be paid to older adults with significant weight loss.

scholarly journals The Registry of Senior Australians outcome monitoring system: quality and safety indicators for residential aged care

2020 ◽  
Vol 32 (8) ◽  
pp. 502-510 ◽  
Author(s):  
Maria C Inacio ◽  
Catherine Lang ◽  
Gillian E Caughey ◽  
Sarah C E Bray ◽  
Stephanie L Harrison ◽  
...  
Keyword(s):  
Emergency Department ◽  
Weight Loss ◽  
Premature Mortality ◽  
Antibiotic Use ◽  
Aged Care ◽  
Residential Aged Care ◽  
Quality And Safety ◽  
Opioid Use ◽  
Outcome Monitoring ◽  
Chronic Opioid Use

Abstract Objectives To introduce the Registry of Senior Australians (ROSA) Outcome Monitoring System, which can monitor the quality and safety of care provided to individuals accessing residential aged care. Development and examination of 12 quality and safety indicators of care and their 2016 prevalence estimates are presented. Design Retrospective. Setting 2690 national and 254 South Australian (SA) aged care facilities. Participants 208 355 unique residents nationally and 18 956 in SA. Main Outcome Measures Risk-adjusted prevalence of high sedative load, antipsychotic use, chronic opioid use, antibiotic use, premature mortality, falls, fractures, medication-related adverse events, weight loss/malnutrition, delirium and/or dementia hospitalisations, emergency department presentations, and pressure injuries. Results Five indicators were estimated nationally; antibiotic use (67.5%, 95% confidence interval (CI): 67.3–67.7%) had the highest prevalence, followed by high sedative load (48.1%, 95% CI: 47.9–48.3%), chronic opioid use (26.8%, 95% CI: 26.6–26.9%), antipsychotic use (23.5%, 95% CI: 23.4–23.7%) and premature mortality (0.6%, 95% CI: 0.6–0.7%). Seven indicators were estimated in SA; emergency department presentations (19.1%, 95% CI: 18.3–20.0%) had the highest prevalence, followed by falls (10.1%, 95% CI: 9.7–10.4%), fractures (4.8%, 95% CI: 4.6–5.1%), pressure injuries (2.9%, 95% CI: 2.7–3.1%), delirium and/or dementia related hospitalisations (2.3%, 95% CI: 2.1–2.6%), weight loss/malnutrition (0.7%, 95% CI: 0.6–0.8%) and medication-related events (0.6%, 95% CI: 0.5–0.7%). Conclusions Twelve quality and safety indicators were developed to monitor aged care provided to older Australians based on the synthesis of existing literature and expert advisory input. These indicators rely on existing data within the aged care and healthcare sectors, therefore creating a pragmatic tool to examine quality and unwarranted care variation.

scholarly journals Health‐related quality of life and related factors among a sample of older people with cognitive impairment

Nursing Open ◽  
2019 ◽  
Vol 6 (3) ◽  
pp. 849-859 ◽  
Author(s):  
Line Christiansen ◽  
Johan Sanmartin Berglund ◽  
Catharina Lindberg ◽  
Peter Anderberg ◽  
Lisa Skär
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Older People ◽  
Health Related Quality ◽  
Related Factors ◽  
Related Quality ◽  
Health Related

Demographic, Socioeconomic, and Health-Related Predictors of Objectively Measured Sedentary Time and Physical Activity During Pregnancy

2021 ◽  
pp. 1-8
Author(s):  
Melissa A. Jones ◽  
Kara Whitaker ◽  
McKenzie Wallace ◽  
Bethany Barone Gibbs
Keyword(s):  
Physical Activity ◽  
Regression Models ◽  
Future Research ◽  
Full Time ◽  
Linear Regression Models ◽  
Related Factors ◽  
Intensity Physical Activity ◽  
Health Related ◽  
History Of ◽  
Objectively Measured

Background: Sedentary behavior (SED) and moderate-to-vigorous intensity physical activity (MVPA) have important implications for health; however, little is known about predictors of these behaviors during pregnancy. Methods: This cohort study measured SED (activPAL) and MVPA (GT3X) in each trimester of pregnancy. Univariate associations of demographic, socioeconomic, and pregnancy health-related factors with SED or MVPA were calculated. Associations with P < .10 were included in stepwise linear regression models to determine independent predictors in each trimester. Results: Pregnant women (n = 127) were age 31.0 (4.9) years and 78% white. In regression models across trimesters, fewer children ≤ age 5 in the household (P < .04) and primarily sitting job activity (P < .008) were related to higher SED and use of assisted reproductive technology (P < .05) was associated with higher MVPA. In at least one trimester, younger age was related to higher SED (P = .014); no history of pregnancy loss (P < .04), being married (P = .003), employed (P < .004, full time or student), white race (P = .006), and higher education (P = .010) were associated with higher MVPA. Conclusions: Predictors of SED in pregnancy were more consistent, and differed from predictors of MVPA. These findings may help identify women at risk of high SED or low MVPA, though future research in larger samples is needed.

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