Medication use in aged care residents in the last year of life: A scoping review

Background: A substantial number of older adults die in residential aged care facilities, yet little is known about the characteristics of and how best to optimise medication use in the last year of life. Aim: The aim of this review was to map characteristics of medication use in aged care residents during the last year of life in order to examine key concepts related to medication safety and draw implications for further research and service provision. Design: A scoping review following Arskey and O’Malley’s framework was conducted using a targeted keyword search, followed by assessments of eligibility based on title and content of abstracts and full papers. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the scoping review protocol was prospectively registered to the Open Science Framework on 27 November 2018. Data Sources: We searched MEDLINE, EMBASE, AMED, CINAHL and Cochrane databases to identify peer-reviewed studies published between 1937 and 2018, written in English and looking at medication use in individuals living in aged care facilities within their last year of life. Results: A total of 30 papers were reviewed. Five key overarching themes were derived from the analysis process: (1) access to medicines at the end of life, (2) categorisation and classes: medicines and populations, (3) polypharmacy and total medication numbers, (4) use of symptomatic versus preventive medications and (5) ‘inappropriate’ medications. Conclusion: Number of prescriptions or blunt categorisations of medications to assess their appropriateness are unlikely to be sufficient to promote well-being and medication safety for older people in residential aged care in the final stages of life.

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Unfinished Care in Residential Aged Care Facilities: An Integrative Review

The Gerontologist ◽

10.1093/geront/gnz145 ◽

2019 ◽

Cited By ~ 3

Author(s):

Kristiana Ludlow ◽

Kate Churruca ◽

Virginia Mumford ◽

Louise A Ellis ◽

Luke Testa ◽

...

Keyword(s):

Staff Member ◽

Well Being ◽

Aged Care ◽

Integrative Review ◽

Residential Aged Care ◽

Knowledge Gaps ◽

Modifiable Factors ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

Abstract Background and Objectives When workload demands are greater than available time and resources, staff members must prioritize care by degree of importance and urgency. Care tasks assigned a lower priority may be missed, rationed, or delayed; collectively referred to as “unfinished care.” Residential aged care facilities (RACFs) are susceptible to unfinished care due to consumers’ complex needs, workforce composition, and constraints placed on resource availability. The objectives of this integrative review were to investigate the current state of knowledge of unfinished care in RACFs and to identify knowledge gaps. Research Design and Methods We conducted a search of academic databases and included English-language, peer-reviewed, empirical journal articles that discussed unfinished care in RACFs. Data were synthesized using mind mapping techniques and frequency counts, resulting in two categorization frameworks. Results We identified 17 core studies and 27 informing studies (n = 44). Across core studies, 32 types of unfinished care were organized under five categories: personal care, mobility, person-centeredness, medical and health care, and general care processes. We classified 50 factors associated with unfinished care under seven categories: staff member characteristics, staff member well-being, resident characteristics, interactions, resources, the work environment, and delivery of care activities. Discussion and Implications This review signifies that unfinished care in RACFs is a diverse concept in terms of types of unfinished care, associated factors, and terminology. Our findings suggest that policymakers and providers could reduce unfinished care by focusing on modifiable factors such as staffing levels. Four key knowledge gaps were identified to direct future research.

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CareTrack Aged: the appropriateness of care delivered to Australians living in residential aged care facilities: a study protocol

BMJ Open ◽

10.1136/bmjopen-2019-030988 ◽

2019 ◽

Vol 9 (6) ◽

pp. e030988

Author(s):

Peter D Hibbert ◽

Louise K Wiles ◽

Ian D Cameron ◽

Alison Kitson ◽

Richard L Reed ◽

...

Keyword(s):

Well Being ◽

Aged Care ◽

Residential Aged Care ◽

Aged Population ◽

Processes Of Care ◽

Appropriate Care ◽

Appropriateness Of Care ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

IntroductionThe aged population is increasing rapidly across the world and this is expected to continue. People living in residential aged care facilities (RACFs) represent amongst the sickest and frailest cohort of the aged population, with a high prevalence of chronic conditions and complex comorbidities. Given the vulnerability of RACF residents and the demands on the system, there is a need to determine the extent that care is delivered in line with best practice (‘appropriate care’) in RACFs. There is also a recognition that systems should provide care that optimises quality of life (QoL), which includes support for physical and psychological well-being, independence, social relationships, personal beliefs and a caring external environment. The aims ofCareTrack Agedare to develop sets of indicators for appropriate care and processes of care for commonly managed conditions, and then assess the appropriateness of care delivered and QoL of residents in RACFs in Australia.Methods and analysisWe will extract recommendations from clinical practice guidelines and, using expert review, convert these into sets of indicators for 15 common conditions and processes of care for people living in RACFs. We will recruit RACFs in three Australian states, and residents within these RACFs, using a stratified multistage sampling method. Experienced nurses, trained in theCareTrack Agedmethods (‘surveyors’), will review care records of recruited residents within a 1-month period in 2019 and 2020, and assess the care documented against the indicators of appropriate care. Surveyors will concurrently assess residents’ QoL using validated questionnaires.Ethics and disseminationThe study has been reviewed and approved by the Human Research Ethics Committee of Macquarie University (5201800386). The research findings will be published in international and national journals and disseminated through conferences and presentations to interested stakeholder groups, including consumers, national agencies, healthcare professionals, policymakers and researchers.

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Teaching strategies and activities to enhance students’ clinical placement in residential aged care facilities: a scoping review

JBI Evidence Synthesis ◽

10.11124/jbisrir-d-19-00334 ◽

2020 ◽

Vol 18 (11) ◽

pp. 2302-2334

Author(s):

Rose McCloskey ◽

Lisa Keeping-Burke ◽

Cindy Donovan ◽

Jessica Cook ◽

Richelle Witherspoon ◽

...

Keyword(s):

Teaching Strategies ◽

Scoping Review ◽

Aged Care ◽

Clinical Placement ◽

Residential Aged Care ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

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NSAID use among residents in 68 residential aged care facilities 2014 to 2017: An analysis of duration, concomitant medication use, and high‐risk conditions

Pharmacoepidemiology and Drug Safety ◽

10.1002/pds.4866 ◽

2019 ◽

Vol 28 (11) ◽

pp. 1480-1488 ◽

Cited By ~ 1

Author(s):

Kimberly E. Lind ◽

Magdalena Z. Raban ◽

Andrew Georgiou ◽

Johanna I. Westbrook

Keyword(s):

High Risk ◽

Concomitant Medication ◽

Medication Use ◽

Aged Care ◽

Residential Aged Care ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

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High-Risk Medication Use in Older Residents of Long-Term Care Facilities: Prevalence, Harms, and Strategies to Mitigate Risks and Enhance Use

The Senior Care Pharmacist ◽

10.4140/tcp.n.2020.419. ◽

2020 ◽

Vol 35 (10) ◽

pp. 419-433 ◽

Cited By ~ 1

Author(s):

Janet K. Sluggett ◽

Stephanie L. Harrison ◽

Leona A. Ritchie ◽

Alexander J. Clough ◽

Debbie Rigby ◽

...

Keyword(s):

High Risk ◽

Long Term Care ◽

Medication Use ◽

Aged Care ◽

Residential Aged Care ◽

Term Care ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

Older residents of long-term care facilities (LTCFs), also known as nursing homes, care homes, or residential aged care facilities, often have multiple health conditions and are exposed to polypharmacy. Use of high-risk medications such as opioids, glucose-lowering medications, antithrombotics, and antipsychotics is prevalent among residents of LTCFs. Ensuring appropriate use of high-risk medications is important to minimize the risk of medication-related harm in this vulnerable population. This paper provides an overview of the prevalence and factors associated with high-risk medication use among residents of LTCFs. Evidencebased strategies to optimize the use of high-risk medications and enhance resident outcomes are also discussed.

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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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