scholarly journals Use of health and aged care services in Australia following hospital admission for myocardial infarction, stroke or heart failure

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Benjumin Hsu ◽  
Rosemary J. Korda ◽  
Richard I. Lindley ◽  
Kirsty A. Douglas ◽  
Vasi Naganathan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Hospital Admission ◽  
Residential Care ◽  
Service Use ◽  
Community Care ◽  
Aged Care ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Care Services

Abstract Background Cardiovascular diseases (CVD), including myocardial infarction (MI), stroke and heart failure (HF) are the leading cause of death amongst the older population worldwide. The aim of this study is to investigate trajectories of use of health and aged care services after hospital admission for MI, stroke or HF among community-dwelling people not previously receiving aged care services. Methods The study population comprised people aged 65+ years from the 45 and Up Study with linked records for hospital stays, aged care services and deaths for the period 2006–14. Among those with an index hospital admission for MI, stroke or HF, we developed Sankey plots to describe and visualize sequences and trajectories of service use (none, re-hospitalization, community care, residential care, death) in the 12 months following discharge. We used Cox proportional hazards models to estimate hazard ratios (HRs), for commencing community care and entering residential care (and the other outcomes) within 3, 6 and 12 months, compared to a matched group without MI, stroke or HF. Results Two thousand six hundred thirty-nine, two thousand five hundred and two thousand eight hundred seventy-three people had an index hospitalization for MI, stroke and HF, respectively. Within 3 months of hospital discharge, 16, 32 and 29%, respectively, commenced community care (multivariable-adjusted HRs: 1.26 (95%CI:1.18–1.35), 1.53 (95%CI:1.44–1.64) and 1.39 (95%CI:1.32–1.48)); and 7, 18 and 14%, respectively, entered residential care (HRs: 1.25 (95%CI:1.12–1.41), 2.65 (95%CI:2.42–2.91) and 1.50 (95%CI:1.37–1.65)). Likewise, 26, 15 and 28%, respectively, were rehospitalized within 3 months following discharge (multivariable-adjusted HRs: 4.78 (95%CI:4.31–5.32), 3.26 (95%CI:2.91–3.65) and 4.94 (95%CI:4.47–5.46)). Conclusions Older people hospitalized for major CVD may be vulnerable to transition-related risks and have poor health trajectories, thus emphasizing the value of preventing such events and care strategies targeted towards this at-risk group.

Social Participation Among Older Adults Receiving Community Care Services

2020 ◽  
pp. 073346482093897
Author(s):  
Joyce Siette ◽  
Helen Berry ◽  
Mikaela Jorgensen ◽  
Lindsey Brett ◽  
Andrew Georgiou ◽  
...  
Keyword(s):  
Older Adults ◽  
Social Participation ◽  
Rural Women ◽  
Service Use ◽  
Community Care ◽  
Care Service ◽  
Geographical Location ◽  
Aged Care ◽  
Care Needs ◽  
Care Services

Aged care services have the potential to support social participation for the growing number of adults aging at home, but little is known about the types of social activities older adults in community care are engaged in. We used cluster analysis to examine the current profiles of social participation across seven domains in 1,114 older Australians, and chi-square analyses to explore between-group differences in social participation and sociodemographic and community care service use. Two distinct participation profiles were identified: (a) connected, capable, older rural women and (b) isolated, high-needs, urban-dwelling men. The first group had higher levels of engagement across six social participation domains compared with the second group. Social participation among older adults receiving community care services varies by gender, age, individual care needs, and geographical location. More targeted service provision at both the individual and community levels may assist older adults to access social participation opportunities.

scholarly journals Comparison of Time-Varying and Landmark Analysis Methods in Estimating the Association Between Medication Adherence and Outcomes: A Heart Failure Cohort

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Benjumin Hsu ◽  
Louisa Jorm
Keyword(s):  
Heart Failure ◽  
Service Use ◽  
Cox Regression ◽  
Care Service ◽  
Aged Care ◽  
Residential Aged Care ◽  
Ageing In Place ◽  
Care Services ◽  
Relative Risks ◽  
Hospital Stays

IntroductionCardiovascular disease (CVD) is a leading contributor to disease burden worldwide. Older people hospitalized with CVD might experience significant decline in physical function and loss of independence. Objectives and ApproachThe aim of this study was to investigate the use of community aged care (CAC) and permanent residential aged care (PRAC) services 3 months, 6 months and 12 months after hospital admission for myocardial infarction (MI), stroke and congestive heart failure (CHF). Survey data from the 45 and Up Study (2006-09) for 266,942 people aged 45+ was linked with records for hospital stays (APDC), aged care service use (NACDC), and deaths (RBDM) for 2006-14 through CHeReL and AIHW. Relative risks of using aged care (CAC or PRAC) after MI, stroke or CHF hospitalization were estimated using Cox regression. We described and visualized sequences of health service states (none, re-hospitalization, CAC, PRAC, death) after the index hospitalization. ResultsCompared with people without MI, people hospitalized with a principal diagnosis of MI (multivariable-adjusted HR:1.11, 95%CI:1.04-1.18), stroke (HR:1.52, 95%CI:1.43-1.61) and CHF (HR:1.12, 95%CI:1.06-1.19) were more likely to use CAC within 3 months of the hospital discharge. Likewise, people with MI (HR:1.16, 95%CI:1.03-1.29), stroke (HR:2.81, 95%CI:2.58-3.05) and CHF (HR:1.36, 95CI:1.24-1.49) were more likely to enter PRAC within 3 months of discharge. Similar findings were observed for 6 months and 12 months. MI, stroke and CHF patients were more likely to die but less likely to be re-hospitalized after the first 3 months. The number use of CAC and PRAC remains unchanged over 12 months. While this study provides a broadly representative sample of the older population, participants may be healthier than the general population. Conclusion / ImplicationsCVD increases use of community and residential care services. Coordination of cardiac and stroke rehabilitation is warranted to maximize ageing in place.

scholarly journals The Impact of Musculoskeletal Conditions on Assessed Levels of Care Required by Older Australians

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Tiffany K Gill ◽  
Steve Wesselingh ◽  
Maria C Inacio
Keyword(s):  
Risk Factors ◽  
Residential Care ◽  
Chronic Conditions ◽  
Community Care ◽  
Care Service ◽  
Functional Limitations ◽  
Aged Care ◽  
Residential Aged Care ◽  
Musculoskeletal Conditions ◽  
The Impact

IntroductionMusculoskeletal problems, including conditions such as back pain, neck pain, rheumatoid arthritis, gout and osteoarthritis are common in the population and significant contributors to global disease burden. Age is one of the most common risk factors for musculoskeletal conditions and over 40% of older people accessing residential aged care have a musculoskeletal condition. It is not known whether individuals living in the community with musculoskeletal conditions have similar needs to those in permanent care and this is important to know in order to provide appropriate care. Objectives and ApproachThe objective of this study was to profile individuals with musculoskeletal conditions in different aged care service settings (i.e. permanent care, community care only, transition/ respite care, or no services). Specifically, we examined the concurrent chronic conditions, health risk factors and functional limitations of individuals by service setting. A cross-sectional evaluation of individuals in the National Historical Cohort of the Registry of Senior Australians (ROSA) between 2004 and 2014 was conducted. Multivariable logistic regression models estimated the factors associated with being in different aged care settings. Odds ratios (OR) and 95% confidence intervals (CI) were determined. Results401,026 (42.5%) individuals with musculoskeletal conditions were assessed for aged care service eligibility during the study period. Of these 197,181 (49.2%) accessed permanent care, 37,003 (9.2%) accessed home care, 54,826 (13.7%) transition/respite, and 112,016 (27.9%) - no care. Individuals accessing community care compared to residential care were more likely to be female, have pain and have difficulty maintaining their home, as were individuals accessing no services compared to residential care. Conclusion / ImplicationsCompared to those in residential care, individuals with musculoskeletal conditions in the community with or without assistance had few differences related to other chronic conditions and functional limitations. But the reasons why some had support, while others did not, are unclear.

Abstract P380: Coronary Artery Disease Extent is Predictive of Heart Failure Incidence After Myocardial Infarction

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Yariv Gerber ◽  
Susan A Weston ◽  
Maurice E Sarano ◽  
Sheila M Manemann ◽  
Alanna M Chamberlain ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Proportional Hazards ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Disease Extent ◽  
Increased Risk ◽  
Artery Disease

Background: Little is known about the association between coronary artery disease (CAD) and the risk of heart failure (HF) after myocardial infarction (MI), and whether it differs by reduced (HFrEF) or preserved (HFpEF) ejection fraction (EF) has yet to be determined. Subjects and Methods: Olmsted County, Minnesota residents (n=1,924; mean age, 64 years; 66% male) with first MI diagnosed in 1990-2010 and no prior HF were followed through 2013. Framingham Heart Study criteria were used to define HF, which was further classified according to EF (applying a 50% cutoff). The extent of angiographic CAD was defined at index MI according to the number of major epicardial coronary arteries with ≥50% lumen diameter obstruction. Fine & Gray and Cox proportional hazards regression models were used to assess the association of CAD categories with incidence of HF, and multiple imputation methodology was applied to account for the 19% with missing EF data. Results: During a mean (SD) follow-up of 6.7 (5.9) years, 594 patients developed HF. Adjusted for age and sex, with death considered a competing risk, the cumulative incidence rates of HF among patients with 1- (n=581), 2- (n=622), and 3-vessel disease (n=721) were 11.2%, 14.6% and 20.5% at 30 days; and 18.1%, 22.3% and 29.4% at 5 years after MI, respectively. The increased risk of HF with greater number of occluded vessels was only modestly attenuated after further adjustment for patient and MI characteristics, and did not differ materially by EF (Table). Conclusions: The extent of angiographic CAD expressed by the number of diseased vessels is independently associated with HF incidence after MI. The association is evident promptly after MI and applies to both HFrEF and HFpEF.

Experiences of ageing and aged care in Australia of older survivors of genocide

2012 ◽  
Vol 34 (3) ◽  
pp. 518-537 ◽  
Author(s):  
KAREN TESHUVA ◽  
YVONNE WELLS
Keyword(s):  
Cultural Awareness ◽  
Distinct Group ◽  
Aged Care ◽  
Community Dwelling ◽  
Care Practice ◽  
Post Traumatic Stress ◽  
Social And Emotional ◽  
Care Services ◽  
Client Group ◽  
Home Based

ABSTRACTThis qualitative study investigated the ageing and aged care experiences in Australia of two cohorts of older survivors of genocide: Jewish Holocaust survivors and older Cambodian genocide survivors. It was carried out in response to an identified need to better train aged care workers who are in contact with these groups. In-depth interviews were conducted with 21 community-dwelling survivors aged 65 and over. Credibility was ensured by methodological triangulation and peer debriefing. The study highlighted the importance of understanding older survivors’ ageing and aged care experiences in the context of their entire lifecourse and in terms of both vulnerability and resilience. It showed that trauma history can heighten older survivors’ sensitivity to many aspects of the social and physical environments in residential, community and home-based aged care settings. The study also uncovered the potential for aged care services to help older survivors cope with the psycho-social and emotional effects of resurfacing post-traumatic stress symptoms. The implications of the study findings for care practice include the importance of recognising older survivors of genocide as a distinct group of clients and the need to distinguish staff training for caring for this client group from general cultural awareness training.

“There isn't an easy way of finding the help that's available.” Barriers and facilitators of service use among dementia family caregivers: a qualitative study

2017 ◽  
Vol 29 (5) ◽  
pp. 765-776 ◽  
Author(s):  
Ashley Macleod ◽  
Gemma Tatangelo ◽  
Marita McCabe ◽  
Emily You
Keyword(s):  
Family Caregivers ◽  
Service Use ◽  
Care Service ◽  
Aged Care ◽  
Community Dwelling ◽  
Barriers And Facilitators ◽  
Care Recipient ◽  
Structured Interviews ◽  
Good Communication ◽  
People With Dementia

ABSTRACTBackground:Family caregivers of people with dementia have significant unmet needs in regard to their caregiving role. Despite this, they are reluctant to utilize services to reduce their burden. The aim of this study was to examine the barriers and facilitators of service use among family caregivers of people with dementia.Method:Semi-structured interviews were conducted with 24 family caregivers of community-dwelling people with dementia. Of these, 12 were partner caregivers (4 men, 8 women) and 12 were offspring caregivers (2 men, 10 women). The interviews were transcribed and analyzed using thematic analysis.Results:Six main barriers and three facilitators were identified. These barriers and facilitators were relevant across many types of services and supports. The barriers were: the inability to find information about relevant services or support, the poor quality or mistrust of the services, the inflexibility of services, caregivers’ beliefs about their obligations to the caregiving role and resistance by the care recipient. Key facilitators were: having good communication with the care recipient, having an “expert” point of contact, and having beliefs about the caregiving role that enabled the use of services.Conclusion:Given the significant changes in the aged care service-system, it is important to discuss the barriers faced by family caregivers of people with dementia. This will inform the development of targeted strategies to address the lack of service use among these family caregivers.

scholarly journals Acute Transition Allliance: rehabilitation at the acute/aged care interface

2004 ◽  
Vol 28 (3) ◽  
pp. 266 ◽  
Author(s):  
Dawn J Kroemer ◽  
Geoffrey Bloor ◽  
Jeff Fiebig
Keyword(s):  
Residential Care ◽  
Public Hospital ◽  
Community Care ◽  
South Australia ◽  
Integrated Approach ◽  
Aged Care ◽  
Residential Aged Care ◽  
Acute Admissions ◽  
Made In

The acute/aged care interface has presented many challenges to funders, providers and planners in the health and aged care sectors. Concerns have long been expressed in the aged care sector about the changing needs of clients admitted permanently into residential aged care from hospitals where the decision for placement would often have been made in a crisis situation, without the opportunity to explore appropriate options. This article describes the process and outcomes to date of a collaborative effort between the acute care and aged care sectors in South Australia to develop a more integrated approach to discharge opportunities for older people. The program involves both residential and community care elements and seeks to provide rehabilitation, to restore function and to avoid inappropriate permanent residential care for older Australians following acute admissions to a public hospital. Interim outcomes are promising and show only 17% of those admitted to the program are discharged to long-term residential care.

scholarly journals Using Health-Related Quality of Life to Identify the Incident Cardiovascular Disease Risk

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 612-613
Author(s):  
Aung Zaw Zaw Phyo ◽  
Joanne Ryan ◽  
David A Gonzalez-Chica ◽  
Nigel P Stocks ◽  
Christopher M Reid ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Older People ◽  
Community Dwelling ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Abstract Previous studies have revealed that poor health-related quality of life (HRQoL) is associated with a higher risk of hospital readmission and mortality in patients with cardiovascular disease (CVD). The association between HRQoL and incident CVD is still limited for general older people. This study explored the associations between baseline HRQoL and incident and fatal CVD in community-dwelling Australian and the United States older people enrolled in ASPREE clinical trial. A cohort of 19,106 individuals aged 65 to 98 years, who were initially free of CVD, dementia, or disability, were followed between March 2010 and June 2017. The SF-12 questionnaire was used to assess HRQoL, and the physical (PCS) and mental component scores (MCS) of SF-12 were derived using norm-based methods. Incident major adverse CVD events included fatal CVD (death due to atherothrombotic CVD), hospitalizations for heart failure, myocardial infarction or stroke. Analyses were performed using Cox proportional-hazard regression. Over a median 4.7 follow-up years, there were 922 incident CVD events, 203 fatal CVD events, 171 hospitalizations for heart failure, 355 fatal or nonfatal myocardial infarction and 403 fatal or nonfatal strokes. A 10-unit higher PCS, but not MCS, was associated with a lower risk of incident CVD (HR=0.86, 95%CI 0.79-0.92), hospitalization for heart failure (HR=0.72, 95%CI 0.60-0.85), and myocardial infarction (HR=0.85, 95%CI 0.75-0.96). Neither PCS nor MCS was associated with fatal CVD events or stroke. Physical HRQoL can be used in combination with clinical data to identify the incident CVD risk among community-dwelling older people.

Variation in Hospital Use at the End of Life Among New South Wales Residents Who Died in Hospital or Soon After Discharge

2019 ◽  
Vol 32 (7-8) ◽  
pp. 708-723
Author(s):  
Hassan Assareh ◽  
Joanne M. Stubbs ◽  
Lieu T. T. Trinh ◽  
Poorani Muruganantham ◽  
Bin Jalaludin ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Community Care ◽  
New South ◽  
New South Wales ◽  
Aged Care ◽  
Care Services ◽  
South Wales ◽  
Hospital Deaths ◽  
Hospital Use

Objective: Hospital use increases in the last 3 months of life. We aimed to examine its association with where people live and its variation across a large health jurisdiction. Methods: We studied a number of emergency department presentations and days spent in hospital, and in-hospital deaths among decedents who were hospitalized within 30 days of death across 153 areas in New South Wales (NSW), Australia, during 2010-2015. Results: Decedents’ demographics and health status were associated with hospital use. Primary care and aged care supply had no or minimal influence, as opposed to the varying effects of areal factors—socioeconomic status, remoteness, and distance to hospital last admitted. Overall, there was an approximate 20% difference in hospital use by decedents across areas. In all, 18% to 57% of areas had hospital use that differed from the average. Discussion: The observed disparity can inform targeted local efforts to strengthen the use of community care services and reduce the burden of end-of-life care on hospitals.

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