scholarly journals A study protocol for the development of a multivariable model predicting 6- and 12-month mortality for people with dementia living in residential aged care facilities (RACFs) in Australia

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Ross Bicknell ◽  
Wen Kwang Lim ◽  
Andrea B. Maier ◽  
Dina LoGiuidice
Keyword(s):  
Mortality Risk ◽  
Clinical Decision Making ◽  
Clinical Care ◽  
External Validation ◽  
Aged Care ◽  
Residential Aged Care ◽  
Term Care ◽  
Data Set ◽  
Calibration Curves ◽  
People With Dementia

Abstract Background For residential aged care facility (RACF) residents with dementia, lack of prognostic guidance presents a significant challenge for end of life care planning. In an attempt to address this issue, models have been developed to assess mortality risk for people with advanced dementia, predominantly using long-term care minimum data set (MDS) information from the USA. A limitation of these models is that the information contained within the MDS used for model development was not collected for the purpose of identifying prognostic factors. The models developed using MDS data have had relatively modest ability to discriminate mortality risk and are difficult to apply outside the MDS setting. This study will aim to develop a model to estimate 6- and 12-month mortality risk for people with dementia from prognostic indicators recorded during usual clinical care provided in RACFs in Australia. Methods A secondary analysis will be conducted for a cohort of people with dementia from RACFs participating in a cluster-randomized trial of a palliative care education intervention (IMPETUS-D). Ten prognostic indicator variables were identified based on a literature review of clinical features associated with increased mortality for people with dementia living in RACFs. Variables will be extracted from RACF files at baseline and mortality measured at 6 and 12 months after baseline data collection. A multivariable logistic regression model will be developed for 6- and 12-month mortality outcome measures using backwards elimination with a fractional polynomial approach for continuous variables. Internal validation will be undertaken using bootstrapping methods. Discrimination of the model for 6- and 12-month mortality will be presented as receiver operating curves with c statistics. Calibration curves will be presented comparing observed and predicted event rates for each decile of risk as well as flexible calibration curves derived using loess-based functions. Discussion The model developed in this study aims to improve clinical assessment of mortality risk for people with dementia living in RACFs in Australia. Further external validation in different populations will be required before the model could be developed into a tool to assist with clinical decision-making in the future.

scholarly journals Benchmarking clinical indicators of quality for Australian residential aged care facilities

2010 ◽  
Vol 34 (1) ◽  
pp. 93 ◽  
Author(s):  
Mary Courtney ◽  
Maria T. O'Reilly ◽  
Helen Edwards ◽  
Stacey Hassall
Keyword(s):  
Quality Of Care ◽  
Clinical Outcomes ◽  
Clinical Care ◽  
Aged Care ◽  
Minimum Data Set ◽  
Residential Aged Care ◽  
Data Set ◽  
Clinical Indicators ◽  
Minimum Data

To undertake exploratory benchmarking of a set of clinical indicators of quality care in residential care in Australia, data were collected from 107 residents within four medium-sized facilities (40–80 beds) in Brisbane, Australia. The proportion of residents in each sample facility with a particular clinical problem was compared with US Minimum Data Set quality indicator thresholds. Results demonstrated variability within and between clinical indicators, suggesting breadth of assessment using various clinical indicators of quality is an important factor when monitoring quality of care. More comprehensive and objective measures of quality of care would be of great assistance in determining and monitoring the effectiveness of residential aged care provision in Australia, particularly as demands for accountability by consumers and their families increase. What is known about the topic?The key to quality improvement is effective quality assessment, and one means of evaluating quality of care is through clinical outcomes. The Minimum Data Set quality indicators have been credited with improving quality in United States nursing homes. What does this paper add?The Clinical Care Indicators Tool was used to collect data on clinical outcomes, enabling comparison of data from a small Australian sample with American quality benchmarks to illustrate the utility of providing guidelines for interpretation. What are the implications for practitioners?Collecting and comparing clinical outcome data would enable practitioners to better understand the quality of care being provided and whether practices required review. The Clinical Care Indicator Tool could provide a comprehensive and systematic means of doing this, thus filling a gap in quality monitoring within Australian residential aged care.

Care trajectories through community and residential aged care services: disease effects

2012 ◽  
Vol 32 (8) ◽  
pp. 1428-1445 ◽  
Author(s):  
ROSEMARY KARMEL ◽  
DIANE GIBSON ◽  
PHIL ANDERSON ◽  
YVONNE WELLS ◽  
STEPHEN DUCKETT
Keyword(s):  
Cardiovascular Disease ◽  
Nursing Home ◽  
Aged Care ◽  
Residential Aged Care ◽  
Term Care ◽  
Musculoskeletal Conditions ◽  
Care Services ◽  
People With Dementia ◽  
Care Assessment ◽  
Over Time

ABSTRACTAs in other ageing populations, dementia, musculoskeletal conditions and cardiovascular disease affect a high proportion of Australians aged over 65 years, and the prevalence of these conditions increases significantly with age. People with these conditions may need to access a range of care services over time to enable them to remain living in their homes. Many eventually need to move into a nursing home.In contrast to the considerable recent literature on the funding of long-term care systems for population ageing, studies on the care pathways followed by individuals are much less common. This paper explores the effect of disease on use of community care services and nursing homes over time, focusing on people with dementia, cardiovascular disease and musculoskeletal conditions. Care-use transitions are identified using linked administrative client data for a cohort of 33,300 community-living Australians who had an aged care assessment in 2003-04 and who had not previously used aged care services.The different symptoms and courses of diseases meant that the patterns of aged care service use, both in terms of care services accessed and the timing of this access, varied considerably for people with different health conditions. These differences persisted across a range of client characteristics. In particular, people with dementia or cerebrovascular disease as their main health condition were more likely to enter nursing home care than those with heart disease or musculoskeletal conditions.The variation in use of aged care services according to disease group need to be taken into account in any projections of demand for aged care. Such projections must allow for predictions of disease prevalence, or else they will yield inaccurate predictions of demand for both community and residential care.

scholarly journals Inadequate completion of advance care directives by individuals with dementia: national audit of health and aged care facilities

2021 ◽  
pp. bmjspcare-2020-002767
Author(s):  
Jamie Bryant ◽  
Marcus Sellars ◽  
Craig Sinclair ◽  
Karen Detering ◽  
Kimberly Buck ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Aged Care ◽  
Care Plan ◽  
Residential Aged Care ◽  
Multinomial Regression ◽  
People With Dementia ◽  
Care Facilities ◽  
Aged Care Facilities ◽  
Advance Care Directives ◽  
Advance Care

Objectives(i) Describe the prevalence and type of advance care directives (ACDs) and other advance care planning (ACP) documentation completed by persons with dementia, healthcare providers and others on behalf of a person with dementia; (ii) identify the personal and ACP programme characteristics associated with having ACP documentation in the health record; (iii) identify the personal and ACP programme characteristics associated with having a self-completed ACD.MethodsA multicentre audit was undertaken in Australian hospitals, general practices and residential aged care facilities. Auditors extracted demographic and ACP data from the records of eligible patients. ACP programme characteristics were provided by a site representative. Logistic and multinomial regression were used respectively to examine the factors associated with completion of any ACP documentation, and self-completion of an ACD by persons with dementia.ResultsA total of 1388 people with dementia (33.2%) from 96 sites were included. Overall, 60.8% (n=844) had ACP documentation; 31.6% (n=438) had a self-completed ACD and 29.3% (n=406) had an ACP document completed by a health professional or someone else on their behalf. Older participants were more likely to have ACP documented. Multivariate analyses indicated the odds of having self-completed ACP documents, compared with no advance care plan or ACP completed by someone else, were significantly influenced by age, country of birth, setting and whether the site had ACP training, policies or guidelines.DiscussionWhile 60% of people with dementia had some form of ACP documentation, only half of the cases in which ACP was documented included an ACD completed by the person themselves.

Person-centered care and engagement via technology of residents with dementia in aged care facilities

2017 ◽  
Vol 29 (12) ◽  
pp. 2099-2103 ◽  
Author(s):  
Anita M. Y. Goh ◽  
Samantha M. Loi ◽  
Alissa Westphal ◽  
Nicola T. Lautenschlager
Keyword(s):  
Aged Care ◽  
Care Staff ◽  
Residential Aged Care ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Person Centered Care ◽  
People With Dementia ◽  
Care Facilities ◽  
Centered Care ◽  
Aged Care Facilities

ABSTRACTTouchscreen technology (TT) is a resource that can improve the quality of life of residents with dementia, and care staff, in residential aged care facilities (RACF) through a person-centered care approach. To enable the use of TTs to engage and benefit people with dementia in RACFs, education is needed to explore how these devices may be used, what facilitates use, and how to address barriers. We sought to provide education and explore RACF staff views and barriers on using TT to engage their residents with dementia. An educational session on using TT with residents with dementia was given to staff from three long-term RACFs in Melbourne, Australia. A cross-sectional convenience sample of 17 staff members (personal care attendants, registered nurses, enrolled nurses, allied health clinicians, and domestic staff) who attended were administered questionnaires pre- and post-sessions. As a result of the education seminar, they were significantly more confident in their ability to use TT devices with residents. TT, and education to staff about its use with residents with dementia, is a useful strategy to enhance RACF staff knowledge and confidence, thereby enhancing the use of technology in RACFs in order to improve care standards in people with dementia.

scholarly journals Medication omission rates in New Zealand Residential Aged Care Homes: a national description

2020 ◽  
Author(s):  
Stephanie M Garratt ◽  
Ngaire M Kerse ◽  
Kathryn Peri ◽  
Monique F Jonas
Keyword(s):  
New Zealand ◽  
Clinical Decision Making ◽  
Home Ownership ◽  
Medication Administration ◽  
Aged Care ◽  
Care Staff ◽  
Residential Aged Care ◽  
Level Of Care ◽  
Ownership Type ◽  
Level Data

Abstract Background A medication omission is an event where a prescribed medication is not taken before the next scheduled dose. Medication omissions are typically classed as errors within Residential Aged Care (RAC) homes, as they have the potential to lead to harm if poorly managed, but may also stem from good clinical decision-making. This study aimed to quantify the incidence, prevalence, and types of medication omissions in RAC homes on a national scale, using a New Zealand-based sample. Methods We conducted retrospective pharmacoepidemiology of de-identified medication administration e-records from December 1st 2016 to December 31st 2017. Four tiers of de-identified data were collected: RAC home level data (ownership, levels of care), care staff level data (competency level/role), resident data (gender, age, level of care), and medication related data (omissions, categories of omissions, recorded reasons for omission). Data were analysed using SPSS version 24 and Microsoft Excel.Results A total of 11, 015 residents from 374 RAC homes had active medication charts; 8,020 resided in care over the entire sample timeframe. A mean rate of 3.59 medication doses were omitted per 100 (±7.43) dispensed doses/resident. Seventy-three percent of residents had at least one dose omission. The most common omission category used was ‘not-administered’ (49.9%), followed by ‘refused’ (34.6%). The relationship between ownership type and mean rate of omission was significant (p=0.002), corporate operated RAC homes had a slightly higher mean (3.73 versus 3.33), with greater variation. The most commonly omitted medications were Analgesics and Laxatives. Forty-eight percent of all dose omissions were recorded without a comment justifying the omission. Conclusions This unique study is the first to report rate of medication omissions per RAC resident over a one-year timeframe. Although the proportion of medications omitted reported in this study is less than previously reported by hospital-based studies, there is a significant relationship between a resident’s level of care, RAC home ownership types, and the rate of omission.

Animal-assisted therapy for dementia: a review of the literature

2006 ◽  
Vol 18 (4) ◽  
pp. 597-611 ◽  
Author(s):  
Susan L. Filan ◽  
Robert H. Llewellyn-Jones
Keyword(s):  
Psychological Symptoms ◽  
Preliminary Evidence ◽  
Aged Care ◽  
Animal Assisted Therapy ◽  
Residential Aged Care ◽  
Pet Dogs ◽  
People With Dementia ◽  
Aged Care Facilities ◽  
Residential Aged Care Facilities ◽  
Potential Benefits

Background: Animal-assisted therapy (AAT) is gaining popularity as part of therapy programs in residential aged care facilities. Humans and pet dogs respond to quiet interaction with a lowering of blood pressure and an increase in neuroche-micals associated with relaxation and bonding. These effects may be of benefit in ameliorating behavioral and psychological symptoms of dementia (BPSD).Methods: Medline, PsychInfo and CINAHL databases (1960–2005) were searched for papers on AAT or pets and dementia. Publications of controlled trials that measured the effect of AAT for dementia were reviewed.Results: Several small studies suggest that the presence of a dog reduces aggression and agitation, as well as promoting social behavior in people with dementia. One study has shown that aquaria in dining rooms of dementia care units stimulate residents to eat more of their meals and to gain weight but is limited by the small number of facilities studied. There is preliminary evidence that robotic pets may provide pleasure and interest to people with dementia.Conclusions: Current literature suggests that AAT may ameliorate BPSD, but the duration of the beneficial effect has not been explored. The relative benefits of “resident” versus “visiting” pet dogs are unclear and are confounded by the positive effect of pet interaction on staff or caregivers. Further research on the potential benefits of AAT is recommended.

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