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 Housing and Care for Older Women in Australia

2021 ◽  
Vol 9 ◽  
Author(s):  
Julie E. Byles ◽  
Emily M. Princehorn ◽  
Peta M. Forder ◽  
Md Mijanur Rahman
Keyword(s):  
Service Use ◽  
Care Service ◽  
Later Life ◽  
Aged Care ◽  
Community Services ◽  
Residential Aged Care ◽  
Institutional Setting ◽  
Care Needs ◽  
Housing Type ◽  
Care Assessment

Background: Housing is essential for healthy ageing, being a source of shelter, purpose, and identity. As people age, and with diminishing physical and mental capacity, they become increasingly dependent on external supports from others and from their environment. In this paper we look at changes in housing across later life, with a focus on the relationship between housing and women's care needs.Methods: Data from 12,432 women in the 1921–26 cohort of the Australian Longitudinal Study on Women's Health were used to examine the interaction between housing and aged care service use across later life.Results: We found that there were no differences in access to home and community care according to housing type, but women living in an apartment and those in a retirement village/hostel were more likely to have an aged care assessment and had a faster rate of admission to institutional residential aged care than women living in a house. The odds of having an aged care assessment were also higher if women were older at baseline, required help with daily activities, reported a fall, were admitted to hospital in the last 12 months, had been diagnosed or treated for a stroke in the last 3 years, or had multiple comorbidities. On average, women received few services in the 24 months prior to admission to institutional residential aged care, indicating a potential need to improve the reach of these services.Discussion: We find that coincident with changes in functional capacities and abilities, women make changes to their housing, sometimes moving from a house to an apartment, or to a village. For some, increasing needs in later life are associated with the need to move from the community into institutional residential aged care. However, before moving into care, many women will use community services and these may in turn delay the need to leave their homes and move to an institutional setting. We identify a need to increase the use of community services to delay the admission to institutional residential aged care.

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 The interface between hospital and residential aged care

2002 ◽  
Vol 25 (5) ◽  
pp. 132 ◽  
Author(s):  
Diane Gibson
Keyword(s):  
Service Use ◽  
Aged Care ◽  
Residential Aged Care ◽  
National Database ◽  
Care Services ◽  
Morbidity Data ◽  
Hospital Morbidity ◽  
National Information ◽  
National Databases ◽  
The Impact

The last 15 years have seen substantial changes in both the aged care and the acute hospital sectors. This article focuses on the impact of those changes on the interface between hospital and residential care. It examines trends in expenditure, supply and patterns of service use in the two sectors.Despite good national databases on hospitals and aged care services, there is little national information on the interface of the two sectors.The material presented here is based on work being undertaken at the Australian Institute of Health and Welfare, as part of a project aimed at developing a national database linking residential aged care and hospital morbidity data.

scholarly journals Cohort profile: Dementia in the Registry of Senior Australians

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e039907
Author(s):  
Monica Cations ◽  
Catherine E Lang ◽  
Stephanie A Ward ◽  
Maria Crotty ◽  
Craig Whitehead ◽  
...  
Keyword(s):  
Service Use ◽  
Care Service ◽  
Aged Care ◽  
Residential Aged Care ◽  
Assessment Data ◽  
Cross Sectional ◽  
People With Dementia ◽  
Psychotropic Medicine ◽  
Care Assessment ◽  
The Impact

PurposeClinical quality registries (CQRs) are being established in many countries to monitor, benchmark, and report on the quality of dementia care over time. Case ascertainment can be challenging given that diagnosis occurs in a variety of settings. The Registry of Senior Australians (ROSA) includes a large cohort of people with dementia from all Australian states and territories identified using routinely collected aged care assessment data. In ROSA, assessment data are linked to information about aged and health service use, medicine dispensing, hospitalisations and the National Death Index. The ROSA dementia cohort was established to capture people for the Australian dementia CQR currently in development who may not be identified elsewhere.ParticipantsThere were 373 695 people with dementia identified in aged care assessments from 2008 to 2016. Cross-sectional analysis from the time of cohort entry (e.g. when first identified with dementia on an aged care assessment) indicates that individuals were 84.1 years old on average, and 63.1% were female. More than 44% were first identified at entry to permanent residential aged care. The cohort recorded more severe cognitive impairment at entry than other international dementia registries.Findings to dateThe cohort has so far been used to demonstrate a declining prevalence of dementia in individuals entering the aged care sector, examine trends in psychotropic medicine prescribing, and to examine the impact of dementia on aged care service use and outcomes.Future plansThe ROSA dementia cohort will be updated periodically and is a powerful resource both on its own and as a contributor to the Australian dementia CQR. Integration of the ROSA dementia cohort with the dementia CQR will ensure that people with dementia using aged care services can benefit from the ongoing monitoring and benchmarking of care that a registry can provide.

scholarly journals Characteristics associated with residential aged care, respite and transitional aged care placement for older people following an injury-related hospitalisation in Australia

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Rebecca Mitchell ◽  
Lara Harvey ◽  
Brian Draper ◽  
Henry Brodaty ◽  
Jacqui Close
Keyword(s):  
Service Use ◽  
Transitional Care ◽  
Care Service ◽  
Aged Care ◽  
Personal Hygiene ◽  
Residential Aged Care ◽  
Older Individuals ◽  
Leg Injuries ◽  
Arm Injuries ◽  
Related Hospitalisation

Objective: This study examines characteristics associated with permanent residential aged care (RAC), respite RAC and transitional care (TC) placement for older individuals following an injury-related hospitalisation. Method: A retrospective analysis of individuals aged ≥65 years who had an injury-related hospitalisation and who had a linked record in RAC, TC or activities of daily living (ADL) data between 1 July 2008 and 30 June 2013 in New South Wales, Australia. Comorbidities were identified using diagnosis classifications and a 1-year lookback period. All hospital episodes of care related to the injury were linked to form a period of care. Both new and existing admissions to RAC were examined. Multinominal logistic regression was used to examine the factors associated with new admissions to permanent RAC, respite RAC and TC compared to return to the community. Results: Of 191,301 injury-related hospitalisations, 41,085 (21.5%) individuals either returned or were new admissions to permanent (87.2%) or respite (12.8%) RAC and 3,218 (1.7%) individuals were admitted to TC. There were 3,864, 4,314 and 2,630 new admissions to permanent RAC, respite RAC and TC, respectively. Of the injury hospitalisations, 70,796 (37.0%) individuals had an ADL assessment. Compared to individuals who returned to the community, individuals newly admitted to permanent RAC were four times as likely to have dementia (OR: 4.36; 95%CI 4.15-4.57), those admitted to respite RAC were twice as likely to have dementia (OR: 2.37; 95%CI 2.21-2.54) and people admitted to TC people were less likely to have dementia (OR: 0.60; 95%CI 0.53-0.68). Individuals with shoulder and upper arm injuries were twice as likely (OR: 2.31; 95%CI 1.98-2.68) and individuals with knee and lower leg injuries were one and a half times as likely (OR: 1.87; 95%CI 1.60-2.18) to be admitted to TC. Overall, individuals who were admitted to permanent or respite RAC had a higher likelihood of experiencing limitations associated with their physical, cognitive or social abilities, with individuals admitted to TC having a higher likelihood of having limitations maintaining personal hygiene and mobility compared to individuals returning to the community. Conclusion: An understanding of the profile of which older individuals are using RAC (permanent or respite) or TC services can usefully inform current and future aged care service use.

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.

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.

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.

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