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

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

Australian Health Review ◽

10.1071/ah040266 ◽

2004 ◽

Vol 28 (3) ◽

pp. 266 ◽

Cited By ~ 2

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.

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Cohort profile: Dementia in the Registry of Senior Australians

BMJ Open ◽

10.1136/bmjopen-2020-039907 ◽

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.

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The impact of dementia on aged care service transitions in the last five years of life

Age and Ageing ◽

10.1093/ageing/afaa254 ◽

2020 ◽

Author(s):

Heidi J Welberry ◽

Louisa R Jorm ◽

Sebastiano Barbieri ◽

Benjumin Hsu ◽

Henry Brodaty

Keyword(s):

Home Care ◽

End Of Life ◽

Residential Care ◽

Service Use ◽

Care Service ◽

Care Home ◽

Aged Care ◽

Dementia Diagnosis ◽

People With Dementia ◽

The Impact

Abstract Objective To investigate the impact of dementia on aged care service use at end-of-life. Methods Our retrospective data linkage study in New South Wales, Australia, used survey data from participants in the 45 and Up Study who died between July 2011–June 2014 linked to routinely collected administrative data for 2006–2014. We investigated movement between aged care “states” (No Services, Home Care including Home Support and Low-and High-Level Home Care and Residential Care) in the last five years of life. The dementia cohort comprised decedents with a dementia diagnosis recorded in hospital records, death certificates or who had claims for dementia-specific medicines prior to death (n = 2,230). The comparison cohort were decedents with no dementia diagnosis, matched 1:1 on age-at-death, sex, income and location. Results Compared to those without dementia, people with dementia were more likely to: use home care (67 versus 60%, P < 0.001), enter residential care (72 versus 30%, P < 0.001) and stay longer in residential care (median 17.9 versus 12.7 months, P < 0.001). Five years before death, more people with dementia were within residential care (6 versus 4%; RR = 1.61, 95%CI = 1.23–2.10) and these rates diverged at the end-of-life (69 versus 28%, RR = 2.48, 95%CI = 2.30–2.66). Use of home-based care was higher among people with dementia five years from death (20 versus 17%; RR = 1.15, 95%CI = 1.02–1.30) but lower at end-of-life (13 versus 24%, RR = 0.55, 95%CI = 0.49–0.63). Conclusion Dementia-specific aged care trajectories were dominated by residential care. Home care use declined towards end-of-life for people with dementia and may not be meeting their needs.

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The impact of electronic medication administration records in a residential aged care home

International Journal of Medical Informatics ◽

10.1016/j.ijmedinf.2015.08.002 ◽

2015 ◽

Vol 84 (11) ◽

pp. 966-973 ◽

Cited By ~ 18

Author(s):

Siyu Qian ◽

Ping Yu ◽

David M. Hailey

Keyword(s):

Care Home ◽

Medication Administration ◽

Aged Care ◽

Residential Aged Care ◽

The Impact ◽

Electronic Medication Administration

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Housing and Care for Older Women in Australia

Frontiers in Public Health ◽

10.3389/fpubh.2021.566960 ◽

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.

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

Frontiers in Public Health ◽

10.3389/fpubh.2021.688640 ◽

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.

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Characteristics of Cognitive Behavioral Therapy for Older Adults Living in Residential Care: Protocol for a Systematic Review (Preprint)

10.2196/preprints.9902 ◽

2018 ◽

Author(s):

Phoebe Chan ◽

Sunil Bhar ◽

Tanya E. Davison ◽

Colleen Doyle ◽

Bob G. Knight ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Cognitive Behavioral Therapy ◽

Residential Care ◽

Behavioral Therapy ◽

Late Life ◽

Aged Care ◽

Residential Aged Care ◽

Late Life Depression ◽

Residential Settings

BACKGROUND The prevalence rates of depressive and anxiety disorders are high in residential aged care settings. Older adults in such settings might be prone to these disorders because of losses associated with transitioning to residential care, uncertainty about the future, as well as a decline in personal autonomy, health, and cognition. Cognitive behavioral therapy (CBT) is efficacious in treating late-life depression and anxiety. However, there remains a dearth of studies examining CBT in residential settings compared with community settings. Typically, older adults living in residential settings have higher care needs than those living in the community. To date, no systematic reviews have been conducted on the content and the delivery characteristics of CBT for older adults living in residential aged care settings. OBJECTIVE The objective of this paper is to describe the systematic review protocol on the characteristics of CBT for depression and/or anxiety for older adults living in residential aged care settings. METHODS This protocol was developed in compliance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Studies that fulfill the inclusion criteria will be identified by systematically searching relevant electronic databases, reference lists, and citation indexes. In addition, the PRISMA flowchart will be used to record the selection process. A pilot-tested data collection form will be used to extract and record data from the included studies. Two reviewers will be involved in screening the titles and abstracts of retrieved records, screening the full text of potentially relevant reports, and extracting data. Then, the delivery and content characteristics of different CBT programs of the included studies, where available, will be summarized in a table. Furthermore, the Downs and Black checklist will be used to assess the methodological quality of the included studies. RESULTS Systematic searches will commence in May 2018, and data extraction is expected to commence in July 2018. Data analyses and writing will happen in October 2018. CONCLUSIONS In this section, the limitations of the systematic review will be outlined. Clinical implications for treating late-life depression and/or anxiety, and implications for residential care facilities will be discussed. CLINICALTRIAL PROSPERO 42017080113; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=80113 (Archived by WebCite at http://www.webcitation.org/70dV4Qf54) REGISTERED REPORT IDENTIFIER RR1-10.2196/9902

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