Remodelling Aged Living to Reduce Stigma

This thesis investigates whether community-based architectural strategies can be used in aged care facility design to reduce the stigma of social isolation. New Zealand has a growing population, with an increasing number of people needing assistance from aged care facilities. However, the elderly resist moving into aged care facilities because of fears of marginalisation, social isolation and associated stigma. Stigma creates outcomes of discrimination towards marginalised individuals, resulting in negative projections on these people and consequent social exclusion. There are two main aims of this research. The first aim was to understand the relationship between stigma and architecture and stigma and aged care facilities. To achieve this aim, stigma and various strategies for addressing that stigma in aged care facilities were defined based on contemporary literature on this subject and analyses of relevant built precedents. The second aim was to develop, a contemporary aged care facility that demonstrates potential strategies for reducing stigma. This aim was achieved by developing criteria that respond to iterative design exercises and contemporary research in the fields of aged care facilities, architecture and stigma. An iterative design process, continually tested these criteria against literature and precedent reviews, was carried out to arrive at a coherent design and more refined set of criteria. Research conclusions showed that community-based architectural strategies can be used to reduce the stigma of social isolation in aged care facility design. This resulted in the outcome of a community-based model and criteria that can be applied to the design of aged care facilities and will resultantly provide residents with a purposive role and inclusion within society.

Remodelling Aged Living to Reduce Stigma

10.26686/wgtn.14865036.v1 ◽

2021 ◽

Author(s):

Georgia Reece

Keyword(s):

Social Isolation ◽

Care Facility ◽

The Elderly ◽

Aged Care ◽

Facility Design ◽

Community Based ◽

Aged Care Facility ◽

Iterative Design ◽

Care Facilities ◽

Integrating pharmacists into aged care facilities to improve the quality use of medicine (PiRACF Study): Protocol for a cluster randomised controlled trial

10.21203/rs.3.rs-38456/v1 ◽

2020 ◽

Author(s):

sam kosari ◽

Jane Koerner ◽

Mark Naunton ◽

Gregory M Peterson ◽

Ibrahim Haider ◽

...

Keyword(s):

Controlled Trial ◽

Medication Management ◽

Care Facility ◽

Cluster Randomised Controlled Trial ◽

Aged Care ◽

Residential Aged Care ◽

Aged Care Facility ◽

Care Facilities ◽

Aged Care Facilities ◽

Abstract BackgroundMedication management in residential aged care facilities is an ongoing concern. Numerous studies have reported high rates of inappropriate prescribing and medication use in aged care facilities, which contribute to residents’ adverse health outcomes. There is a need for new models of care that enhance inter-disciplinary collaboration between residential aged care facility staff and healthcare professionals, to improve medication management. Pilot research has demonstrated the feasibility and benefits of integrating a pharmacist into the aged care facility team to improve the quality use of medicines. This protocol describes the design and methods for a cluster randomised controlled trial to evaluate the outcomes and conduct economic evaluation of a service model where on-site pharmacists are integrated into residential aged care facility healthcare teams to improve medication management.MethodsIntervention aged care facilities will employ on-site pharmacists to work as part of their healthcare teams. Pharmacists will assume responsibility for medication management, and collaborate with facility nurses, prescribers, community pharmacists, residents and families to improve the quality use of medicines. The intervention will last for 12 months. Aged care facilities in the control group will continue usual care. The target sample size is 1,188 residents from a minimum of 13 aged care facilities. The primary outcome is the appropriateness of prescribing, measured by the proportion of residents who are prescribed at least one potentially inappropriate medicine according to the 2019 Beers Criteria. Secondary outcomes include hospital and Emergency Department presentations, fall rates, prevalence and dose of antipsychotics and benzodiazepines, Anticholinergic Cognitive Burden Score, staff influenza vaccination rate, time spent on medication rounds, appropriateness of dose form modification and completeness of resident’s allergy and adverse drug reaction documentation. A cost-consequence and cost-effectiveness analysis will be embedded in the trial.DiscussionThe results of this study will provide information on clinical and economic outcomes of a model that integrates on-site pharmacists into Australian residential aged care facilities. The results will provide policymakers with recommendations relevant to further implementation of this model.Trial registrationACTRN: ACTRN12620000430932, retrospectively registered with ANZCTR on 1 April 2020. Available from https://www.anzctr.org.au/TrialSearch.aspx#&&conditionCode=&dateOfRegistrationFrom=&interventionDescription=&interventionCodeOperator=OR&primarySponsorType=&gender=&distance=&postcode=&pageSize=20&ageGroup=&recruitmentCountryOperator=OR&recruitmentRegion=&ethicsReview=&countryOfRecruitment=&registry=&searchTxt=ACTRN12620000430932&studyType=&allocationToIntervention=&dateOfRegistrationTo=&recruitmentStatus=&interventionCode=&healthCondition=&healthyVolunteers=&page=1&conditionCategory=&fundingSource=&trialStartDateTo=&trialStartDateFrom=&phase=

More action needed: Psychotropic prescribing in Australian residential aged care

Australian & New Zealand Journal of Psychiatry ◽

10.1177/0004867418758919 ◽

2018 ◽

Vol 53 (2) ◽

pp. 136-147 ◽

Cited By ~ 17

Author(s):

Juanita Westbury ◽

Peter Gee ◽

Tristan Ling ◽

Alex Kitsos ◽

Gregory Peterson

Keyword(s):

New South ◽

Care Facility ◽

Aged Care ◽

Residential Aged Care ◽

Aged Care Facility ◽

South Wales ◽

Residential Aged Care Facility ◽

Care Facilities ◽

Aged Care Facilities ◽

Objective: For at least two decades, concerns have been raised about inappropriate psychotropic prescribing in Australian residential aged care facilities, due to their modest therapeutic benefit and increased risk of falls and mortality. To date, the majority of prevalence data has been collected in Sydney exclusively and it is not known if recent initiatives to promote appropriate psychotropic prescribing have impacted utilisation. Thus, we aimed to comprehensively analyse psychotropic use in a large national sample of residential aged care facility residents. Method: A cross-sectional, retrospective cohort study of residents from 150 residential aged care facilities distributed nationally during April 2014–October 2015. Antipsychotic, anxiolytic/hypnotic and antidepressant utilisation was assessed, along with anticonvulsant and anti-dementia drug use. Negative binomial regression analysis was used to examine variation in psychotropic use. Results: Full psychotropic prescribing data was available from 11,368 residents. Nearly two-thirds (61%) were taking psychotropic agents regularly, with over 41% prescribed antidepressants, 22% antipsychotics and 22% of residents taking benzodiazepines. Over 30% and 11% were charted for ‘prn’ (as required) benzodiazepines and antipsychotics, respectively. More than 16% of the residents were taking sedating antidepressants, predominantly mirtazapine. South Australian residents were more likely to be taking benzodiazepines ( p < 0.05) and residents from New South Wales/Australian Capital Territory less likely to be taking them ( p < 0.01), after adjustment for rurality and size of residential aged care facility. Residents located in New South Wales/Australian Capital Territory were also significantly less likely to take antidepressants ( p < 0.01), as were residents from outer regional residential aged care facilities ( p < 0.01). Antipsychotic use was not associated with State, rurality or residential aged care facility size. Conclusion: Regular antipsychotic use appears to have decreased in residential aged care facilities but benzodiazepine prevalence is higher, particularly in South Australian residential aged care facilities. Sedating antidepressant and ‘prn’ psychotropic prescribing is widespread. Effective interventions to reduce the continued reliance on psychotropic management, in conjunction with active promotion of non-pharmacological strategies, are urgently required.

Rehabilitation in Residential Aged Care Facilities: Barriers and Facilitators in a Dementia Context

Australian Journal of Rehabilitation Counselling ◽

10.1017/jrc.2013.5 ◽

2013 ◽

Vol 19 (1) ◽

pp. 57-63 ◽

Cited By ~ 1

Author(s):

Leander K. Mitchell ◽

Nancy A. Pachana

Keyword(s):

Care Facility ◽

Aged Care ◽

Communication Process ◽

Residential Aged Care ◽

Open Communication ◽

Aged Care Facility ◽

Potential Barriers ◽

Care Facilities ◽

Aged Care Facilities ◽

This review of the literature sought to highlight key barriers to the implementation of rehabilitation-based interventions in an aged care facility context. It then identifies how such barriers might be actively countered with a view to facilitating rehabilitation-based strategies within such contexts. Key barriers identified included staffing issues, heterogeneity of residents, and the potential complexity behind establishing appropriate forms of rehabilitation for the residents. The most successful facilitators identified included training, the provision of appropriate support, and an open communication process. Having an awareness and an appreciation of potential barriers to the use of rehabilitation interventions in aged care facilities provides the opportunity to actively plan around them, thereby increasing and improving their use.

Servicescapes in Healthcare: A qualitative study on the elderly’s perception of an aged care facility

Asia Pacific Journal of Health Management ◽

10.24083/apjhm.v15i1.309 ◽

2020 ◽

Vol 15 (1) ◽

pp. 26-34

Author(s):

Ngoc Cindy Pham ◽

Huan Henry Pham ◽

Tofazzal Hossain ◽

Yuanqing Li

Keyword(s):

Care Facility ◽

The Elderly ◽

Healthcare Services ◽

Aged Care ◽

Social Contexts ◽

Cultural Dimensions ◽

Asia Pacific ◽

Aged Care Facility ◽

Home Context ◽

Objective: The paper aims to understand how the elderly perceive the healthcare services of their aged care facilities. This paper explores different dimensions of servicescape elements, which ultimately affect the development of healthcare services. Design: Both naturalistic observations and in-depth interviews were conducted to discover the perceptions servicesape elements. Results: The authors discovered that servicescape elements rely not only on physical, social and socially symbolic dimensions but also on cultural dimensions. Conclusions: This study uses the elderly home context in City of Harlingen, Rio Grande Valley, Texas, USA, and finds support to Rosenbaum and Massiah [1]’s multidimensional model and suggests improvements in servicescape elements. We found that factors such as ambience, signage, layout, and socially symbolic structure at the aged care facility, were highly appreciated by the elder residents. Other factors such as privacy, quiet environment, and social interactions among patients via group activities require improvements and further attention. Findings of the study can be generalized in other similar social contexts, particularly in improving Asia Pacific region’s healthcare services.

Integrating pharmacists into aged care facilities to improve the quality use of medicine (PiRACF Study): protocol for a cluster randomised controlled trial

Trials ◽

10.1186/s13063-021-05335-0 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Sam Kosari ◽

Jane Koerner ◽

Mark Naunton ◽

Gregory M. Peterson ◽

Ibrahim Haider ◽

...

Keyword(s):

Controlled Trial ◽

Medication Management ◽

Care Facility ◽

Cluster Randomised Controlled Trial ◽

Aged Care ◽

Residential Aged Care ◽

Aged Care Facility ◽

Care Facilities ◽

Aged Care Facilities ◽

Abstract Background Medication management in residential aged care facilities is an ongoing concern. Numerous studies have reported high rates of inappropriate prescribing and medication use in aged care facilities, which contribute to residents’ adverse health outcomes. There is a need for new models of care that enhance inter-disciplinary collaboration between residential aged care facility staff and healthcare professionals, to improve medication management. Pilot research has demonstrated the feasibility and benefits of integrating a pharmacist into the aged care facility team to improve the quality use of medicines. This protocol describes the design and methods for a cluster randomised controlled trial to evaluate the outcomes and conduct economic evaluation of a service model where on-site pharmacists are integrated into residential aged care facility healthcare teams to improve medication management. Methods Intervention aged care facilities will employ on-site pharmacists to work as part of their healthcare teams 2 to 2.5 days per week for 12 months. On-site pharmacists, in collaboration with facility nurses, prescribers, community pharmacists, residents and families will conduct medication management activities to improve the quality use of medicines. Aged care facilities in the control group will continue usual care. The target sample size is 1188 residents from a minimum of 13 aged care facilities. The primary outcome is the appropriateness of prescribing, measured by the proportion of residents who are prescribed at least one potentially inappropriate medicine according to the 2019 Beers Criteria. Secondary outcomes include hospital and emergency department presentations, fall rates, prevalence and dose of antipsychotics and benzodiazepines, Anticholinergic Cognitive Burden Score, staff influenza vaccination rate, time spent on medication rounds, appropriateness of dose form modification and completeness of resident’s allergy and adverse drug reaction documentation. A cost-consequence and cost-effectiveness analysis will be embedded in the trial. Discussion The results of this study will provide information on clinical and economic outcomes of a model that integrates on-site pharmacists into Australian residential aged care facilities. The results will provide policymakers with recommendations relevant to further implementation of this model. Trial registration ACTRN12620000430932. Registered on 1 April 2020 with ANZCTR

Registered nurses' medication management of the elderly in aged care facilities

International Nursing Review ◽

10.1111/j.1466-7657.2009.00760.x ◽

2010 ◽

Vol 57 (1) ◽

pp. 98-106 ◽

Cited By ~ 17

Author(s):

L.M. Lim ◽

L.H. Chiu ◽

J. Dohrmann ◽

K.-L. Tan

Keyword(s):

Registered Nurses ◽

Medication Management ◽

The Elderly ◽

Aged Care ◽

Care Facilities ◽

Norovirus genotype diversity associated with gastroenteritis outbreaks in aged-care facilities

Epidemiology and Infection ◽

10.1017/s095026881500031x ◽

2015 ◽

Vol 143 (14) ◽

pp. 3064-3068 ◽

Cited By ~ 4

Author(s):

L. D. BRUGGINK ◽

N. L. DUNBAR ◽

J. A. MARSHALL

Keyword(s):

The Elderly ◽

Aged Care ◽

Residential Aged Care ◽

Detailed Knowledge ◽

Viral Gastroenteritis ◽

Reading Frame ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities ◽

One Year

SUMMARYNoroviruses are a major cause of gastroenteritis. Vaccine strategies against norovirus are currently under consideration but depend on a detailed knowledge of the capsid genotypes. This study examined the incidence of norovirus outbreaks in residential aged-care facilities in Victoria, Australia over one year (2013) and documented the (capsid) norovirus genotypes associated with these outbreaks. It was found that 65·0% of 206 outbreaks tested were associated with norovirus infection, thereby showing norovirus to be the major cause of viral gastroenteritis in residential aged-care facilities. Fifteen capsid (open reading frame 2) genotypes were identified as follows: GI.2 (0·9%), GI.3 (1·8%), GI.4 (3·7%), GI.6 (0·9%), GI.7 (0·9%), GI.8 (0·9%), GII.1 (0·9%), GII.2 (0·9%), GII.3 (1·8%), GII.4 (2009-like) (0·9%), GII.4 (2012) (48·6%), GII.4 (2012-like) (16·5%), GII.4 (unknown) (9·2%), GII.5 (2·8%), GII.6 (0·9%), GII.7 (0·9%), GII.13 (6·4%) and an as yet unclassified GII genotype (0·9%). Although GII.4 was the most common norovirus capsid genotype detected, the great diversity of norovirus genotypes in the elderly indicates vaccination strategies for this demographic are not straightforward.