Background rates of hospital transfer and death in Australian aged care facilities: estimates to assist interpretation of rates after COVID‐19 vaccination

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.

Download Full-text

Dementia in Aboriginal people in Residential Aged Care Facilities in Alice Springs: A Descriptive Study

Brain Impairment ◽

10.1017/brimp.2019.23 ◽

2019 ◽

Vol 20 (2) ◽

pp. 171-179

Author(s):

Bruce Hocking ◽

Michael Lowe ◽

Tricia Nagel ◽

Caroline Phillips ◽

Melissa Lindeman ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Assessment ◽

Aboriginal People ◽

Aged Care ◽

Residential Aged Care ◽

Aboriginal Populations ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities ◽

Clinical File

AbstractBackground:A high prevalence of dementia among Aboriginal and Torres Strait Islanders has been reported but knowledge of underlying causes and associations remains limited.Objective:To identify the prevalence of factors that may be associated with the categories of Major neurocognitive disorders (Major NCDs) in Aboriginal people living in residential aged care facilities in Alice Springs in the Northern Territory (NT).Design and Setting:This descriptive cross-sectional study analysed clinical file and cognitive assessment data of participants who were identified as having cognitive impairment between January and June 2016.Method:Screening for the presence of cognitive impairment using the Kimberley Indigenous Cognitive Assessment (KICA) was undertaken and 58 of 84 Aboriginal people were admitted to the study. Using a clinical file audit, diagnoses of Major NCDs consistent with the DSM-5 classification were made and the prevalence of factors possibly associated with these diagnoses described.Results:Fifty of the 58 participants were diagnosed with a Major NCD. The most frequent diagnoses were Major NCD due to vascular disease (30%), Major NCD due to Alzheimer’s Disease (26%) and Major NCD due to brain injury (20%). Hypertension, Type 2 Diabetes Mellitus and alcohol misuse were commonly reported together with hypothyroidism, hypoglycaemia and vitamin D deficiency.Conclusion(s):This study identified possible associations with Major NCDs in this population as well as a different spread of Major NCD diagnoses to previous studies in Aboriginal populations. There is a need for further research to understand the causes of dementia in Australian Aboriginal people and to use this information to appropriately tailor treatment and prevention programmes.

Download Full-text

CASH, CUSTOMERS, AND CARE: THE EXPERIENCE AND MEANING OF DIFFERENTIAL PAYMENT FOR HIGH CARE PLACES IN AGED CARE FACILITIES

Australian Journal of Social Issues ◽

10.1002/j.1839-4655.2002.tb01127.x ◽

2002 ◽

Vol 37 (4) ◽

pp. 383-396 ◽

Cited By ~ 4

Author(s):

Cheryl Tilse

Keyword(s):

Aged Care ◽

Care Facilities ◽

High Care ◽

Aged Care Facilities

Download Full-text

Enhancing palliative care in rural Australia: the residential aged care setting

Australian Journal of Primary Health ◽

10.1071/py10054 ◽

2011 ◽

Vol 17 (1) ◽

pp. 95 ◽

Cited By ~ 18

Author(s):

Geoffrey Mitchell ◽

Caroline Nicholson ◽

Keith McDonald ◽

Anne Bucetti

Keyword(s):

Palliative Care ◽

End Of Life Care ◽

Aged Care ◽

Care Staff ◽

Residential Aged Care ◽

Care Facilities ◽

Aged Care Facilities ◽

Residential Aged Care Facilities ◽

Advance Care

The delivery of palliative care in residential aged care communities is challenging, even more so in rural areas due to workforce ageing and shortages. The objectives of the present study were to: (i) assess the needs of, and quality of palliative care delivered to residents of 16 residential aged care facilities in rural southern Australia; and (ii) identify the needs of care staff to facilitate the delivery of quality palliative care. A cross-sectional survey of all residents, assessing the degree of functional limitation, stage of palliative care, and the presence of several quality indicators was conducted. Separate focus groups of care staff and relatives of residents sought information on the quality of care delivered, perceived strengths and weaknesses of the care delivered, and education and training needs. Quality palliative care in residential aged care facilities (RACFs) is hampered by workforce shortages, with low ratios of registered nurses, limited access to general practitioners after hours, and some communication difficulties. Some staff reported low confidence in technical and psychosocial aspects of care, especially for relatives. Relatives described mostly appropriate care, while acknowledging workload constraints. Most residents whose condition was unstable, deteriorating or terminal received advance care planning, though family expectations and unwillingness to discuss end-of-life care did tend to delay planning. Unstable residents with a reasonable prognosis were more likely to be transferred to hospital than terminally ill residents. Palliative care in participating RACFs appears to be adequate. Provision of targeted education for health care providers and implementation of protocols for advance care planning and end-of life care pathways will enhance this care.

Download Full-text