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Ling, Rod, Andrew Searles, Jacqueline Hewitt, Robyn Considine, Catherine Turner, Susan Thomas, Kelly Thomas, et al. "Cost analysis of an integrated aged care program for residential aged care facilities." Australian Health Review 43, no. 3 (2019): 261. http://dx.doi.org/10.1071/ah16297.
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Objective To compare annual costs of an intervention for acutely unwell older residents in residential age care facilities (RACFs) with usual care. The intervention, the Aged Care Emergency (ACE) program, includes telephone clinical support aimed to reduce avoidable emergency department (ED) presentations by RACF residents. Methods This costing of the ACE intervention examines the perspective of service providers: RACFs, Hunter Medicare Local, the Ambulance Service of New South Wales, and EDs in the Hunter New England Local Health District. ACE was implemented in 69 RACFs in the Hunter region of NSW, Australia. Analysis used 14 weeks of ACE and ED service data (June–September 2014). The main outcome measure was the net cost and saving from ACE compared with usual care. It is based on the opportunity cost of implementing ACE and the opportunity savings of ED presentations avoided. Results Our analysis estimated that 981 avoided ED presentations could be attributed to ACE annually. Compared with usual care, ACE saved an estimated A$921214. Conclusions The ACE service supported a reduction in avoidable ED presentations and ambulance transfers among RACF residents. It generated a cost saving to health service providers, allowing reallocation of healthcare resources. What is known about the topic? Residents from RACFs are at risk of further deterioration when admitted to hospital, with high rates of delirium, falls, and medication errors. For this cohort, some conditions can be managed in the RACF without hospital transfer. By addressing avoidable presentations to EDs there is an opportunity to improve ED efficiency as well as providing care that is consistent with the resident’s goals of care. RACFs generate some avoidable ED presentations for residents who may be more appropriately treated in situ. What does this paper add? Telephone triaging with nursing support and training is a means by which ED presentations from RACFs can be reduced. One of the consequences of this intervention is ‘cost avoided’, largely through savings on ambulance costs. What are the implications for practitioners? Unnecessary transfer from RACFs to ED can be avoided through a multicomponent program that includes telephone support with cost-saving implications for EDs and ambulance services.
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Pachana, Nancy A., Edward Helmes, Gerard J. A. Byrne, Barry A. Edelstein, Candace A. Konnert, and Anne Margriet Pot. "Screening for mental disorders in residential aged care facilities." International Psychogeriatrics 22, no. 7 (April 6, 2010): 1107–20. http://dx.doi.org/10.1017/s1041610210000128.
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ABSTRACTIntroduction: The International Psychogeriatric Association Task Force on Mental Health Services in Long-Term Care Facilities seeks to improve care of persons in residential aged care facilities (RACFs). As part of that effort the current authors have contributed an overview and discussion of the uses of brief screening instruments in RACFs.Methods: While no current guidelines on the use of screening instruments in nursing homes were found, relevant extant guidelines were consulted. The literature on measurement development, testing standards, psychometric considerations and the nursing home environment were consulted.Results: Cognitive, psychiatric, behavioral, functional and omnibus screening instruments are described at a category level, along with specifics about their use in a RACF environment. Issues surrounding the selection, administration, interpretation and uses of screening instruments in RACFs are discussed. Issues of international interest (such as translation of measures) or clinical concern (e.g. impact of severe cognitive decline on assessment) are addressed. Practical points surrounding who can administer, score and interpret such screens, as well as their psychometric and clinical strengths more broadly, are articulated.Conclusions: Guidelines for use of screening instruments in the RACF environment are offered, together with broad recommendations concerning the appropriate use of brief screening instruments in RACFs. Directions for future research and policy directions are outlined, with particular reference to the international context.
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Hibbert, Peter D., Louise K. Wiles, Ian D. Cameron, Alison Kitson, Richard L. Reed, Andrew Georgiou, Len Gray, et al. "CareTrack Aged: the appropriateness of care delivered to Australians living in residential aged care facilities: a study protocol." BMJ Open 9, no. 6 (June 2019): e030988. http://dx.doi.org/10.1136/bmjopen-2019-030988.
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IntroductionThe aged population is increasing rapidly across the world and this is expected to continue. People living in residential aged care facilities (RACFs) represent amongst the sickest and frailest cohort of the aged population, with a high prevalence of chronic conditions and complex comorbidities. Given the vulnerability of RACF residents and the demands on the system, there is a need to determine the extent that care is delivered in line with best practice (‘appropriate care’) in RACFs. There is also a recognition that systems should provide care that optimises quality of life (QoL), which includes support for physical and psychological well-being, independence, social relationships, personal beliefs and a caring external environment. The aims ofCareTrack Agedare to develop sets of indicators for appropriate care and processes of care for commonly managed conditions, and then assess the appropriateness of care delivered and QoL of residents in RACFs in Australia.Methods and analysisWe will extract recommendations from clinical practice guidelines and, using expert review, convert these into sets of indicators for 15 common conditions and processes of care for people living in RACFs. We will recruit RACFs in three Australian states, and residents within these RACFs, using a stratified multistage sampling method. Experienced nurses, trained in theCareTrack Agedmethods (‘surveyors’), will review care records of recruited residents within a 1-month period in 2019 and 2020, and assess the care documented against the indicators of appropriate care. Surveyors will concurrently assess residents’ QoL using validated questionnaires.Ethics and disseminationThe study has been reviewed and approved by the Human Research Ethics Committee of Macquarie University (5201800386). The research findings will be published in international and national journals and disseminated through conferences and presentations to interested stakeholder groups, including consumers, national agencies, healthcare professionals, policymakers and researchers.
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Hearn, Lydia, and Linda Slack-Smith. "Engaging dental professionals in residential aged-care facilities: staff perspectives regarding access to oral care." Australian Journal of Primary Health 22, no. 5 (2016): 445. http://dx.doi.org/10.1071/py15028.
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The limited access to oral care for older people living in residential aged care facilities (RACFs) has been noted repeatedly in the literature. The aim of this study was to explore RACF staff perspectives on how to engage dental professionals in the provision of oral care for RACF residents. Semi-structured interviews were conducted with 30 staff from six purposively selected RACFs located in high socioeconomic areas to gain understanding of the multidimensional issues that influenced the engagement of dental professionals from a carer perspective. Analysis revealed that staff perceived tensions regarding affordability, availability, accessibility and flexibility of dental professionals as significant barriers to better oral care for their residents. Participants raised a series of options for how to better engage dental professionals and reduce these barriers. Their ideas included: the engagement of RACF staff in collaborative discussions with representatives of public and private dental services, dental associations, corporate partners and academics; the use of hygienists/oral health therapists to educate and motivate RACF staff; the promotion of oral health information for troubleshooting and advice on how to deal with residents’ dental pain while waiting for support; the encouragement of onsite training for dental professionals; and the importance of gerodontology (geriatric dentistry). Findings highlighted the need to explore alternative approaches to delivering oral care that transcend the model of private clinical practice to focus instead on the needs of RACFs and take into account quality of end-of-life oral care.
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Adebayo, Bola, Pam Nichols, Karen Heslop, and Bianca Brijnath. "Migrant Care Workers’ Perceptions of Their Working Conditions in Australian Residential Aged Care Facilities." Journal of Transcultural Nursing 34, no. 3 (April 18, 2023): 229–37. http://dx.doi.org/10.1177/10436596231152204.
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Introduction: Staff shortages and retention are the major challenges in residential aged care facilities (RACFs). This study aimed to explore migrant care workers’ perceptions of job demands, their coping strategies, and employment intentions to leave or stay in the sector. Methods: Using a descriptive qualitative research design, semi-structured interviews were conducted with n = 20, RACF migrant care workers from Filipino, Indian, and Nigerian backgrounds in Perth, Western Australia, from April to December 2019. Data were thematically analyzed. Results: Motivating factors included the availability of care work in RACFs, and positive cultural norms associated with caring for older family members. Participants experienced a combination of resettlement and workplace challenges specifically, limited support network, communication challenges, and racial discrimination. Relevance to Practice: Work challenges that are compounded by post-migration stressors should be recognized and addressed in the design and implementation of the aged care workforce reforms to attract and retain migrant care workers.
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Goh, Anita M. Y., Samantha M. Loi, Alissa Westphal, and Nicola T. Lautenschlager. "Person-centered care and engagement via technology of residents with dementia in aged care facilities." International Psychogeriatrics 29, no. 12 (August 8, 2017): 2099–103. http://dx.doi.org/10.1017/s1041610217001375.
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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.
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Dai, Yunyun, Jia Zhao, Shenmei Li, Chaochao Zhao, Yan Gao, and Claire Elizabeth Johnson. "Caregivers’ Dementia Knowledge and Care Approach in Residential Aged Care Facilities in China." American Journal of Alzheimer's Disease & Other Dementiasr 35 (January 1, 2020): 153331752093709. http://dx.doi.org/10.1177/1533317520937096.
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Objective: To investigate the dementia knowledge and care approach used by caregivers in residential aged care facilities (RACFs) in China. Method: A cross-sectional survey of 785 caregivers from a random sample of 34 RACFs in China. Caregivers’ knowledge and care approach were assessed using the Chinese version of the Dementia Knowledge Assessment Tool 2 and Advanced Dementia Care Questionnaire. Results: The majority of caregivers showed limited knowledge of dementia and tended not to adopt a person-centered approach to care. Educational level, dementia care training, and years of work experience were positively associated with dementia knowledge. Educational level and years of work experience were also associated with a person-centered approach to care. Conclusions: This study provides insight into the care available to people with dementia in RACFs in China. The results suggest dementia care education programs as well as person-centered care training are urgently needed for caregivers in China.
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Moore, Kirsten J., Keith D. Hill, Andrew L. Robinson, Terry P. Haines, Betty Haralambous, and Jennifer C. Nitz. "The state of physical environments in Australian residential aged care facilities." Australian Health Review 35, no. 4 (2011): 412. http://dx.doi.org/10.1071/ah10932.
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Objective. This paper examines the quality and safety of the physical environment in Australian residential aged care facilities (RACFs). Design. Cross-sectional study. One assessor completed environmental audits to identify areas of the physical environment that needed to be addressed to improve the wellbeing and safety of residents. Setting. Nine RACFs participating in a broader falls prevention project were audited. RACFs were located in Queensland, Tasmania or Victoria and were chosen by convenience to represent high level, low level, dementia and psychogeriatric care, regional and metropolitan facilities, small and large facilities and a culturally specific facility. Main outcome measure. An environmental audit tool was adapted from a tool designed to foster older person friendly hospital environments. The tool consisted of 147 items. Results. Across all sites 450 items (34%) required action. This ranged from 21 to 44% across sites. The audit domains most commonly requiring action included signage, visual perception and lighting, and outdoor areas. Conclusions. Although not representative of all residential facilities in Australia, this audit process has identified common environmental problems across a diverse mix of residential care facilities. Results highlight the need for further investigation into the quality of physical environments, and interventions to improve physical environments in Australian RACFs. What is known about the topic? Despite the importance of the physical environment on the health, wellbeing and safety of older people in residential aged care facilities, few studies have comprehensively evaluated the physical environment in facilities in Australia. What does this paper add? This paper provides findings from comprehensive audits of nine residential aged care facilities representing a broad range of facility settings in terms of location, level and type of care and target population. Findings indicate that each facility had at least 21% of items requiring action with an average of 34% of items requiring action across all facilities. What are the implications for practitioners? There is a need to undertake intermittent, thorough assessments of the physical environments in which residents live and, if applicable, implement strategies or modifications to improve the environment. Areas requiring particular consideration may be lighting, colour contrasts, signage and outdoor areas.
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Montalto, Michael, Simon Shay, and Andy Le. "Evaluation of a mobile X-ray service for elderly residents of residential aged care facilities." Australian Health Review 39, no. 5 (2015): 517. http://dx.doi.org/10.1071/ah15059.
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Objective The Royal Melbourne Hospital established a mobile X-ray service (MXS) in 2013. The goal of the MXS is to address the radiology needs of frail, elderly or demented residents of residential aged care facilities (RACFs) who would otherwise require transportation to attend for X-ray. The present study describes the activity of the MXS, and the impact of the MXS on emergency department (ED) attendances by residents of RACFs. Methods The study is a descriptive study and uses a before-and-after cohort approach. Activity for the first year of operation was collected and described. At the end of the first year of operation, the top 30 RACF users of the MXS were identified. The hospital Department of Radiology database was examined to find all plain X-rays performed on any patient presenting from the same 30 RACFs for the 1 year before commencement of the MXS (1 July 2012–30 June 2013) and for the 1 year period after the commencement of the MXS (1 July 2013–30 June 2014). Attendances were compared. Results The MXS delivered 1532 service attendances to 109 different RACFs. The mean age of patients receiving MXS services was 86 years (range 16–107 years). In all, 1124 services (73.4%) were delivered to patients in high-care RACFs. Most patients (n = 634; 41.4%) were bed or wheelchair bound, followed by those who required assistance to ambulate (n = 457; 29.8%). The most common X-ray examinations performed were chest, hip and pelvis, spine and abdomen. There were 919 service attendances to the top 30 RACFs using the MXS (60.0% of all attendances). There was an 11.5% reduction in ED presentations requiring plain X-ray in the year following the commencement of the MXS (95% confidence interval 0.62–3.98; P = 0.019). Conclusion The present study suggests a reduction in hospital ED attendances for high users of the MXS. This has benefits for hospitals, patients and nursing homes. It also allows the extension of other programs designed to treat patients in their RACFs. Special rebates for home-based radiology service provision should be considered. What is already known about this subject? Digital processing has changed the way radiology delivers services. The Australian community is in the middle of a shift towards an aging population, with a greater numbers of residents in RACFs. It has been suggested in previous studies that mobile X-ray reduces the rate of delirium in patients who require X-ray. What does this paper add? There is an unmet demand for MXS to residents of RACFs. MXS may reduce presentations by elderly residents of RACFs to hospital EDs for X-rays. MXS may assist general practitioners, and other innovative programs, such as Hospital in the Home and Inreach, to better manage care for patients in RACFs. What are the implications for practitioners? Providers of radiology services should examine the opportunities and benefits of establishing MXS. Funders of services should examine ways of rebating MXS to encourage further development. Hospitals (Hospital in the Home and Inreach services), RACFs and general practitioners should use mobile X-ray and integrate these services into their management of aged care delivered in RACFs.
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Batten, Miranda, Sam Kosari, Joanne Lewis, Mark Naunton, and Karen Strickland. "Exploration of an On-Site Pharmacist Intervention within Australian Residential Aged Care Facilities Using Normalisation Process Theory: A Mixed-Methods Study." Health & Social Care in the Community 2023 (September 19, 2023): 1–19. http://dx.doi.org/10.1155/2023/4370884.
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Residents living in residential aged care facilities (RACFs) continue to experience medication-related harm. There is ongoing interest in expanding the role of pharmacists, including on-site pharmacists (OSPs), to help improve medication management in RACFs. The objectives of this mixed-methods study were to explore the extent and ways in which on-site pharmacists (OSPs) were normalised within RACFs as part of a complex intervention seeking to improve medication management. This study consisted of semistructured interviews informed by normalisation process theory (NPT) and a quantitative survey adapted from the normalisation measure development questionnaire (NoMAD) instrument which is underpinned by NPT. Semistructured interviews with prescribers, RACF managers, RACF nursing staff, OSPs, residents, and family members (n = 47) indicated that most participants supported OSPs within RACFs that having OSPs in RACFs made sense and was perceived as beneficial and that participants were invested in working with OSPs who often became part of routine practice, i.e., “normalised.” Prescribers, RACF managers, and nursing staff (health care team members) completed the adapted survey, and their responses (n = 16) strongly complemented the positive qualitative findings. Overall, OSPs were positively appraised by health care team members as well as residents and family members and were generally considered to be normalised within their respective RACFs. This study explored the normalisation of OSPs within RACFs. From the perspective of residents, family members, health care team members, and OSPs, OSPs could become part of routine practice within Australian RACFs. The findings of this study also highlighted the value of using theory to guide the evaluation of a pharmacist intervention in RACFs and the utility of applying NPT in a new setting, Australian RACFs. Importantly, the findings of this study could help inform the future role of OSPs working and the rollout of OSPs within Australian RACFs.
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Conway, Jane, Sophie Dilworth, Carolyn Hullick, Jacqueline Hewitt, Catherine Turner, and Isabel Higgins. "A multi-organisation aged care emergency service for acute care management of older residents in aged care facilities." Australian Health Review 39, no. 5 (2015): 514. http://dx.doi.org/10.1071/ah15049.
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This case study describes a multi-organisation aged care emergency (ACE) service. The service was designed to enable point-of-care assessment and management for older people in residential aged care facilities (RACFs). Design of the ACE service involved consultation and engagement of multiple key stakeholders. The ACE service was implemented in a large geographical region of a single Medicare Local (ML) in New South Wales, Australia. The service was developed over several phases. A case control pilot evaluation of one emergency department (ED) and four RACFs revealed a 16% reduction in presentations to the ED as well as reductions in admission to the hospital following ED presentation. Following initial pilot work, the ACE service transitioned across another five EDs and 85 RACFs in the local health district. The service has now been implemented in a further 10 sites (six metropolitan and four rural EDs) across New South Wales. Ongoing evaluation of the implementation continues to show positive outcomes. The ACE service offers a model shown to reduce ED presentations and admissions from RACFs, and provide quality care with a focus on the needs of the older person.
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Tuckett, Anthony G. "The experience of lying in dementia care." Nursing Ethics 19, no. 1 (December 2, 2011): 7–20. http://dx.doi.org/10.1177/0969733011412104.
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This analysis examines the practice of care providers in residential aged care lying to residents with dementia. Qualitative data were collected through multiple methods. Data here represents perceptions from registered and enrolled nurses, personal care assistants, and allied health professionals from five residential aged care facilities located in Queensland, Australia. Care providers in residential aged care facilities (RACFs) lie to residents with dementia. Lying is conceptualized as therapeutic whereby the care provider’s intent is to eliminate harm and also control behaviour. Care providers of residents with dementia in RACFs need guidance around lying. An ethical framework cognisant of an ethical theory of good and ethical theory of right supplemented by a theory of virtue is proposed. A complimentary four stage communication strategy that promotes truth telling as a first option while also recommending the lie as a suitable strategy is also promoted.
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Dawson, Elizabeth, and Elise Campbell. "SG-APSIC1061: First-response infection prevention and control during COVID-19 outbreaks in residential aged-care facilities." Antimicrobial Stewardship & Healthcare Epidemiology 3, S1 (February 2023): s22. http://dx.doi.org/10.1017/ash.2023.66.
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Objectives: COVID-19 has highlighted the importance of the hierarchy of controls and early implementation of transmission-based precautions during outbreaks in residential aged-care facilities (RACFs). The RACF outreach team is a service provided by the Sydney Local Health District (SLHD) that provides RACFs with expert clinical care and advice, along with outbreak management and infection control and prevention education. Methods: The RACF outreach team developed 2 unique IPC management tools designed to assist RACFs during the COVID-19 pandemic: (1) the comprehensive initial review and (2) first-responder assessment tool designed to assist the team in identifying high-risk issues during afterhours shifts. The tool reviews 5 key components in outbreak management: screening, PPE usage, resident care, communication and signage, and infection control and prevention. The outreach team provides an IPC report of the comprehensive initial review, which provides site-specific advice regarding zoning, cohorting, implementation of donning and doffing stations, safe staffing and workflows, ventilation, personal protective equipment (PPE) use, and PPE safety. The recommendations supplied in the SLHD IPC report are provided to facilities and are implemented at the facility level. These reviews are followed up in meetings of the outbreak management team conducted virtually via Zoom videoconferencing. These meetings include an RACF senior manager and a representative from the local PHU, the outreach service, the Australian Commonwealth, the Aged Care Commission, an SLHD executive manager, and an infectious diseases practitioner. Results: Since the outbreak of the SARS-CoV-2 ο (omicron) variant began in Sydney, Australia, in November 2021, 58 facilities with >2,500 residents have been reviewed, and 57 of these facilities had a COVID-19 outbreak at some point during the pandemic. Conclusions: The RACFs in SLHD continue to report death rates <5% among all SARS-COV-2–positive residents.
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Reymond, Liz, Fiona J. Israel, and Margaret A. Charles. "A residential aged care end-of-life care pathway (RAC EoLCP) for Australian aged care facilities." Australian Health Review 35, no. 3 (2011): 350. http://dx.doi.org/10.1071/ah10899.
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The objective of this study was to develop, implement and evaluate an end-of-life (terminal) care pathway and associated infrastructure suitable for Australian residential aged care facilities that improves resident and health system outcomes. The residential aged care end-of-life care pathway was developed by a multidisciplinary collaboration of government and non-government professionals and incorporated best clinical management for dying residents to guide care and increase palliative care capacity of generalist staff. Implementation included identifying and up-skilling Link Nurses to champion the pathway, networking facilities with specialist palliative care services, delivering education to generalists and commencing a Palliative Care Medication Imprest System in each facility. The primary outcome measure for evaluation was transfer to hospital; secondary measures included staff perceived changes in quality of palliative care provided and family satisfaction with care. Results indicated that the pathway, delivered within a care framework that guides provision of palliative care, resulted in improved resident outcomes and decreased inappropriate transfers to acute care settings. What is known about the topic? Residential aged care facilities (RACFs) are the hospices of today. Many RACF staff are not confident in the delivery of high quality palliative care, resulting in inappropriate transfers of dying residents to acute care facilities. Needs-based palliative care pathways are being used increasingly to direct care in a variety of healthcare environments. What does this paper add? Provides the first evidence in Australia that a residential aged care end-of-life care pathway (RAC EoLCP) improves outcomes of care for dying residents and results in fewer residents being inappropriately transferred to acute care facilities. What are the implications for practitioners? Use of the RAC EoLCP will improve resident and health system outcomes by guiding the delivery of high quality palliative care and improving the palliative care capacity of generalist health providers.
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Loi, Samantha M., and Nicola T. Lautenschlager. "Investigating the current methods of assessing behavioral and psychological symptoms in residential aged care facilities in a metropolitan city." International Psychogeriatrics 29, no. 5 (December 21, 2016): 855–58. http://dx.doi.org/10.1017/s104161021600226x.
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ABSTRACTUp to 90% of people with dementia living in residential aged care facilities (RACFs) display behavioral and psychological symptoms of dementia (BPSD), and these are associated with poorer quality of life and increased morbidity and mortality. In order to implement appropriate interventions, it is important to understand the symptoms in more detail. Despite the availability of BPSD assessment tools, it is unknown what the current practice of monitoring of BPSD in RACFs. We sought to investigate the current BPSD assessment tools being used in RACFs and explore different stakeholders’ views on current practices. A cross-sectional convenience sample of 21 clinicians were identified and administered a questionnaire.Old age psychiatrists, aged psychiatry clinicians, behavior management teams and RACF staff completed the questionnaires. Clinicians reported that objective consistent information about BPSD were important for recommending and implementing pharmacological and non-pharmacological strategies for BPSD; however, the use of validated BPSD assessments in RACFs was not a usual part of clinical practice. RACF staff stated the major barrier to assessment of BPSD was lack of time. Alternate methods of assessing BPSD which consider preferences from clinicians and RACF staff should be further investigated. Modern technology which can allow “real time” assessment may be a solution.
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Liyanage, Thilini, Geoffrey Mitchell, and Hugh Senior. "Identifying palliative care needs in residential care." Australian Journal of Primary Health 24, no. 6 (2018): 524. http://dx.doi.org/10.1071/py17168.
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The aim of this study is to determine the accuracy, feasibility and acceptability of the surprise question (SQ) in combination with a clinical prediction tool (Supportive and Palliative Care Indicator Tool (SPICT)) in identifying residents who have palliative care needs in residential aged care facilities (RACFs) in Australia. A prospective cohort study in two RACFs containing both high-level care (including dementia) and low-level care beds. Directors of Nursing screened 187 residents at risk of dying by 12 months using first the SQ, and if positive, then the SPICT. At 12-months follow-up, deaths, hospitalisations, use of palliative care services, end-of-life care and clinical indicators were recorded. The SQ had a sensitivity of 70%, a specificity of 69.6%, a positive predictive value of 40.6% and a negative predictive value of 88.7% for death. All residents identified by the SQ had at least two general indicators of deterioration, while 98.8% had at least one disease-specific indicator on the SPICT. The SPICT marginally increased the ability to identify residents in need of proactive end-of-life planning. A combination of the SQ and the SPICT is effective in predicting palliative care needs in residents of aged care facilities, and may trigger timely care planning.
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Soofi, Hojjat. "Using Antipsychotics for Self-Defense Purposes by Care Staff in Residential Aged Care Facilities: An Ethical Analysis." Cambridge Quarterly of Healthcare Ethics 31, no. 4 (October 2022): 487–95. http://dx.doi.org/10.1017/s0963180122000391.
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AbstractPeople with dementia at times exhibit threatening and physically aggressive behavior toward care staff in residential aged care facilities (RACFs). Current clinical guidelines recommend judicious use of antipsychotic (AP) medications when there is an immediate risk of harm to care staff in RACFs and non-pharmacological interventions have failed to avert the threats. This article examines an account of how this recommendation can be ethically defensible: caregivers in RACFs may have a prima facie ethical justification, in certain cases, to use APs as an act of self-defense. The author examines whether such uses of APs meet the three commonly invoked conditions of ethically permissible acts of self-defense—namely, the conditions of liability, proportionality, and necessity—and argues that such conditions obtain only in a restricted range of cases. The liability constraint can be satisfied if residents are the only ones who are causally responsible for the threats they pose. Further, the condition of proportionality obtains if there is sufficient objective ground to demonstrate that the harm of using the medications does not outweigh the good to be secured. Lastly, the necessity condition obtains when the medications are used at their lowest effective dosage and caregivers in RACFs can reasonably assume that, for the purpose of averting threats posed by residents, the use of APs is the only available course of action. Not meeting any of these fairly stringent conditions renders uses of APs as acts of self-defense in RACFs morally impermissible actions.
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Sellars, M., W. Silvester, R. Fullam, R. Sjanta, L. Jackson, D. Mawren, and R. Mountjoy. "CPR POLICY AND PRACTICE IN AUSTRALIAN RESIDENTIAL AGED CARE FACILITIES (RACFS)." BMJ Supportive & Palliative Care 3, no. 2 (June 2013): 268.3–269. http://dx.doi.org/10.1136/bmjspcare-2013-000491.111.
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Kilian, Melissa, Tania Rauch Van der Merwe, and Sanetta H. J. du Toit. "Evidence-Based Practice: Implementing REIS Findings in South African Aged Care Facilities." OTJR: Occupational Therapy Journal of Research 44, no. 1 (April 25, 2023): 106–16. http://dx.doi.org/10.1177/15394492231164948.
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Background: Older adults living in Residential Aged Care Facilities (RACFs) in South Africa are often exposed to environments that fail to provide adequate occupational opportunities. Practitioners in developing economies are challenged to provide therapeutic services in environments that emphasize occupational deprivation. Objectives: This study investigated barriers and enablers to implementing recommendations derived from the findings generated by the Residential Environment Impact Scale (REIS). Method: A two-phased embedded mixed methodology was employed. Phase 1 was the administration of the REIS. In Phase 2, leadership staff considered factors to implementing findings of the REIS, using the nominal discussion group technique. Data were thematically analyzed. Findings: Findings indicated an organizational culture characterized by top-down management and a medically dominated care approach, constrained by financial and operational concerns. Conclusion: Using the REIS to holistically assess, RACFs are an applicable tool that could promote collaborative approaches to enhance organizational culture change, cultivating more occupational opportunities.
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Adebayo, Bola, Angela Durey, and Linda M. Slack-Smith. "Role of information and communication technology in promoting oral health at residential aged care facilities." Australian Journal of Primary Health 23, no. 3 (2017): 216. http://dx.doi.org/10.1071/py15168.
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Information and communication technology (ICT) can provide knowledge and clinical support to those working in residential aged care facilities (RACFs). This paper aims to: (1) review literature on ICT targeted at residents, staff and external providers in RACFs including general practitioners, dental and allied health professionals on improving residents’ oral health; (2) identify barriers and enablers to using ICT in promoting oral health at RACFs; and (3) investigate evidence of effectiveness of these approaches in promoting oral health. Findings from this narrative literature review indicate that ICT is not widely used in RACFs, with barriers to usage identified as limited training for staff, difficulties accessing the Internet, limited computer literacy particularly in older staff, cost and competing work demands. Residents also faced barriers including impaired cognitive and psychosocial functioning, limited computer literacy and Internet use. Findings suggest that more education and training in ICT to upskill staff and residents is needed to effectively promote oral health through this medium.
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Newton, Wendy, Tania Signal, and Jenni A. Judd. "Fur, Fin, and Feather: Management of Animal Interactions in Australian Residential Aged Care Facilities." Animals 12, no. 24 (December 19, 2022): 3591. http://dx.doi.org/10.3390/ani12243591.
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Animal-assisted interventions (AAI) have been occurring in Australian Residential Aged Care Facilities (RACF) for more than 40 years and may relieve loneliness and improve quality of life. The presence of animals in RACF poses an inherent risk to residents and the animals involved. Little is known about the policies and guidelines for including animals in the Australian RACF. We anticipated that most RACFs would have some policies, but they may lack the detail necessary to keep humans and animals safe. Using an adapted survey, we surveyed and interviewed a small but representative sample of Australian RACF managers. The results demonstrated that RACF did have animal policies; however, the content regarding the need for hand washing, infection prevention, and animal welfare was lacking. Including unregulated family pets in RACF was an unexpected additional risk factor identified during data analysis. There is a need for national guidelines tied to the national aged care policy, which includes training and educational resources for RACF and AAI providers.
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Petrov, Ljubica, Catherine Joyce, and Tonina Gucciardo-Masci. "Aging in Australia: country of birth and language preferences of residents in aged care facilities." Australian Health Review 43, no. 1 (2019): 78. http://dx.doi.org/10.1071/ah17032.
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Objective There is a need to better understand the use of aged care services by people from culturally and linguistically diverse backgrounds. The aim of the present study was to describe the prevalence of people living in residential aged care facilities (RACFs) who were born in non-English-speaking countries and/or have a preferred language other than English and to describe service utilisation rates. Methods The present study consisted of a secondary analysis of data from the Australian Institute of Health and Welfare National Aged Care Data Clearinghouse. Data were analysed by country of birth, preferred language, state or territory and Aged Care Planning Regions within Victoria. Results Nationally, over 30000 (18.3%) RACF residents were born in a non-English-speaking country. In Victoria, almost one in four RACF residents (23.9%) was born in a non-English-speaking country, and approximately one in eight (13.1%) has a preferred language other than English. Most Victorian RACFs (72.4%) have at least one resident with a preferred language other than English. Approximately one in four residents (26.1%) with a preferred language other than English are the sole speaker of the language in their facility. Conclusion All RACFs need to effectively address the needs and preferences of their residents, including those who were born in a non-English-speaking country or prefer to speak a language other than English. What is known about the topic? The number of older people from a non-English-speaking background continues to increase, but little is known about the prevalence of this cohort living in RACFs and how aged care providers are responding to their needs and preferences. What does this paper add? The present study provides detailed, service- and policy-relevant information, demonstrating a substantial degree of diversity among people living in RACFs, with wide distribution across facilities and regions. The findings confirm the need for a systematic, sector-wide approach to addressing linguistic diversity and developing inclusive practices. What are the implications for practitioners? All RACFs are required to develop policies and procedures in order to cater to the needs and preferences of residents who were born in non-English-speaking countries and/or who prefer to speak a language other than English.
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BENNETT, MICHELLE K., ELIZABETH C. WARD, NERINA A. SCARINCI, and MONIQUE C. WAITE. "Service providers' perceptions of working in residential aged care: a qualitative cross-sectional analysis." Ageing and Society 35, no. 9 (August 1, 2014): 1989–2010. http://dx.doi.org/10.1017/s0144686x14000853.
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ABSTRACTA number of professional disciplines employed internally and externally provide services in Residential Aged Care Facilities (RACFs). Literature has long highlighted numerous workplace issues in RACFs, yet little progress has been made in addressing these. As such there has been a call for greater understanding of shared issues among service providers. The aim of the current study is to explore and compare the perceptions of a cross-section of service providers regarding the challenges and motivators to working in RACFs. In-depth semi-structured interviews were conducted with 61 participants including: care managers, nurses, assistants in nursing, care, domestic and support staff, and speech pathologists. Analysis revealed few issues unique to any one service discipline, with four key themes identified: (a) working in RACFs is both personally rewarding and personally challenging; (b) relationships and philosophies of care directly impact service provision, staff morale and resident quality of life; (c) a perceived lack of service-specific education and professional support impacts service provision; and (d) service provision in RACFs should be seen as a specialist area. These data confirm there are key personal and professional issues common across providers. Providers must work collaboratively to address these issues and advocate for greater recognition of RACFs as a specialist service area. Acknowledging, accepting and communicating shared perceptions will reduce ongoing issues and enhance multi-disciplinary care.
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Sawan, M., R. Fois, and T. F. Chen. "Organisational culture and psychotropic medicine use in Residential Aged Care Facilities (RACFs)." Research in Social and Administrative Pharmacy 10, no. 5 (September 2014): e36. http://dx.doi.org/10.1016/j.sapharm.2014.07.094.
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Mitchell, Geoffrey, Caroline Nicholson, Keith McDonald, and Anne Bucetti. "Enhancing palliative care in rural Australia: the residential aged care setting." Australian Journal of Primary Health 17, no. 1 (2011): 95. http://dx.doi.org/10.1071/py10054.
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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.
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Cronan, Karl, and Linda Winn. "Development of an Evacuation Exercise for Residential Aged Care Facilities Using the Emergo Train System (ETS)." Prehospital and Disaster Medicine 34, s1 (May 2019): s1—s2. http://dx.doi.org/10.1017/s1049023x19000232.
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Introduction:Events such as the Sydney Quakers Hill Nursing Home fire highlighted the great need for robust evacuation plans for Residential Aged Care Facilities (RACFs). However, plans alone are not sufficient and routine exercises are necessary to test the capability of a facility’s emergency plan. Current methods of exercising facility evacuations, such as live drills, are limited and only test isolated elements of the evacuation process, which fall drastically short of being able to simulate the real-time resources and procedures required to perform a large scale evacuation of a RACF.Aim:To develop an exercise tool that assists Residential Aged Care Facilities (RACF) to evaluate their evacuation procedures using quantifiable data, based on real-time and providing minimal disruption to existing residents.Methods:Utilizing the existing ETS framework, an aged care resident patient bank was developed by NSW Health Emergency Management Unit, including: A bank of 200 residents from data sourced from the Australian Institute of Health and Welfare.Layout for the resident gubers and Summary Care Plans.Resources and equipment routinely used in RACF’s.Real-world testing of the prototype in exercises across NSW, AustraliaMortality and morbidity data to measure outcomes.Validation of the exercise tool nationally and internationally.Results:A bank of residents was developed to test evacuation systems and processes, in a scalable, realistic simulation based on patient outcomes. This will result in improved planning and process, empowerment of RACFs, better patient outcomes, and increased resilience and preparedness.Discussion:A significant investment of data, time, and effort has gone into producing this resident bank for use in RACF evacuation exercises across NSW Australia. A presentation delivered at the ETS World Congress in the Netherlands (2018), by NSW Health Emergency Management Unit, showcased the relevance and suitability of this tool across the world.
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Pu, Dai, Yuen-Yu Choi, Karen Man-Kei Chan, and May Man-Wai Poon. "Modifying Puree Meals in Residential Aged Care Facilities: A Multi-Centre Feasibility and Acceptability Study." Geriatrics 6, no. 4 (November 5, 2021): 108. http://dx.doi.org/10.3390/geriatrics6040108.
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Purees are often recommended for older adults in residential aged care facilities (RACFs) to target swallowing difficulties and nutrition. However, they lack appeal and may have negative impacts on nutritional intake. This study investigated the subjective experiences and objective swallowing function and safety of older adults in response to a modified puree. Twenty-eight residents from three RACFs whose regular diets consisted of purees were recruited. Purees were modified to improve visual appeal by adding a commercial enzyme gellant. Each participant was observed during three puree and three modified puree meals, and completed a brief questionnaire after each meal. A videofluoroscopic swallowing study (VFSS) was performed with 16 of the participants. Compared to purees, modified purees were observed to be easier for oral processing and intake amount was higher, but participants required assistance more often and mealtimes were longer. Participants did not show preference for either type of puree. VFSS showed similar swallowing responses between the two puree types; however, a distinction was observed for modified pureed meat compared to other ingredients. Modifying puree meals in RACFs is a feasible approach to improve nutritional intake while maintaining swallowing safety, but their appeal to consumers is not definitive.
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Haider, Ibrahim, Sam Kosari, Mark Naunton, Theo Niyonsenga, Gregory M. Peterson, Jane Koerner, and Rachel Davey. "Quality Use of Medicines Indicators and Associated Factors in Residential Aged Care Facilities: Baseline Findings from the Pharmacists in RACF Study in Australia." Journal of Clinical Medicine 11, no. 17 (September 1, 2022): 5189. http://dx.doi.org/10.3390/jcm11175189.
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Prescribing potentially inappropriate medications (PIMs), including antipsychotics and benzodiazepines, has been used as an indicator of the quality use of medicines in residential aged care facilities (RACFs). PIMs are associated with an increased risk of falls and hospitalisations in the elderly. The purpose of this study is to assess the extent of prescribing of PIMs in RACFs at baseline in the Pharmacists in residential aged care facilities (PiRACF) study and examine the association of resident and system factors with the number of PIMs. A cross-sectional analysis of 1368 participants from 15 Australian RACFs was performed to detect PIMs using the American Geriatrics Society 2019 Beers® criteria. Most residents (68.1%) were taking at least one regular PIM; 16.9% were taking regular antipsychotics and 11.1% were taking regular benzodiazepines. Long-term proton pump inhibitors were the most frequent class of PIMs. History of falls and higher Charlson Comorbidity Index were associated with an increased number of prescribed PIMs, while dementia diagnosis and older age (85 years or more) were associated with decreased number of PIMs (p-value <0.05). Residents in facilities with lower nurse-to-resident ratios were more likely to have an increased number of PIMs (p value = 0.001). This study indicates that potentially inappropriate prescribing is common in RACFs and interventions to target residents at highest risk are needed.
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Omar, Marhanis-Salihah. "Knowledge, Attitude and Practice of Caregivers on Medication Management at Residential Aged Care Facilities in Malaysia." Medicine & Health 15, no. 2 (December 31, 2020): 56–65. http://dx.doi.org/10.17576/mh.2020.1502.08.
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An escalating proportion of the aged group is associated with a growth in the prevalence of ill health. With the complexity of age-related diseases, a good medication management system is important to prevent medication errors. This study was aimed to develop a questionnaire to assess the knowledge, attitude and practice (KAP) of caregivers on medication management at residential aged care facilities (RACFs). A cross-sectional study was performed involving caregivers from 90 RACFs throughout Malaysia. The validated self-administered questionnaire was developed based on the extensive literature review and expert`s opinions containing 41-items divided into three domains. In this study, the response rate was 71% with 128 questionnaires returned. Median scores obtained for knowledge, attitude and practice were 77.27, 70.83 and 68.66, respectively. Majority of the caregivers (71.9%) deemed to know what medication management was. However, nearly half of them (48.4%) did not experience any training. More than half of the caregivers possessed good level of knowledge (69.5%, n = 89), around half (57.8%, n= 74) had a good attitude and less than half had a good practice (46.9%, n= 60) of medication management. Level of education, special qualification and experience of medication management training were the factors that correlated with good score outcome (p<0.05). Therefore, it is assumed that more support and training can be provided to the caregivers in RACF on medication management.
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Engelbrecht, Romy. "P163: Closing the gap: Funded psychology in residential aged care in Australia." International Psychogeriatrics 35, S1 (December 2023): 182. http://dx.doi.org/10.1017/s1041610223003241.
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Objective:Historically, older adults in residential aged care facilities (RACF) in Australia had no access to government funded psychology services despite high rates of anxiety and depression. Change Futures is a registered charity that provides funded psychology to more than 220 RACFs in south-east Queensland and northern New South Wales, Australia, and since 2015 has been providing free psychology services to older adults living in aged care, using a predominately provisional psychologist workforce. This presentation will discuss the model of service that is provided, and the findings of a recent outcomes report.Method:Data was collected via clinician entered eHealth records in the 2021/2022 financial year from 01/07/2021 to 30/06/2022. Outcome measures were analysed using six repeated measure t-tests to compare clinical change from first and last assessments.Results:A total of 2865 residents were seen in 17,754 individual sessions and 298 group sessions. Staff education was provided in 94 sessions with 838 participants, who worked in RACFs. The most common presenting issue was difficulties with adjustment (70%), comorbid anxiety and depression (28%), depression (27%), loneliness (18%), and anxiety (17%). Outcomes of the psychology program showed statistically significant improvements on all measures, including the Kessler 5 psychological distress scale, Geriatric anxiety scale, Patient health Questionaire-9, De Jong Gierveld Loneliness Scale, and Brief Adjustment Scale.Conclusion:The described service model resulted in significant improvements to the psychological wellbeing of older adults, and represents an effective and sustainable training approach for provisional psychologists.
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Sluggett, Janet K., Ria E. Hopkins, Esa YH Chen, Jenni Ilomäki, Megan Corlis, Jan Van Emden, Michelle Hogan, et al. "Impact of Medication Regimen Simplification on Medication Administration Times and Health Outcomes in Residential Aged Care: 12 Month Follow Up of the SIMPLER Randomized Controlled Trial." Journal of Clinical Medicine 9, no. 4 (April 8, 2020): 1053. http://dx.doi.org/10.3390/jcm9041053.
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In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we evaluated the impact of structured medication regimen simplification on medication administration times, falls, hospitalization, and mortality at 8 residential aged care facilities (RACFs) at 12 month follow up. In total, 242 residents taking ≥1 medication regularly were included. Opportunities for simplification among participants at 4 RACFs were identified using the validated Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE). Simplification was possible for 62 of 99 residents in the intervention arm. Significant reductions in the mean number of daily medication administration times were observed at 8 months (−0.38, 95% confidence intervals (CI) −0.69 to −0.07) and 12 months (−0.47, 95%CI −0.84 to −0.09) in the intervention compared to the comparison arm. A higher incidence of falls was observed in the intervention arm (incidence rate ratio (IRR) 2.20, 95%CI 1.33 to 3.63) over 12-months, which was primarily driven by a high falls rate in one intervention RACF and a simultaneous decrease in comparison RACFs. No significant differences in hospitalizations (IRR 1.78, 95%CI 0.57–5.53) or mortality (relative risk 0.81, 95%CI 0.48–1.38) over 12 months were observed. Medication simplification achieves sustained reductions in medication administration times and should be implemented using a structured resident-centered approach that incorporates clinical judgement.
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Mitchell, Rebecca, Brian Draper, Lara Harvey, Henry Brodaty, and Jacqueline Close. "56 Examining Fall-Related HIP Fractures in Long-Term Residential Aged Care and the Community: Trends, Health Outcomes and Treatment Costs." Age and Ageing 48, Supplement_4 (December 2019): iv13—iv17. http://dx.doi.org/10.1093/ageing/afz164.56.
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Abstract Background Hip fracture risk is higher for older adults living in residential aged care facilities (RACF) and their health outcomes worse compared to older adults living in the community. Pre-hip fracture residential status is not well recorded within hospital records, necessitating linkage of hospital and residential aged care data to better ascertain residential location pre-fracture. Aim To examine temporal trends, characteristics and health outcomes following a fall-related hip fracture hospitalisation of people living in RACFs to those living in the community. Method A retrospective analysis of fall-related hip fracture hospitalisations of people aged ≥65 years during 2008-2013 in New South Wales, Australia. Linked hospitalisation and RACF data were examined. Negative binomial regression examined the significance of hospitalisation temporal trends. Results There were 28,897 hip fracture hospitalisations and 32.5% were living in RACFs at time of fracture. The hospitalisation rate was 2,180 per 100,000 (95%CI: 2,097.0-2,263.7) for RACF residents and 390 per 100,000 (95%CI 384.8-395.8) for the community-living. Over 5 years, the hospitalisation rate for RACF residents declined by 2.9% annually (95%CI: -4.3 to -1.5). Hospital treatment cost for hip fractures was $958.5 million. Compared to older people living in the community, a higher proportion of RACF residents were aged ≥90 years (36.1% vs 17.2%), were female (75.3% vs 71.8%), had >1 Charlson comorbidity (37.6% vs 35.6%), and had dementia (58.2% vs 14.4%). RACF residents had fewer in-hospital rehabilitation episodes (18.7% vs 60.9%) and a higher proportion of unplanned readmissions (10.6% vs 9.1%) and in-hospital mortality (5.9% vs 3.3%) compared to older people living in the community. Conclusions RACF residents are a vulnerable cohort of older people who experience worse health outcomes and survival post-hip fracture than older people living in the community. Whether access to individualised hip fracture rehabilitation for RACF residents could improve health outcomes should be examined.
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Ludlow, Kristiana, Kate Churruca, Louise A. Ellis, Virginia Mumford, and Jeffrey Braithwaite. "Understanding the priorities of residents, family members and care staff in residential aged care using Q methodology: a study protocol." BMJ Open 9, no. 3 (March 2019): e027479. http://dx.doi.org/10.1136/bmjopen-2018-027479.
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IntroductionResidential aged care facilities (RACFs) are under increasing pressure to provide high-quality, round the clock care to consumers. However, they are often understaffed and without adequate skill mix and resources. As a result, staff must prioritise care by level of importance, potentially leading to care that is missed, delayed or omitted. To date, the literature on prioritisation and missed care has been dominated by studies involving nursing staff, thereby failing to take into account the complex networks of diverse stakeholders that RACFs comprise. This study aims to investigate the priorities of residents, family members and care staff in order to make comparisons between how care is prioritised in RACFs by the different stakeholder groups.Methods and analysisThis study comprises a Q sorting activity using Q methodology, a think-aloud task, a demographics questionnaire and semi-structured interview questions. The study will be conducted in five RACFs across NSW and QLD, Australia. Using purposive sampling, the project will recruit up to 33 participants from each of the three participant groups. Data from the Q sorting activity will be analysed using the analytic software PQMethod to identify common factors (shared viewpoints). Data from the think-aloud task and semi-structured interviews questions will be thematically analysed using the Framework Method and NVivo qualitative data analysis software.Ethics and disseminationThe study has been approved by St Vincent’s Health and Aged Care Human Research and Ethics Committee and Macquarie University Human Research Ethics Committee. It is expected that findings from the study will be disseminated: in peer-reviewed journals; as an executive report to participating facilities and a summary sheet to participants; as a thesis to fulfill the requirements of a Doctor of Philosophy; and presented at conferences and seminars.
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Dugré, Nicolas, J. Simon Bell, Ria E. Hopkins, Jenni Ilomäki, Esa Y. H. Chen, Megan Corlis, Jan Van Emden, Michelle Hogan, and Janet K. Sluggett. "Impact of Medication Regimen Simplification on Medication Incidents in Residential Aged Care: SIMPLER Randomized Controlled Trial." Journal of Clinical Medicine 10, no. 5 (March 6, 2021): 1104. http://dx.doi.org/10.3390/jcm10051104.
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In the SImplification of Medications Prescribed to Long-tErm care Residents (SIMPLER) cluster-randomized controlled trial, we investigated the impact of a structured medication regimen simplification intervention on medication incidents in residential aged care facilities (RACFs) over a 12-month follow-up. A clinical pharmacist applied the validated 5-step Medication Regimen Simplification Guide for Residential Aged CarE (MRS GRACE) for 96 of the 99 participating residents in the four intervention RACFs. The 143 participating residents in the comparison RACFs received usual care. Over 12 months, medication incident rates were 95 and 66 per 100 resident-years in the intervention and comparison groups, respectively (adjusted incident rate ratio (IRR) 1.13; 95% confidence interval (CI) 0.53–2.38). The 12-month pre/post incident rate almost halved among participants in the intervention group (adjusted IRR 0.56; 95%CI 0.38–0.80). A significant reduction in 12-month pre/post incident rate was also observed in the comparison group (adjusted IRR 0.67, 95%CI 0.50–0.90). Medication incidents over 12 months were often minor in severity. Declines in 12-month pre/post incident rates were observed in both study arms; however, rates were not significantly different among residents who received and did not receive a one-off structured medication regimen simplification intervention.
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Lehnbom, E., K. Oliver, A. Georgiou, C. Rowe, T. Osmond, J. Westbrook, and A. Tariq. "Design Challenges for Electronic Medication Administration Record Systems in Residential Aged Care Facilities." Applied Clinical Informatics 05, no. 04 (2014): 971–87. http://dx.doi.org/10.4338/aci-2014-08-ra-0062.
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SummaryIntroduction: Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements.Methods: A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system.Results: The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues.We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows.Discussion: Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.Citation: Tariq A, Lehnbom E, Oliver K, Georgiou A, Rowe C, Osmond T, Westbrook J. Design challenges for electronic medication administration record systems in residential aged care facilities: a formative evaluation. Appl Clin Inf 2014; 5: 971–987http://dx.doi.org/10.4338/ACI-2014-08-RA-0062
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Battams, Samantha, and Angelita Martini. "The Impact of the COVID-19 Pandemic on People With Cognitive Impairment Residing in Aged Care Facilities: An Integrative Review." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 60 (January 2023): 004695802311608. http://dx.doi.org/10.1177/00469580231160898.
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This review explored the impact of the COVID-19 pandemic on people with cognitive impairment living in aged care facilities. It also considered policy and organizational responses to COVID-19, and makes recommendations to ameliorate the impact of the pandemic on residents with cognitive impairment in aged care facilities. ProQuest, PubMed, CINAHL, Google Scholar, and Cochrane Central were searched April-May 2022 for peer reviewed articles, and an integrative review of reviews was conducted. Nineteen reviews were identified which referred to people with cognitive impairment living in residential aged care facilities (RACFs) during COVID-19. Negative impacts were highlighted, including COVID-19 related morbidity and mortality, social isolation, and cognitive, mental health and physical decline. Few research articles and policy responses consider people with cognitive impairment in residential aged care. Reviews highlighted that social engagement of residents should be better enabled to reduce the impact of COVID-19. However, residents with cognitive impairment may have inequitable access to communications technology for the purposes of assessment, health care and social engagement, and require more support (along with their families) to access this technology. Greater investment in the residential aged care sector (eg, for workforce and training) is required to address the significant impacts of the COVID-19 pandemic on people with cognitive impairment.
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Sawan, M., R. Fois, and T. F. Chen. "Organisational climate and use of medicines: Patients’ perspective of Residential Aged Care Facilities (RACFs)." Research in Social and Administrative Pharmacy 10, no. 5 (September 2014): e35-e36. http://dx.doi.org/10.1016/j.sapharm.2014.07.093.
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Chua, Tzy Harn, Jessica Ru-Jia Foong, Ryan Renxin Tan, Princess Natsai Rukasha, and Carolyn Hullick. "Assessment of advance care planning documentation for residents of residential aged care facilities presenting to the emergency department." Australian Health Review 44, no. 6 (2020): 847. http://dx.doi.org/10.1071/ah19238.
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ObjectiveThis study assessed the availability and quality of advance care planning (ACP) documentation among older residential aged care facility (RACF) residents who presented to the emergency department (ED). MethodsA prospective review of the medical records of RACF residents aged ≥75 years who presented to the ED from May to June 2018 was conducted. Availability of ACP was determined based on the presence of an ACP document inclusive of an advance care directive (ACD) in the medical record. The quality of ACP documentation was determined based on the presence of nine key components. ResultsIn all, 48.8% of patients presented to the ED with either ACP or an ACD. However, only a mean total of 3.8 (out of 9) ACP components were documented in these documents. ConclusionsJust under half (48.8%) of RACF residents presented to the ED with ACP documentation. There was limited coverage of core ACP components needed to guide clinical decision making. What is known about the topic?RACF residents are in the last years of their life and commonly lack capacity to make decisions regarding health care. Residents are at high risk of dying when acutely unwell in hospital. ACP documentation, when readily available, helps provide appropriate end-of-life care and improves both patient and family satisfaction. What does this paper add?Less than half the residents reporting to the ED from an RACF had ACP documentation available for clinicians. For those who presented to the ED with ACP documentation, most lacked sufficient information needed to provide care in full accordance with the patient’s preferences. What are the implications for practitioners?There is a need to encourage, initiate, actively engage and develop systems for ACP conversations, documentation and availability when acutely unwell for people living in RACFs to provide sufficient information to guide clinical decision making. Without quality ACP, the provision of patient-centred health care may be compromised.
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Detering, Karen M., Kimberly Buck, Rasa Ruseckaite, Helana Kelly, Marcus Sellars, Craig Sinclair, Josephine M. Clayton, and Linda Nolte. "Prevalence and correlates of advance care directives among older Australians accessing health and residential aged care services: multicentre audit study." BMJ Open 9, no. 1 (January 2019): e025255. http://dx.doi.org/10.1136/bmjopen-2018-025255.
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ObjectivesIt is important that the outcomes of advance care planning (ACP) conversations are documented and available at the point of care. Advance care directives (ACDs) are a subset of ACP documentation and refer to structured documents that are completed and signed by competent adults. Other ACP documentation includes informal documentation by the person or on behalf of the person by someone else (eg, clinician, family). The primary objectives were to describe the prevalence and correlates of ACDs among Australians aged 65 and over accessing health and residential aged care services. The secondary aim was to describe the prevalence of other ACP documentation.Design and settingA prospective multicentre health record audit in general practices (n=13), hospitals (n=12) and residential aged care facilities (RACFs; n=26).Participants503 people attending general practice, 574 people admitted to hospitals and 1208 people in RACFs.Primary and secondary outcome measuresPrevalence of one or more ACDs; prevalence of other ACP documentation.Results29.8% of people had at least one ACD on file. The majority were non-statutory documents (20.9%). ACD prevalence was significantly higher in RACFs (47.7%) than hospitals (15.7%) and general practices (3.2%) (p<0.001), and varied across jurisdictions. Multivariate logistic regression showed that the odds of having an ACD were positively associated with greater functional impairment and being in an RACF or hospital compared with general practice. 21.6% of people had other ACP documentation.ConclusionsIn this study, 30% of people had ACDs accessible and a further 20% had other ACP documentation, suggesting that approximately half of participants had some form of ACP. Correlates of ACD completion were greater impairment and being in an RACF or hospital. Greater efforts to promote and standardise ACDs across jurisdictions may help to assist older people to navigate and complete ACDs and to receive care consistent with their preferences.Trial registration numberACTRN12617000743369.
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Jokanovic, Natali, Terry Haines, Allen C. Cheng, Kathryn E. Holt, Sarah N. Hilmer, Yun-Hee Jeon, Andrew J. Stewardson, et al. "Multicentre stepped-wedge cluster randomised controlled trial of an antimicrobial stewardship programme in residential aged care: protocol for the START trial." BMJ Open 11, no. 3 (March 2021): e046142. http://dx.doi.org/10.1136/bmjopen-2020-046142.
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IntroductionAntimicrobial resistance is a growing global health threat, driven by increasing inappropriate use of antimicrobials. High prevalence of unnecessary use of antimicrobials in residential aged care facilities (RACFs) has driven demand for the development and implementation of antimicrobial stewardship (AMS) programmes. The Stepped-wedge Trial to increase antibiotic Appropriateness in Residential aged care facilities and model Transmission of antimicrobial resistance (START) will implement and evaluate the impact of a nurse-led AMS programme on antimicrobial use in 12 RACFs.Methods and analysisThe START trial will implement and evaluate a nurse-led AMS programme via a stepped-wedge cluster randomised controlled trial design in 12 RACFs over 16 months. The AMS programme will incorporate education, aged care-specific treatment guidelines, documentation forms, and audit and feedback strategies that will target aged care staff, general practitioners, pharmacists, and residents and their families. The intervention will primarily focus on urinary tract infections, lower respiratory tract infections, and skin and soft tissue infections. RACFs will transition from control to intervention phases in random order, two at a time, every 2 months, with a 2-month transition, wash-in period. The primary outcome is the cumulative proportion of residents within each facility prescribed an antibiotic during each month and total days of antibiotic use per 1000 occupied bed days. Secondary outcomes include the number of courses of systemic antimicrobial therapy, antimicrobial appropriateness, antimicrobial resistant organisms, Clostridioides difficile infection, change in antimicrobial susceptibility profiles, hospitalisations and all-cause mortality. Analyses will be conducted according to the intention-to-treat principle.Ethics and disseminationEthics approval has been granted by the Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/591). Research findings will be disseminated through peer-reviewed publications, conferences and summarised reports provided to participating RACFs.Trial registration numberNCT03941509.
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Loi, Samantha M., Alissa Westphal, and Nicola T. Lautenschlager. "An investigation of residential facility staff usage of touchscreen technology." International Psychogeriatrics 29, no. 12 (April 24, 2017): 2095–98. http://dx.doi.org/10.1017/s1041610217000515.
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ABSTRACTOlder adults may become more familiar and interested in using touchscreen technology (TT). TT can be used to engage older adults living in residential aged care facilities (RACFs) and staff there can play an important role in supporting residents to use TT. However, before these are introduced, it is crucial to investigate their opinions in using TT with residents. A questionnaire based on the Technology Acceptance Model was administered to assess staff usage and confidence in using TT, their perceptions in TT ease-of-use and usefulness in helping them care for their residents. Perhaps unsurprisingly, results found that respondents were familiar using TT. More importantly, staff reported that they were interested in engaging residents with TT and nominated different training methods to support them such as group in-services. This project provides information about staff experience and acceptance of the use of TT for residents in RACFs.
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Ooi, Meidelynn, Ebony T. Lewis, Julianne Brisbane, Evalynne Tubb, Tom McClean, Hassan Assareh, Ken Hillman, Helen Achat, and Magnolia Cardona. "Feasibility of Using a Risk Assessment Tool to Predict Hospital Transfers or Death for Older People in Australian Residential Aged Care. A Retrospective Cohort Study." Healthcare 8, no. 3 (August 21, 2020): 284. http://dx.doi.org/10.3390/healthcare8030284.
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Residents of Aged Care Facilities (RACF) experience burdensome hospital transfers in the last year of life, which may lead to aggressive and potentially inappropriate hospital treatments. Anticipating these transfers by identifying risk factors could encourage end-of-life discussions that may change decisions to transfer. The aim was to examine the feasibility of identifying an end-of-life risk profile among RACF residents using a predictive tool to better anticipate predictors of hospital transfers, death or poor composite outcome of hospitalisation and/or death after initial assessment. A retrospective cohort study of 373 permanent residents aged 65+ years was conducted using objective clinical factors from records in nine RACFs in metropolitan Sydney, Australia. In total, 26.8% died and 34.3% experienced a composite outcome. Cox proportional hazard regression models confirmed the feasibility of estimating the level of risk for death or a poor composite outcome. Knowing this should provide opportunities to initiate advance care planning in RACFs, facilitating decision making near the end of life. We conclude that the current structure of electronic RACF databases could be enhanced to enable comprehensive assessment of the risk of hospital re-attendance without admission. Automation tools to facilitate the risk score calculation may encourage the adoption of prediction checklists and evaluation of their association with hospital transfers.
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Maddocks, Ian. "The Community Hub: a proposal to change the role of Residential Aged Care Facilities (RACFs)." Family Medicine and Community Health 2, no. 4 (December 1, 2014): 20–25. http://dx.doi.org/10.15212/fmch.2014.0139.
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Raban, Magdalena Z., Melissa T. Baysari, Mikaela L. Jorgensen, Amina Tariq, Andrew Georgiou, and Johanna I. Westbrook. "Unmet Needs for Transdermal Patch Management in Electronic Medication Administration Records: An Analysis of Data from 66 Aged Care Facilities." Applied Clinical Informatics 11, no. 05 (October 2020): 812–20. http://dx.doi.org/10.1055/s-0040-1721011.
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Abstract Background Transdermal medication patches have caused serious adverse events in residential aged care facilities (RACFs). Preliminary research suggests that facilities are using a workaround consisting of manually entered reminders in their electronic medication administration records (eMARs) to prompt staff to check and remove patches, because the eMAR does not support these tasks. However, the prevalence and factors associated with use of this workaround among facilities is unknown. Objectives The objectives of this study were to (1) examine the frequency and consistency with which manual reminders to check and remove transdermal patches were used in facility eMARs, and (2) identify resident and facility factors associated with reminder use, to inform eMAR redesign. Methods This was a retrospective cross-sectional analysis of eMAR data from 66 Australian RACFs including 4,787 permanent residents, aged ≥65 years in January 2017. Prevalence of the use of reminders to check and remove patches, and consistency in their application within facilities were examined. Generalized estimating equations were used to determine factors associated with use of manual reminders. Results One in five (n = 937) residents used a patch, and 83.6% of patches contained opioids, a high-risk medicine. 56.9% of facilities implemented manually entered check patch reminders in the eMAR, and 72.3% implemented remove reminders. The reminders were applied inconsistently, with only half of these facilities having reminders for all residents with patches. Residents in facilities in regional areas were more likely to have a check reminder compared with those in major cities (adjusted odds ratio = 4.72 [95% confidence interval: 1.69–13.20]). Conclusion Transdermal patches containing high-risk medicines are frequently used in RACFs, but their safe administration is not supported by a widely implemented eMAR. The frequent, but inconsistent use of a workaround to manually enter reminders indicates an unmet need for new eMAR functionality to improve safety.
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Sharp, Catherine. "Prevalence of methicillin-resistant Staphylococcus aureus in residents who died with pressure ulcers in residential aged care facilities." Asian Journal of Medical Sciences 15, no. 1 (January 1, 2024): 113–18. http://dx.doi.org/10.3126/ajms.v15i1.58777.
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Background: As mobility in the elderly declines, dependence on care increases, and that care involves preventing pressure ulcers (PUs). PUs may become colonized with methicillin-resistant Staphylococcus aureus, causing cross-infection problems and leading to sepsis and death. Aims and Objectives: The aim of this paper was to examine the prevalence of methicillin-resistant S. aureus in residents with PUs and consider regulations. Materials and Methods: A retrospective review of 80 records of residents aged ≥65 years from eight residential aged care facilities (RACFs) in Australia was undertaken. Records were reviewed for sex, age at death, source of admission, Stage of PU, and colonization with methicillin-resistant S. aureus. Results: A third of residents, 34% (95% confidence interval [CI] 25%–44%, 27/80), had PUs in the last week of life. Of residents admitted from hospital 13% (95% CI 9%–32%, 7/40) had PUs. Most (63%, 95% CI 44–78%, 17/27) residents with a PU had been admitted from hospital, and most PUs (78%, 95% CI 59–89%, 21/27) were open wounds, stages 2–4. Half of all residents with a PU (48%, 95% CI 30–67%, 13/27) were colonized with methicillin-resistant S. aureus, and a third of residents with stages 2–4 PUs (31%, 95% CI 13–58%, 4/13) were colonized with methicillin-resistant S. aureus. Conclusion: Nearly half of all PUs were colonized with methicillin-resistant S. aureus, suggesting PUs may be a reservoir for methicillin-resistant S. aureus. Regulations that could reduce PUs in RACFs “an air mattress appropriate to each care recipient’s condition” are not being utilized. If PUs were prevented, reservoirs for methicillin-resistant S. aureus would be eradicated.
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Siette, Joyce, Laura Dodds, Didi Surian, Mirela Prgomet, Adam Dunn, and Johanna Westbrook. "Social interactions and quality of life of residents in aged care facilities: A multi-methods study." PLOS ONE 17, no. 8 (August 29, 2022): e0273412. http://dx.doi.org/10.1371/journal.pone.0273412.
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Background The relationship between social contact and quality of life is well-established within the general population. However, limited data exist about the extent of social interactions in residential aged care facilities (RACFs) providing long-term accommodation and care. We aimed to record the frequency and duration of interpersonal interactions among residents in RACFs and identify the association between residents’ interpersonal interactions and quality of life (QoL). Materials and methods A multi-methods study, including time and motion observations and a QoL survey, was conducted between September 2019 to January 2020. Thirty-nine residents from six Australian RACFs were observed between 09:30–17:30 on weekdays. Observations included residents’ actions, location of the action, and who the resident was with during the action. At the end of the observation period, residents completed a QoL survey. The proportion of time residents spent on different actions, in which location, and with whom were calculated, and correlations between these factors and QoL were analysed. Results A total of 312 hours of observations were conducted. Residents spent the greatest proportion of time in their own room (45.2%, 95%CI 40.7–49.8), alone (47.9%, 95%CI 43.0–52.7) and being inactive (25.6%, 95%CI 22.5–28.7). Residents were also largely engaged in interpersonal communication (20.2%, 95%CI 17.9–22.5) and self-initiated or scheduled events (20.5%, 95%CI 18.0–23.0). Residents’ interpersonal communication was most likely to occur in the common area (29.3%, 95%CI 22.9–35.7), residents’ own room (26.7%, 95%CI 21.0–32.4) or the dining room (24.6%, 95%CI 18.9–30.2), and was most likely with another resident (54.8%, 95%CI 45.7–64.2). Quality of life scores were low (median = 0.68, IQR = 0.54–0.76). Amount of time spent with other residents was positively correlated with QoL (r = 0.39, p = 0.02), whilst amount of time spent with facility staff was negatively correlated with QoL (r = -0.45, p = 0.008). Discussion and conclusions Our findings confirm an established association between social interactions and improved QoL. Opportunities and activities which encourage residents to engage throughout the day in common facility areas can support resident wellbeing.
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Kosheleva, Ludmila, and Irene Ngune. "Registered Nurses’ Decisions Around Referral of Residents With Urinary Tract Infections: A Retrospective Cohort Study." Journal of Primary Care & Community Health 11 (January 2020): 215013272095744. http://dx.doi.org/10.1177/2150132720957441.
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Background Referral of residents with urinary tract infections (UTIs) in residential aged care facilities (RACFs) to hospital are common. However, there is limited information on what influences Registered Nurses’ (RN) decision-making process. Aim To investigate resident factors that influence RN’s decisions to escalate care. Design A retrospective cohort approach audited electronic clinical records of residents with UTIs. Methods Data were extracted from the electronic database and analyzed using descriptive and regression analysis. Approval was obtained from both the RACFs and University Human Research Ethics Committee. Results There was a higher likelihood of being referred to hospital if residents were female, had had a past fall, had related comorbidity, or had abnormal vital signs. However, being older and having a urinary catheter were protective factors for referral by the RN. Conclusion Referral of residents with UTIs by RNs to hospital is common in RACFs. Resident characteristics such as abnormal vital signs, past falls, and presence of comorbidity influence referrals by RNs. Nurse Practitioners dedicated to the RACFs could complement the role of a general practitioner. UTI-specific escalation protocols can assist RNs to make decisions about referrals. RNs’ related risk factors also need to be examined to understand other influencing factors.
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Nhongo, Dorika, Joyce Hendricks, Julie Bradshaw, and Kasia Bail. "Leadership and registered nurses (RNs) working after-hours in Residential Aged Care Facilities (RACFs): A structured literature review." Journal of Clinical Nursing 27, no. 21-22 (July 24, 2018): 3872–81. http://dx.doi.org/10.1111/jocn.14565.
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Sluggett, Janet K., Georgina A. Hughes, Choon Ean Ooi, Esa Y. H. Chen, Megan Corlis, Michelle E. Hogan, Tessa Caporale, Jan Van Emden, and J. Simon Bell. "Process Evaluation of the SImplification of Medications Prescribed to Long-tErm Care Residents (SIMPLER) Cluster Randomized Controlled Trial: A Mixed Methods Study." International Journal of Environmental Research and Public Health 18, no. 11 (May 27, 2021): 5778. http://dx.doi.org/10.3390/ijerph18115778.
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Complex medication regimens are highly prevalent, burdensome for residents and staff, and associated with poor health outcomes in residential aged care facilities (RACFs). The SIMPLER study was a non-blinded, matched-pair, cluster randomized controlled trial in eight Australian RACFs that investigated the one-off application of a structured 5-step implicit process to simplify medication regimens. The aim of this study was to explore the processes underpinning study implementation and uptake of the medication simplification intervention. A mixed methods process evaluation with an explanatory design was undertaken in parallel with the main outcome evaluation of the SIMPLER study and was guided by an established 8-domain framework. The qualitative component included a document analysis and semi-structured interviews with 25 stakeholders (residents, family, research nurses, pharmacists, RACF staff, and a general medical practitioner). Interviews were transcribed verbatim and reflexively thematically content analyzed. Descriptive statistics were used to summarize quantitative data extracted from key research documents. The SIMPLER recruitment rates at the eight RACFs ranged from 18.9% to 48.6% of eligible residents (38.4% overall). Participation decisions were influenced by altruism, opinions of trusted persons, willingness to change a medication regimen, and third-party hesitation regarding potential resident distress. Intervention delivery was generally consistent with the study protocol. Stakeholders perceived regimen simplification was beneficial and low risk if the simplification recommendations were individualized. Implementation of the simplification recommendations varied between the four intervention RACFs, with simplification implemented at 4-month follow-up for between 25% and 86% of residents for whom simplification was possible. Good working relationships between stakeholders and new remunerated models of medication management were perceived facilitators to wider implementation. In conclusion, the one-off implicit medication simplification intervention was feasible and generally delivered according to the protocol to a representative sample of residents. Despite variable implementation, recommendations to simplify complex regimens were valued by stakeholders, who also supported wider implementation of medication simplification in RACFs.
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Trankle, Steven A., and Jennifer Reath. "Afterhours telehealth in Australian residential aged care facilities: a mixed methods evaluation." BMC Health Services Research 23, no. 1 (November 15, 2023). http://dx.doi.org/10.1186/s12913-023-10257-5.
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Abstract Background The aged care system in Australia is under pressure. Residential aged care facilities (RACFs) and general practitioners (GPs) have difficulty providing the care needed by their residents, particularly after hours. Many residents are given ambulance support and transferred to hospital emergency departments (EDs) for care that could be provided at RACFs. The MyEmergencyDoctor (MED) service was commissioned in a 12-month program (February 2020-February 2021) using ED physicians to provide afterhours telehealth care in six RACFs. Methods Using the NASSS framework, we synthesised descriptive analyses of statistical data from the MED service, RACFs and the ambulance service and a thematic analysis of interview data collected from GPs, RACF and MED service staff, and family members of residents. Results Most calls to MED (179/209) were resolved with in-house treatment thereby reducing ambulance usage and hospital admissions. Interviews further revealed that MED enabled timely care for residents who were unwell but did not need hospital transfer. Technology, training, and rapid access to MED assisted RACF staff and complemented usual GP care. MED potentially reduced GP burnout. Refresher training was considered important especially in RACFs with high staff turnover, as was greater afterhours access to medications. Conclusions The afterhours telehealth model provided in-house care and reduced ambulance transfers, and GPs and RACF staff generally felt supported. The service was easy to use and fostered good communications with GPs and RACF staff. Some GPs preferred to provide their own care, commenting on the need for a good understanding of patient and family needs and of the local context. Other stakeholders suggested this model could be extended to palliative care settings and to normal business hours when GPs were unavailable. The reduced ambulance and hospital use suggested benefits to wider health systems, however policies and funding that remunerate GPs, support community-based care and provide additional staffing in RACFs are needed to sustain afterhours telehealth in RACFs. Use of the NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) Framework provided a valuable explanatory lens for our analyses.