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Jorissen RN, Wesselingh SL, Whitehead C, Maddison J, Forward J, Bourke A, Harvey G, Crotty M, Inacio MC. Predictors of mortality shortly after entering a long-term care facility. Age Ageing 2024; 53:afae098. [PMID: 38773946 PMCID: PMC11109518 DOI: 10.1093/ageing/afae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Indexed: 05/24/2024] Open
Abstract
OBJECTIVE Moving into a long-term care facility (LTCF) requires substantial personal, societal and financial investment. Identifying those at high risk of short-term mortality after LTCF entry can help with care planning and risk factor management. This study aimed to: (i) examine individual-, facility-, medication-, system- and healthcare-related predictors for 90-day mortality at entry into an LTCF and (ii) create risk profiles for this outcome. DESIGN Retrospective cohort study using data from the Registry of Senior Australians. SUBJECTS Individuals aged ≥ 65 years old with first-time permanent entry into an LTCF in three Australian states between 01 January 2013 and 31 December 2016. METHODS A prediction model for 90-day mortality was developed using Cox regression with the purposeful variable selection approach. Individual-, medication-, system- and healthcare-related factors known at entry into an LTCF were examined as predictors. Harrell's C-index assessed the predictive ability of our risk models. RESULTS 116,192 individuals who entered 1,967 facilities, of which 9.4% (N = 10,910) died within 90 days, were studied. We identified 51 predictors of mortality, five of which were effect modifiers. The strongest predictors included activities of daily living category (hazard ratio [HR] = 5.41, 95% confidence interval [CI] = 4.99-5.88 for high vs low), high level of complex health conditions (HR = 1.67, 95% CI = 1.58-1.77 for high vs low), several medication classes and male sex (HR = 1.59, 95% CI = 1.53-1.65). The model out-of-sample Harrell's C-index was 0.773. CONCLUSIONS Our mortality prediction model, which includes several strongly associated factors, can moderately well identify individuals at high risk of mortality upon LTCF entry.
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Affiliation(s)
- Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Steve L Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia; and National Health and Medical Research Council, ACT, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - John Maddison
- Northern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - John Forward
- Northern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Alice Bourke
- Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Brotherhood K, Searle B, Spiers GF, Caiado C, Hanratty B. Variations in older people's emergency care use by social care setting: a systematic review of international evidence. Br Med Bull 2024; 149:32-44. [PMID: 38112600 PMCID: PMC10938536 DOI: 10.1093/bmb/ldad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/16/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Older adults' use of social care and their healthcare utilization are closely related. Residents of care homes access emergency care more often than the wider older population; however, less is known about emergency care use across other social care settings. SOURCES OF DATA A systematic review was conducted, searching six electronic databases between January 2012 and February 2022. AREAS OF AGREEMENT Older people access emergency care from a variety of community settings. AREAS OF CONTROVERSY Differences in study design contributed to high variation observed between studies. GROWING POINTS Although data were limited, findings suggest that emergency hospital attendance is lowest from nursing homes and highest from assisted living facilities, whilst emergency admissions varied little by social care setting. AREAS TIMELY FOR DEVELOPING RESEARCH There is a paucity of published research on emergency hospital use from social care settings, particularly home care and assisted living facilities. More attention is needed on this area, with standardized definitions to enable comparisons between studies.
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Affiliation(s)
- Kelly Brotherhood
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building (Second Floor), Newcastle upon Tyne NE1 7RU, UK
| | - Ben Searle
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building (Second Floor), Newcastle upon Tyne NE1 7RU, UK
| | - Gemma Frances Spiers
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building (Second Floor), Newcastle upon Tyne NE1 7RU, UK
| | - Camila Caiado
- Department of Mathematical Sciences, Mathematical Sciences & Computer Science Building, Durham University, Upper Mountjoy Campus, Stockton Road, Durham, DH1 3LE, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building (Second Floor), Newcastle upon Tyne NE1 7RU, UK
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Eshetie TC, Caughey GE, Whitehead C, Crotty M, Corlis M, Visvanathan R, Wesselingh S, Inacio MC. The risk of fractures after entering long-term care facilities. Bone 2024; 180:116995. [PMID: 38145862 DOI: 10.1016/j.bone.2023.116995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Stratifying residents at increased risk for fractures in long-term care facilities (LTCFs) can potentially improve awareness and facilitate the delivery of targeted interventions to reduce risk. Although several fracture risk assessment tools exist, most are not suitable for individuals entering LTCF. Moreover, existing tools do not examine risk profiles of individuals at key periods in their aged care journey, specifically at entry into LTCFs. PURPOSE Our objectives were to identify fracture predictors, develop a fracture risk prognostic model for new LTCF residents and compare its performance to the Fracture Risk Assessment in Long term care (FRAiL) model using the Registry of Senior Australians (ROSA) Historical National Cohort, which contains integrated health and aged care information for individuals receiving long term care services. METHODS Individuals aged ≥65 years old who entered 2079 facilities in three Australian states between 01/01/2009 and 31/12/2016 were examined. Fractures (any) within 365 days of LTCF entry were the outcome of interest. Individual, medication, health care, facility and system-related factors were examined as predictors. A fracture prognostic model was developed using elastic nets penalised regression and Fine-Gray models. Model discrimination was examined using area under the receiver operating characteristics curve (AUC) from the 20 % testing dataset. Model performance was compared to an existing risk model (i.e., FRAiL model). RESULTS Of the 238,782 individuals studied, 62.3 % (N = 148,838) were women, 49.7 % (N = 118,598) had dementia and the median age was 84 (interquartile range 79-89). Within 365 days of LTCF entry, 7.2 % (N = 17,110) of individuals experienced a fracture. The strongest fracture predictors included: complex health care rating (no vs high care needs, sub-distribution hazard ratio (sHR) = 1.52, 95 % confidence interval (CI) 1.39-1.67), nutrition rating (moderate vs worst, sHR = 1.48, 95%CI 1.38-1.59), prior fractures (sHR ranging from 1.24 to 1.41 depending on fracture site/type), one year history of general practitioner attendances (≥16 attendances vs none, sHR = 1.35, 95%CI 1.18-1.54), use of dopa and dopa derivative antiparkinsonian medications (sHR = 1.28, 95%CI 1.19-1.38), history of osteoporosis (sHR = 1.22, 95%CI 1.16-1.27), dementia (sHR = 1.22, 95%CI 1.17-1.28) and falls (sHR = 1.21, 95%CI 1.17-1.25). The model AUC in the testing cohort was 0.62 (95%CI 0.61-0.63) and performed similar to the FRAiL model (AUC = 0.61, 95%CI 0.60-0.62). CONCLUSIONS Critical information captured during transition into LTCF can be effectively leveraged to inform fracture risk profiling. New fracture predictors including complex health care needs, recent emergency department encounters, general practitioner and consultant physician attendances, were identified.
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Affiliation(s)
- Tesfahun C Eshetie
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia.
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation (SA Branch), Adelaide, South Australia, Australia
| | - Renuka Visvanathan
- Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Research, Central Adelaide Local Health Network, SA Health, South Australia, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Harrison SL, Lang C, Eshetie TC, Crotty M, Whitehead C, Evans K, Corlis M, Wesselingh S, Caughey GE, Inacio MC. Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia. AUST HEALTH REV 2024; 48:182-190. [PMID: 38537302 DOI: 10.1071/ah24019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/06/2024] [Indexed: 04/05/2024]
Abstract
Objective The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8-43.3], vs 37.8% [37.6-38.0]), unplanned hospitalisation (39.8% [39.6-40.1] vs 33.4% [33.2-33.6]) and potentially preventable hospitalisation (11.8% [11.6-12.0] vs 8.2% [8.1-8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency.
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Affiliation(s)
- Stephanie L Harrison
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Tesfahun C Eshetie
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; and UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Keith Evans
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation SA Branch, Adelaide, SA, Australia
| | - Steve Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and National Health and Medical Research Council, ACT, Australia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Caughey GE, Rahja M, Collier L, Air T, Thapaliya K, Crotty M, Williams H, Harvey G, Sluggett JK, Gill TK, Kadkha J, Roder D, Kellie AR, Wesselingh S, Inacio MC. Primary health care service utilisation before and after entry into long-term care in Australia. Arch Gerontol Geriatr 2024; 117:105210. [PMID: 37812974 DOI: 10.1016/j.archger.2023.105210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES To examine utilisation of primary health care services (subsidised by the Australian Government, Medicare Benefits Schedule, MBS) before and after entry into long-term care (LTC) in Australia. METHODS A retrospective cohort study of older people (aged ≥65 years) who entered LTC in Australia between 2012 and 2016 using the Historical Cohort of the Registry of Senior Australians. MBS-subsidised general attendances (general practitioner (GP), medical and nurse practitioners), health assessment and management plans, allied health, mental health services and selected specialist attendances accessed in 91-day periods 12 months before and after LTC entry were examined. Adjusted relative changes in utilisation 0-3 months before and after LTC entry were estimated using risk ratios (RR) calculated using Generalised Estimating Equation Poisson models. RESULTS 235,217 residents were included in the study with a median age of 84 years (interquartile range 79-89) and 61.1% female. In the first 3 months following LTC entry, GP / medical practitioner attendances increased from 86.6% to 95.6% (aRR 1.10 95%CI 1.10-1.11), GP / medical practitioner urgent after hours (from 12.3% to 21.1%; aRR 1.72, 95%CI 1.70-1.74) and after-hours attendances (from 18.5% to 33.8%; aRR 1.83, 95%CI 1.81-1.84) increased almost two-fold. Pain, palliative and geriatric specialist medicine attendances were low in the 3 months prior (<3%) and decreased further following LTC admission. CONCLUSION There is an opportunity to improve the utilisation of primary health care services following LTC entry to ensure that residents' increasingly complex care needs are adequately met.
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Affiliation(s)
- Gillian E Caughey
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
| | - Miia Rahja
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia
| | - Luke Collier
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Tracy Air
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Kailash Thapaliya
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Maria Crotty
- Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia; College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
| | | | - Gillian Harvey
- College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
| | - Janet K Sluggett
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Tiffany K Gill
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Jyoti Kadkha
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; College of Nursing and Health Science, Flinders University, Adelaide, SA, Australia
| | - David Roder
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | | | - Steve Wesselingh
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Maria C Inacio
- The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Chae HW, Zhao J, Ah YM, Choi KH, Lee JY. Potentially inappropriate medication use as predictors of hospitalization for residents in nursing home. BMC Geriatr 2023; 23:467. [PMID: 37532993 PMCID: PMC10394923 DOI: 10.1186/s12877-023-04165-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/11/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Hospitalization of nursing home (NH) residents impose a significant healthcare burden. However, there is still a lack of information regarding the risk of hospitalization from inappropriate prescribing in NH residents. We aimed to estimate the nationwide prevalence of potentially inappropriate medication (PIM) use among NH residents using the Korean tool and 2019 Beers criteria and to assess their associations with hospitalization or emergency department (ED) visits. METHODS We included older adults aged 65 years or above who were admitted to NHs between July 2008 and December 2018 using national senior cohort database. The prevalence of PIM use based on the Korean medication review tool and Beers criteria on the date of admission to NH was estimated. And the adjusted hazard ratios (aHRs) of polypharmacy, numbers of PIM, each PIM category for hospitalization/ED visits within 30 days of admission to NH was calculated using Cox proportional hazard model to show the association. RESULTS Among 20,306 NH residents, the average number of medications per person was 7.5 ± 4.7. A total of 89.3% and 67.9% of the NH residents had at least one PIM based on the Korean tool and 2019 Beers criteria, respectively. The risk of ED visits or hospitalization significantly increased with the number of PIMs based on the Korean tool (1-3: aHR = 1.24, CI 1.03-1.49; ≥4: aHR = 1.46, CI 1.20-1.79). Having four or more PIMs based on the Beers criteria increased the risk significantly (aHR = 1.30, CI 1.06-1.53) while using 1-3 PIMs was not significantly associated (aHR = 1.07, CI 0.97-1.19). Residents with any potential medication omission according to the Korean criteria, were at 23% higher risk of hospitalization or ED visits (aHR = 1.23, CI 1.07-1.40). CONCLUSIONS This study demonstrated that PIMs, based on the Korean tool and Beers criteria, were prevalent among older adults living in NHs and the use of PIMs were associated with hospitalization or ED visits. The number of PIMs based on the Korean tool showed dose-response increase in the risk of hospitalization or ED visits.
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Affiliation(s)
- Hyun-Woo Chae
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Jing Zhao
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongsangbuk, 38541, Republic of Korea
| | - Kyung Hee Choi
- College of Pharmacy, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon, 21936, Republic of Korea
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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Aged and Health Care Service Utilization by Older Australians Receiving Home Care Packages. J Am Med Dir Assoc 2023; 24:395-399.e2. [PMID: 36581309 DOI: 10.1016/j.jamda.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/17/2022] [Accepted: 11/26/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To examine the (1) cohort of individuals living at home with Home Care Packages (HCPs) in 2016, (2) their access to other aged care services after HCP commencement, and (3) their hospital and ambulance service utilization. DESIGN A cross-sectional study was conducted using integrated aged care and health care data contained within the National Historical Cohort of the Registry of Senior Australians. SETTING AND PARTICIPANTS This study included people who accessed HCP between January 1, 2016 and December 31, 2016. METHODS The access to permanent residential aged care, transition care, respite care, hospital and ambulance services among Australian HCP recipients ≥65 years old in 2016 was evaluated. Descriptive statistics were employed. RESULTS In 2016, 84,681 individuals received HCPs, of which 68.4% (n = 57,942) accessed HCP levels 1‒2, 26.0% (n = 22,057) accessed HCP levels 3‒4, and 5.5% (n = 4682) accessed both care levels within the year. Of the individuals receiving HCP, 34.0% (n = 27,787) started services that year and 16.7% (n = 14,117) moved to permanent residential aged care, 18.4% (n = 15,592) used respite care and 5.8% (n = 4937) used transition care that year. Emergency department (ED) presentations [43.6%, 95% confidence interval (CI) 43.3‒44.0] were the most common hospital encounters, followed by inpatient hospitalizations for any reason (43.3%, 95% CI 42.9‒43.7), and unplanned hospitalizations (38%, 95% CI 37.6‒38.3). Forty-four percent (44.5%, 95% CI 43.9‒45.0) of individuals utilized ambulance services. ED presentations, hospitalization for any reason, and unplanned hospitalizations were more common in individuals receiving HCP levels 3‒4 compared with those accessing HCP levels 1‒2. CONCLUSIONS AND IMPLICATIONS HCP recipients in Australia have frequent hospitalizations, including ED presentations. In addition, almost 1 in 5 access respite care and 16.7% transition to permanent residential care each year. As the population accessing HCP is increasing, adequate support for these individuals to live well at home and avoid health events that lead to hospitalizations are necessary.
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Sluggett JK, Air T, Cations M, Caughey GE, Lang CE, Ward SA, Ahern S, Lin X, Wallis K, Crotty M, Inacio MC. Clinical Quality Indicators for Monitoring Hospitalizations Among Older People with Dementia Accessing Aged Care Services. J Alzheimers Dis 2023; 96:1747-1758. [PMID: 38007661 DOI: 10.3233/jad-230730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
BACKGROUND There is a need for clinical quality indicators (CQIs) that can be applied to dementia quality registries to monitor care outcomes for people with Alzheimer's disease and other forms of dementia. OBJECTIVE To develop tertiary and primary care-based dementia CQIs for application to clinical registries for individuals with dementia accessing aged care services and determine 1) annual trends in CQI incidence between 2011-2012 and 2015-2016, 2) associated factors, and 3) geographic and facility variation in CQI incidence. METHODS This retrospective repeated cross-sectional study included non-Indigenous individuals aged 65-105 years who lived with dementia between July 2008-June 2016, were assessed for government-funded aged care services, and resided in New South Wales or Victoria (n = 180,675). Poisson or negative binomial regression models estimated trends in annual CQI incidence and associated factors. Funnel plots examined CQI variation. RESULTS Between 2011-2012 and 2015-2016, CQI incidence increased for falls (11.0% to 13.9%, adjusted incidence rate ratio (aIRR) 1.05 (95% CI 1.01-1.06)) and delirium (4.7% to 6.7%, aIRR 1.09 (95% CI 1.07-1.10)), decreased for unplanned hospitalizations (28.7% to 27.9%, aIRR 0.99 (95% CI 0.98-0.99)) and remained steady for fracture (6.2% to 6.5%, aIRR 1.01 (95% CI 0.99-1.01)) and pressure injuries (0.5% to 0.4%, aIRR 0.99 (95% CI 0.96-1.02)). Being male, older, having more comorbidities and living in a major city were associated with higher CQI incidence. Considerable geographical and facility variation was observed for unplanned hospitalizations and delirium CQIs. CONCLUSIONS The CQI results highlighted considerable morbidity. The CQIs tested should be considered for application in clinical quality registries to monitor dementia care quality.
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Affiliation(s)
- Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Monica Cations
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Catherine E Lang
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, The Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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Dyer SM, Suen J, Williams H, Inacio MC, Harvey G, Roder D, Wesselingh S, Kellie A, Crotty M, Caughey GE. Impact of relational continuity of primary care in aged care: a systematic review. BMC Geriatr 2022; 22:579. [PMID: 35836118 PMCID: PMC9281225 DOI: 10.1186/s12877-022-03131-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/06/2022] [Indexed: 11/21/2022] Open
Abstract
Background Greater continuity of care has been associated with lower hospital admissions and patient mortality. This systematic review aims to examine the impact of relational continuity between primary care professionals and older people receiving aged care services, in residential or home care settings, on health care resource use and person-centred outcomes. Methods Systematic review of five databases, four trial registries and three grey literature sources to October 2020. Included studies (a) aimed to increase relational continuity with a primary care professional, (b) focused on older people receiving aged care services (c) included a comparator and (d) reported outcomes of health care resource use, quality of life, activities of daily living, mortality, falls or satisfaction. Cochrane Collaboration or Joanna Briggs Institute criteria were used to assess risk of bias and GRADE criteria to rate confidence in evidence and conclusions. Results Heterogeneity in study cohorts, settings and outcome measurement in the five included studies (one randomised) precluded meta-analysis. None examined relational continuity exclusively with non-physician providers. Higher relational continuity with a primary care physician probably reduces hospital admissions (moderate certainty evidence; high versus low continuity hazard ratio (HR) 0.94; 95% confidence interval (CI) 0.92–0.96, n = 178,686; incidence rate ratio (IRR) 0.99, 95%CI 0.76–1.27, n = 246) and emergency department (ED) presentations (moderate certainty evidence; high versus low continuity HR 0.90, 95%CI 0.89–0.92, n = 178,686; IRR 0.91, 95%CI 0.72–1.15, n = 246) for older community-dwelling aged care recipients. The benefit of providing on-site primary care for relational continuity in residential settings is uncertain (low certainty evidence, 2 studies, n = 2,468 plus 15 care homes); whilst there are probably lower hospitalisations and may be fewer ED presentations, there may also be an increase in reported mortality and falls. The benefit of general practitioners’ visits during hospital admission is uncertain (very low certainty evidence, 1 study, n = 335). Conclusion Greater relational continuity with a primary care physician probably reduces hospitalisations and ED presentations for community-dwelling aged care recipients, thus policy initiatives that increase continuity may have cost offsets. Further studies of approaches to increase relational continuity of primary care within aged care, particularly in residential settings, are needed. Review registration CRD42021215698. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03131-2.
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Affiliation(s)
- Suzanne M Dyer
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia.
| | - Jenni Suen
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | | | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - David Roder
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Steve Wesselingh
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Maria Crotty
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia.,Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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The Utilization and National Variation of Plain X-Ray Services by Australian Residents of Long-Term Care Facilities. J Am Med Dir Assoc 2022; 23:1564-1572.e9. [PMID: 35667412 DOI: 10.1016/j.jamda.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/26/2022] [Accepted: 05/07/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To (1) estimate incidence, trends, and determinants of government-subsidized diagnostic radiography (ie, plain x-ray) services utilization by Australian long-term care facility (LTCF) residents between 2009 and 2016; (2) examine national variation in services use. DESIGN A repeated cross-sectional study. SETTING AND PARTICIPANTS Australian LTCF residents who were ≥65 years old. METHODS Medicare Benefits Schedule subsidized plain x-rays employed for diagnosing fall-related injuries, pneumonia, heart failure, and acute abdomen or bowel obstruction were identified. Yearly sex- and age-standardized utilization rates were calculated. Poisson and negative binomial regression models were employed. Facility-level variation was examined graphically. Overall and examination site-specific analyses were conducted. RESULTS A total of 521,497 LTCF episodes for 453,996 individuals living in 3018 LTCFs were examined. The median age was 84 years (interquartile range 79-88), 65% (n = 339,116) were women, and 53.9% (n = 281,297) had dementia. In addition, 34.5% (n = 341,6863) of episodes had at least 1 x-ray service. Overall, there was a 12% increase in utilization between 2009 and 2016 (from 535/1000 in 2009 to 602/1000 person-years in 2016, incidence rate ratio=1.02, 95% CI 1.02-1.02). Factors associated with x-ray use included being 80-89 years old, being a man, not having dementia, having multiple health conditions (4-6 or ≥7 compared to 0-3), being at a smaller facility (0-24 bed compared to 50-74), facility located in the Australian state of New South Wales, or in major cities (compared to regional areas). National variation in x-ray service use, with largest differences observed by state, was detected. CONCLUSIONS AND IMPLICATIONS Plain x-ray service utilization by LTCF residents increased 12% between 2009 and 2016. Sex, age, dementia status, having multiple health conditions as well as facility size, and location were associated with plain x-ray use in LTCFs and use varied geographically. Differences in x-ray service utilization by residents highlight lack of consistent access and potential over- or underutilization.
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Chiswell K, Bein K, Simpkins D, Latt M, Dinh M. Emergency department presentations and 30-day mortality in patients from residential aged care facilities. AUST HEALTH REV 2022; 46:414-420. [PMID: 35576988 DOI: 10.1071/ah21275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 03/16/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveTo describe patterns of emergency department (ED) presentations and predictors of 30-day mortality in patients referred from a residential aged care facility (RACF).MethodsA retrospective analysis of linked state-wide emergency, inpatient and death data from 136 public ED hospitals in New South Wales, Australia. Data were collected from the NSW Emergency Department Data Collection database, the NSW Admitted Patient Data Collection database and the NSW Registry of Births, Deaths and Marriages. All patients aged ≥65 years presenting to the ED from a RACF between January 2017 and July 2018 were included. ED diagnosis categories, re-admission rates within 30 days and 30-day all-cause mortality were measured.ResultsIn total, 43 248 presentations were identified. The most common ED diagnosis categories were: injury (26.48%), respiratory conditions (14.12%) and cardiovascular conditions (10.74%). Prolonged ED length of stay was associated with higher adjusted hazard ratios for 30-day all-cause mortality after adjustments for age Charlson Comorbidity Index, triage category and diagnosis category (HR 1.10 95% CI 1.05-1.14 P < 0.001).ConclusionsA large proportion of ED presentations from RACFs were for injuries associated with falls and chest infections. There was a range of both high- and low-urgency presentations. Both the 30-day mortality and re-admission rates were high. Predictors of increased mortality included prolonged length of stay in the ED and re-admission within 30 days. The findings are useful in informing discussion around improving access to care in RACFs and coordination of healthcare providers in this cohort.
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Affiliation(s)
- Kate Chiswell
- Medical Training Unit, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - Kendall Bein
- Royal Prince Alfred Hospital Green Light Institute for Emergency Care, Sydney Local Health District, NSW, Australia
| | - Daniel Simpkins
- Geriatrics Department, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - Mark Latt
- Geriatrics Department, Royal Prince Alfred Hospital, Sydney Local Health District, NSW, Australia
| | - Michael Dinh
- Royal Prince Alfred Hospital Green Light Institute for Emergency Care, Sydney Local Health District, NSW, Australia; and The University of Sydney, Faculty of Medicine and Health, NSW, Australia
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