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Hutchinson C, Khadka J, Crocker M, Lay K, Milte R, Whitehirst DG, Engel L, Ratcliffe J. Examining interrater agreement between self-report and proxy-report responses for the quality of life-aged care consumers (QOL-ACC) instrument. J Patient Rep Outcomes 2024; 8:28. [PMID: 38436803 PMCID: PMC10912388 DOI: 10.1186/s41687-024-00705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Quality of life is an important quality indicator for health and aged care sectors. However, self-reporting of quality of life is not always possible given the relatively high prevalence of cognitive impairment amongst older people, hence proxy reporting is often utilised as the default option. Internationally, there is little evidence on the impact of proxy perspective on interrater agreement between self and proxy report. OBJECTIVES To assess the impacts of (i) cognition level and (ii) proxy perspective on interrater agreement using a utility instrument, the Quality of Life-Aged Care Consumers (QOL-ACC). METHODS A cross-sectional study was undertaken with aged care residents and family member proxies. Residents completed the self-report QOL-ACC, while proxies completed two proxy versions: proxy-proxy perspective (their own opinion), and proxy-person perspective (how they believe the resident would respond). Interrater agreement was assessed using quadratic weighted kappas for dimension-level data and concordance correlation coefficients and Bland-Altman plots for utility scores. RESULTS Sixty-three residents (22, no cognitive impairment; 41, mild-to-moderate cognitive impairment) and proxies participated. In the full sample and in the mild-to-moderate impairment group, the mean self-reported QOL-ACC utility score was significantly higher than the means reported by proxies, regardless of perspective (p < 0.01). Agreement with self-reported QOL-ACC utility scores was higher when proxies adopted a proxy-person perspective. CONCLUSION Regardless of cognition level and proxy perspective, proxies tend to rate quality of life lower than residents. Further research is needed to explore the impact of such divergences for quality assessment and economic evaluation in aged care.
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Affiliation(s)
- Claire Hutchinson
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia.
| | - Jyoti Khadka
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
- ROSA, Adelaide, South Australia, Australia
| | - Matthew Crocker
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - Kiri Lay
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
| | - David Gt Whitehirst
- Faculty of Health Sciences, Simon Fraser University, British Columbia, Burnaby, Canada
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University Health Economics Group, Monash University, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Science, Flinders University, Adelaide, South Australia, Australia
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Boord MS, Brown P, Soriano J, Meola T, Dumuid D, Milte R, Roughead EE, Lovell NH, Stone H, Whitehouse J, Janetzki JL, Gebreyohannes EA, Lim R. A Digitally Enabled, Pharmacist service to detecT medicine harms in residential aged care (nursing home) (ADEPT): protocol for a feasibility study. BMJ Open 2024; 14:e080148. [PMID: 38341209 PMCID: PMC10862280 DOI: 10.1136/bmjopen-2023-080148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION This feasibility study aims to develop and test a new model of practice in Australia using digital technologies to enable pharmacists to monitor early signs and symptoms of medicine-induced harms in residential aged care. METHODS AND ANALYSIS Thirty residents will be recruited from an aged care facility in South Australia. The study will be conducted in two phases. In phase I, the study team will work with aged care software providers and developers of digital technologies (a wearable activity tracker and a sleep tracking sensor) to gather physical activity and sleep data, as well as medication and clinical data from the electronic medication management system and aged care clinical software. Data will be centralised into a cloud-based monitoring platform (TeleClinical Care (TCC)). The TCC will be used to create dashboards that will include longitudinal visualisations of changes in residents' health, function and medicine use over time. In phase II, the on-site pharmacist will use the centralised TCC platform to monitor each resident's medicine, clinical, physical activity and sleep data to identify signs of medicine-induced harms over a 12-week period.A mixed methods process evaluation applying the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) evaluation framework will be used to assess the feasibility of the service. Outcome measures include service reach, changes in resident symptom scores (measured using the Edmonton Symptom Assessment System), number of medication adverse events detected, changes in physical activity and sleep, number of pharmacist recommendations provided, cost analysis and proportion of all pharmacists' recommendations implemented at 4-week, 8-week and 12-week postbaseline period. ETHICS AND DISSEMINATION Ethical approval has been obtained from the University of South Australia's Human Research Ethics Committee (205098). Findings will be disseminated through published manuscripts, conference presentations and reporting to the study funder. TRIAL REGISTRATION NUMBER ACTRN12623000506695.
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Affiliation(s)
- Monique S Boord
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Peter Brown
- Tyree Foundation Institute of Health Engineering (IHealthE) and Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Julian Soriano
- Tanunda Lutheran Home Inc, Tanunda, South Australia, Australia
- SA Pharmacy, Adelaide, South Australia, Australia
| | - Tahlia Meola
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, South Australia, Australia
| | - Rachel Milte
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Nigel H Lovell
- Tyree Foundation Institute of Health Engineering (IHealthE) and Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Stone
- Pharmaceutical Society of Australia, Deakin, Australian Capital Territory, Australia
| | | | - Jack L Janetzki
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Eyob Alemayehu Gebreyohannes
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Lay K, Crocker M, Engel L, Ratcliffe J, Milte R, Hutchinson C. Exploring older people's understanding of the QOL-ACC, a new preference-based quality-of-life measure, for quality assessment and economic evaluation in aged care: the impact of cognitive impairment and dementia. Health Qual Life Outcomes 2024; 22:4. [PMID: 38185654 PMCID: PMC10773014 DOI: 10.1186/s12955-023-02222-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/13/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Quality-of-life is an essential outcome for quality assessment and economic evaluation in health and social care. The-Quality-of-Life - Aged Care Consumers (QOL-ACC) is a new preference-based quality-of-life measure, psychometrically validated with older people in aged care. More evidence is needed to inform the self-report reliability of the QOL-ACC in older people with varying levels of cognitive impairment and dementia. METHODS A think-aloud protocol was developed and applied with older residents. The Mini Mental State Examination (MMSE) was applied to assign participants to no cognitive impairment (NCI - MMSE score ≥ 27) and cognitive impairment (MMCI - MMSE score < 27) subgroups. Three independent raters utilised a Tourangeau survey response model-based framework to identify response issues. Data were compared across cognition subgroups and synthesized using a 'traffic light' grading to classify frequency and type of response issues. Gradings were utilised to assess self-report reliability according to different levels of cognitive impairment. RESULTS Qualitative data from 44 participants (NCI = 20, MMCI = 24) were included for analysis. Response issues were more evident in the cognitive impairment subgroup than the no cognitive impairment subgroup. All participants who received a 'red' grade had an MMSE score of < 20 and 66% of 'amber' grades occurred in the cognitive impairment subgroup. CONCLUSIONS The QOL-ACC is able to be completed reliably by older residents with an MMSE score > 17. Future research is needed to assess the generalisability of these findings to other preference-based quality of life instruments and for older people in other care settings including health systems.
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Affiliation(s)
- Kiri Lay
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, Adelaide, SA, 5001, Australia.
| | - Matthew Crocker
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, Adelaide, SA, 5001, Australia
| | - Lidia Engel
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, Adelaide, SA, 5001, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, Adelaide, SA, 5001, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, Adelaide, SA, 5001, Australia
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Hutchinson C, Cleland J, McBain C, Walker R, Milte R, Swaffer K, Ratcliffe J. What quality of life domains are most important to older adults in residential care? J Aging Soc Policy 2024; 36:21-42. [PMID: 36252046 DOI: 10.1080/08959420.2022.2134691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 07/14/2022] [Indexed: 10/24/2022]
Abstract
Quality of life is a critically important outcome measure in aged care. However, few studies have provided a detailed examination of what quality of life means to older adults living in residential care. In the current study, N = 43 older adults (67 to 99 years) living in six residential aged care facilities in four Australian states took part in semi-structured interviews. Participants had normal cognition through to mild /moderate cognitive impairment as measured by the PAS-Cog, were able to provide informed consent, and could participate in an interview conducted in English. Interviews were transcribed, and data was analyzed in NVivo using thematic analysis. Both physical and psycho-social aspects were identified as important for older adults' quality of life with six key quality of life domains identified: independence, mobility, pain management, social connections, emotional well-being, and activities. More research is needed to test these domains with a more diverse sample of older adults living in residential aged care, in particular older adults from culturally and linguistically diverse communities. Such qualitative work is essential for the development of suitable quality of life measures for this population and provides valuable information to inform improvements to care practices and service provision. Some ways in which the identified quality of life domains could be used to enhance care provision are discussed.
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Affiliation(s)
- Claire Hutchinson
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Jenny Cleland
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Candice McBain
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Ruth Walker
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Rachel Milte
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Kate Swaffer
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
- School of Society and Justice, University of South Australia, Magill, SA 5072, Australia
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Ratcliffe J, Lay K, Crocker M, Engel L, Milte R, Hutchinson C, Khadka J, Whitehurst DGT, Mulhern B, Viney R, Norman R. Unravelling the Self-Report Versus Proxy-Report Conundrum for Older Aged Care Residents: Findings from a Mixed-Methods Study. Patient 2024; 17:53-64. [PMID: 37985620 DOI: 10.1007/s40271-023-00655-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES No guidance currently exists as to the cognition threshold beyond which self-reported quality of life for older people with cognitive impairment and dementia is unreliable. METHODS Older aged care residents (≥ 65 years) were randomly assigned to complete the EQ-5D-5L in computer-based (eye movements were tracked) or hard copy (participants were encouraged to 'think aloud') format. Cognition was assessed using the Mini-Mental State Examination (MMSE). Think aloud and eye tracking data were analysed by two raters, blinded to MMSE scores. At the participant level, predefined criteria were used to assign traffic light grades (green, amber, red). These grades indicate the extent to which extracted data elements provided evidence of self-report reliability. The MMSE-defined cognition threshold was determined following review of the distributions of assigned traffic light grades. RESULTS Eighty-one residents participated and provided complete data (38 eye tracking, 43 think aloud). In the think aloud cohort, all participants with an MMSE score ≤ 23 (n = 10) received an amber or red grade, while 64% of participants with an MMSE score ≥ 24 (21 of 33) received green grades. In the eye tracking cohort, 68% of participants with an MMSE score ≥ 24 (15 of 22) received green grades. Of the 16 eye tracking participants with an MMSE score ≤ 23, 14 (88%) received an amber or red grade. CONCLUSIONS Most older residents with an MMSE score ≥ 24 have sufficient cognitive capacity to self-complete the EQ-5D-5L. More research is needed to better understand self-completion reliability for other quality-of-life instruments in cognitively impaired populations.
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Affiliation(s)
- Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, Australia.
| | - Kiri Lay
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, Australia
| | - Matthew Crocker
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, Australia
| | - Lidia Engel
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, Australia
| | | | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Richard Norman
- School of Population Health, Curtin University, Perth, Australia
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Milte R, Crocker M, Lay K, Ratcliffe J, Mulhern B, Norman R, Viney R, Khadka J. Feasibility of self-reported health related quality of life assessment with older people in residential care: insights from the application of eye tracking technology. Qual Life Res 2023; 32:3557-3569. [PMID: 37474850 PMCID: PMC10624716 DOI: 10.1007/s11136-023-03488-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE Increasingly there are calls to routinely assess the health-related quality of life (HRQoL) of older people receiving aged care services, however the high prevalence of dementia and cognitive impairment remains a challenge to implementation. Eye-tracking technology facilitates detailed assessment of engagement and comprehension of visual stimuli, and may be useful in flagging individuals and populations who cannot reliably self-complete HRQoL instruments. The aim of this study was to apply eye-tracking technology to provide insights into self-reporting of HRQoL among older people in residential care with and without cognitive impairment. METHODS Residents (n = 41), recruited based on one of three cognition subgroups (no, mild, or moderate cognitive impairment), completed the EQ-5D-5L on a computer with eye tracking technology embedded. Number and length of fixations (i.e., eye gaze in seconds) for key components of the EQ-5D-5L descriptive system were calculated. RESULTS For all dimensions, participants with no cognitive impairment fixated for longer on the Area of Interest (AOI) for the response option they finally chose, relative to those with mild or moderate cognitive impairment. Participants with cognitive impairment followed similar fixation patterns to those without. There was some evidence that participants with cognitive impairment took longer to complete and spent relatively less time attending to the relevant AOIs, but these differences did not reach statistical significance generally. CONCLUSIONS This exploratory study applying eye tracking technology provides novel insights and evidence of the feasibility of self-reported HRQoL assessments in older people in aged care settings where cognitive impairment and dementia are highly prevalent.
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Affiliation(s)
- Rachel Milte
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Matthew Crocker
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Kiri Lay
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Richard Norman
- Curtin School of Population Health, Curtin University, Bentley, WA, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Jyoti Khadka
- Caring Futures Institute, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Milte R, Jemere D, Lay K, Hutchinson C, Thomas J, Murray J, Ratcliffe J. A scoping review of the use of visual tools and adapted easy-read approaches in Quality-of-Life instruments for adults. Qual Life Res 2023; 32:3291-3308. [PMID: 37344727 PMCID: PMC10624740 DOI: 10.1007/s11136-023-03450-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Self-Reporting using traditional text-based Quality-of-Life (QoL) instruments can be difficult for people living with sensory impairments, communication challenges or changes to their cognitive capacity. Adapted communication techniques, such as Easy-Read techniques, or use of pictures could remove barriers to participation for a wide range of people. This review aimed to identify published studies reporting adapted communication approaches for measuring QoL, the methodology used in their development and validation among adult populations. METHODS A scoping review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews checklist was undertaken. RESULTS The initial search strategy identified 13,275 articles for screening, with 264 articles identified for full text review. Of these 243 articles were excluded resulting in 21 studies for inclusion. The majority focused on the development of an instrument (12 studies) or a combination of development with some aspect of validation or psychometric testing (7 studies). Nineteen different instruments were identified by the review, thirteen were developed from previously developed generic or condition-specific quality of life instruments, predominantly aphasia (7 studies) and disability (4 studies). Most modified instruments included adaptations to both the original questions, as well as the response categories. CONCLUSIONS Studies identified in this scoping review demonstrate that several methods have been successfully applied e.g. with people living with aphasia post-stroke and people living with a disability, which potentially could be adapted for application with more diverse populations. A cohesive and interdisciplinary approach to the development and validation of communication accessible versions of QOL instruments, is needed to support widespread application, thereby reducing reliance on proxy assessors and promoting self-assessment of QOL across multiple consumer groups and sectors.
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Affiliation(s)
- Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Digisie Jemere
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Kiri Lay
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Claire Hutchinson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jolene Thomas
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Joanne Murray
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Bhar S, Davison TE, Schofield P, Quinn S, Ratcliffe J, Waloszek JM, Dunkerley S, Silver M, Linossier J, Koder D, Collins R, Milte R. Study protocol for ELders AT Ease (ELATE): a cluster randomised controlled trial of cognitive behaviour therapy to reduce depressive symptoms in aged care residents. BMC Geriatr 2023; 23:555. [PMID: 37700236 PMCID: PMC10498637 DOI: 10.1186/s12877-023-04257-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND This protocol describes a study of the effectiveness of cognitive behaviour therapy (CBT) for reducing depressive symptoms in older adults living in residential aged care (RAC) facilities in Australia. Depressive symptoms are highly prevalent in this population, yet the benefits of CBT for reducing such symptoms in RAC facilities have not been widely investigated. Elders at Ease (ELATE) is a 16-session CBT intervention designed for implementation in RAC facilities. The intervention includes cognitive, behavioural and reminiscence strategies and is delivered by mental health trainees (MHTs) in collaboration with RAC facility staff and residents' family. METHODS AND ANALYSIS ELATE will be evaluated using a cluster randomised trial comparing outcomes for residents who participate in the intervention with those living in usual care control facilities. The participants are RAC residents aged 65 years or above, with depressive symptoms (Patient Health Questionnaire-2 ≥ 3) and normal cognition or mild cognitive impairment (Standardised Mini Mental Status Examination ≥ 21). They are assessed at four time points: baseline prior to randomisation (T1), mid-treatment (T2; 2.5 months post randomisation), post-treatment (T3; 5 months post-randomisation) and 3-month follow-up (T4; 8 months post randomisation). The primary outcome is change in depressive symptoms between T1 and T3. Secondary outcomes are depressive symptoms at T4, anxiety, suicide ideation, sleep problems, quality of life, staff and family knowledge of late-life depression, stress levels and efficacy in caring for residents, and MHT levels of geropsychology competencies. Residents receiving the intervention are hypothesised to report a greater decrease in depressive symptoms between T1 and T3 compared to residents receiving usual care. The primary analysis is a regression, clustered over site to account for correlated readings, and independent variables are condition and depressive symptoms at T1. A cost-utility analysis is also undertaken. DISCUSSION ELATE is a comprehensive CBT intervention for reducing depressive symptoms in RAC residents. It is designed to be implemented in collaboration with facility staff and residents' families, individually tailored to residents with normal cognition to mild cognitive impairment and delivered by trainee therapists. ELATE offers a model that may be widely applicable across the RAC sector. TRIAL REGISTRATION Trial registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR) Number ACTRN12619001037190, prospectively registered on 22 July 2019.
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Affiliation(s)
- Sunil Bhar
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia.
| | - Tanya E Davison
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
- Silverchain, Osborne Park, WA, Australia
| | - Penelope Schofield
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
- Health Services Research and Implementation Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Stephen Quinn
- Department of Health Sciences and Biostatistics, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Joanna M Waloszek
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
| | - Sofie Dunkerley
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
| | - Mark Silver
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
| | - Jennifer Linossier
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
| | - Deborah Koder
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
| | - Rebecca Collins
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, PO Box 218, H99, Hawthorn, VIC, 3122, Australia
| | - Rachel Milte
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
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Cleland J, Hutchinson C, McBain C, Khadka J, Milte R, Cameron I, Ratcliffe J. From the ground up: assessing the face validity of the Quality of Life – Aged Care Consumers (QOL-ACC) measure with older Australians. QAOA 2023. [DOI: 10.1108/qaoa-07-2022-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Purpose
This paper aims to assess the face validity to inform content validity of the Quality of Life – Aged Care Consumers (QOL-ACC), a new measure for quality assessment and economic evaluation in aged care.
Design/methodology/approach
Semi-structured interviews were conducted with older adults (66–100 years) receiving aged care services at home (n = 31) and in residential care (n = 28). Participants provided feedback on draft items to take forward to the next stage of psychometric assessment. Items were removed according to several decision criteria: ambiguity, sensitive wording, not easy to answer and/or least preferred by participants.
Findings
The initial candidate set was reduced from 34 items to 15 items to include in the next stage of the QOL-ACC development alongside the preferred response category. The reduced set reflected the views of older adults, increasing the measure’s acceptability, reliability and relevance.
Originality/value
Quality of life is a key person-centred quality indicator recommended by the recent Royal Commission into Aged Care Quality and Safety. Responding to this policy reform objective, this study documents a key stage in the development of the QOL-ACC measure, a new measure designed to assess aged care specific quality of life.
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10
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Khadka J, Hutchinson C, Milte R, Cleland J, Muller A, Bowes N, Ratcliffe J. Assessing feasibility, construct validity, and reliability of a new aged care-specific preference-based quality of life instrument: evidence from older Australians in residential aged care. Health Qual Life Outcomes 2022; 20:159. [PMID: 36456953 PMCID: PMC9713096 DOI: 10.1186/s12955-022-02065-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Quality of Life-Aged Care Consumers (QOL-ACC) is a new older-person-specific quality of life instrument designed for application in quality assessment and economic evaluation in aged care. The QOL-ACC was designed from its inception with older people receiving aged care services ensuring its strong content validity. Given that the QOL-ACC has already been validated in home care settings and a preference-weighted value set developed, we aimed to assess feasibility, construct validity and reliability of the QOL-ACC in residential aged care settings. METHODS: Individuals living in residential aged care facilities participated in an interviewer-facilitated survey. The survey included the QOL-ACC, QCE-ACC (quality of aged care experience measure) and two other preference-based quality of life instruments (ASCOT and EQ-5D-5L). Feasibility was assessed using missing data and ceiling/floor effects. Construct validity was assessed by exploring the relationship between the QOL-ACC and other instruments (convergent validity) and the QOL-ACC's ability to discriminate varying levels of self-rated health and quality of life. Internal consistency reliability was assessed using Cronbach's alpha (α). RESULTS Of the 200 residents (mean age, 85 ± 7.7 years) who completed the survey, 60% were female and 69% were born in Australia. One in three participating residents self-rated their health as fair/poor. The QOL-ACC had no missing data but had small floor effects (0.5%) and acceptable ceiling effects (7.5%). It demonstrated moderate correlation with ASCOT (r = 0.51, p < 0.001) and EQ-5D-5L (r = 0.52, p < 0.001) and a stronger correlation with the QCE-ACC (r = 0.57, p < 0.001). Residents with poor self-rated health and quality of life had significantly lower scores on the QOL-ACC. The internal consistency reliability of the QOL-ACC and its dimensions was good (α = 0.70-0.77). CONCLUSIONS The QOL-ACC demonstrated good feasibility, construct validity and internal consistency reliability to assess aged care-related quality of life. Moderate correlations of the QOL-ACC and other instruments provide evidence of its construct validity and signifies that the QOL-ACC adds non-redundant and non-interchangeable information beyond the existing instruments. A stronger correlation with the QCE-ACC than other instruments may indicate that quality of life is more intimately connected with the care experience than either health- or social-related quality of life in residential aged care settings.
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Affiliation(s)
- J Khadka
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia ,grid.430453.50000 0004 0565 2606Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia Australia
| | - C Hutchinson
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - R Milte
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - J Cleland
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia
| | - A Muller
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia Australia
| | - N Bowes
- Uniting AgeWell, Melbourne, VIC Australia
| | - J Ratcliffe
- grid.1014.40000 0004 0367 2697Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Sturt North, GPO Box 2100, Adelaide, South Australia 5001 Australia
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11
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Ratcliffe J, Bourke S, Li J, Mulhern B, Hutchinson C, Khadka J, Milte R, Lancsar E. Valuing the Quality-of-Life Aged Care Consumers (QOL-ACC) Instrument for Quality Assessment and Economic Evaluation. Pharmacoeconomics 2022; 40:1069-1079. [PMID: 35922616 PMCID: PMC9550725 DOI: 10.1007/s40273-022-01158-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 05/19/2023]
Abstract
OBJECTIVE This paper reports on the valuation of the classification system for the Quality-of-Life Aged Care Consumers (QOL-ACC) instrument using a discrete choice experiment (DCE) with duration with a large sample of older people receiving aged care services. METHODS A DCE with 160 choice sets of two quality-of-life state-survival duration combinations blocked into 20 survey versions, with eight choice sets in each version, was designed and administered through an on-line survey to older Australians receiving aged care services in home and via interviewer facilitation with older people in residential aged care settings. Model specifications investigating preferences with respect to survival duration and interactions between QOL-ACC dimension levels were estimated. Utility weights were developed, with estimated coefficients transformed to the 0 (being dead) to 1 (full health) scale to generate a value set suitable for application in quality assessment and for the calculation of quality-adjusted life-years for use in economic evaluation. RESULTS In total, 953 older people completed the choice experiment with valid responses. The estimation results from econometric model specifications indicated that utility increased with survival duration and decreased according to quality-of-life impairment levels. An Australian value set (range - 0.56 to 1.00) was generated for the calculation of utilities for all QOL-ACC states. CONCLUSION The QOL-ACC is unique in its focus on measuring and valuing quality of life from the perspective of older people themselves, thereby ensuring that the preferences of aged care service users are the primary focus for quality assessment and economic evaluation.
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Affiliation(s)
- Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia.
| | - Siobhan Bourke
- Department of Health Services Research and Policy, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Jinhu Li
- Department of Health Services Research and Policy, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Bedford Park, SA, Australia
| | - Emily Lancsar
- Department of Health Services Research and Policy, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
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Bracci EL, Milte R, Keogh JB, Murphy KJ. Developing and Piloting a Novel Ranking System to Assess Popular Dietary Patterns and Healthy Eating Principles. Nutrients 2022; 14:nu14163414. [PMID: 36014923 PMCID: PMC9415867 DOI: 10.3390/nu14163414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/07/2022] [Accepted: 08/13/2022] [Indexed: 11/23/2022] Open
Abstract
A multitude of weight loss diets exist. However, no one diet has been proven to be superior, despite their claims. Resultingly, this creates confusion amongst consumers and conflicting nutrition messages. The aim of the ranking system was to evaluate a range of dietary pattern’s nutrition profile and financial costs, as well as their potential long-term sustainability and associated adverse effects. Nutrition profile is typically the focal point of weight loss diets with less attention focused towards other factors that may affect their suitability. Five popular diets (Keto, Paleo, Intermittent Fasting, Optifast, and 8 Weeks to Wow) and two energy restricted healthy eating principles (Australian Guide to Healthy Eating and the Mediterranean Diet) were compared for diet quality, cost, adverse effects, and support for behaviour change. In general, healthy eating principles scored more favourably compared to popular weight loss diets in all categories. Lower carbohydrate diets tended to score lower for diet quality due to restricting multiple food groups, had more associated adverse effects and did not encourage behaviour change compared to the other weight loss diets. Optifast was the only weight loss diet to receive a negative score for cost. There should be considerations when undertaking a change to dietary patterns beyond nutrition profile. Diets indeed vary in terms of diet quality, and in addition can be costly, incur adverse effects, and disregard behaviour change which is important for sustainable weight loss and maintenance. This ranking system could create a reference point for future comparisons of diets.
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Affiliation(s)
- Ella L. Bracci
- Clinical and Health Sciences, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
- Correspondence:
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Jennifer B. Keogh
- Clinical and Health Sciences, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
| | - Karen J. Murphy
- Clinical and Health Sciences, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia
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George S, Barr C, Berndt A, Milte R, Nussio A, Adey-Wakeling Z, Liddle J. Effects of the CarFreeMe Traumatic Injuries, a Community Mobility Group Intervention, to Increase Community Participation for People With Traumatic Injuries: A Randomized Controlled Trial With Crossover. Front Neurol 2022; 13:821195. [PMID: 35847230 PMCID: PMC9283567 DOI: 10.3389/fneur.2022.821195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction After traumatic injuries community participation is a common goal, promoting wellbeing and independence. Community mobility and transportation influence an individual's independence in community participation. With the ability to drive safely often compromised after traumatic injuries, the adverse consequences of driving cessation include a loss of identity and reduced participation in chosen activities. In rehabilitation, individualized community mobility intervention is not routinely provided. The primary aim of this trial was to evaluate whether a group-based intervention, the CarFreeMe TI program was more effective than standard intervention, an information sheet of alternative transport, in improving community mobility for people following traumatic injuries. The secondary aim of this study was to evaluate the effect: types of transport used, transport satisfaction, community mobility self-efficacy, quality of life, goal satisfaction and performance, for people following traumatic injuries; and to undertake a preliminary assessment of the potential resource use associated with the intervention, and lessons for implementation. Design Prospective, pilot, randomized, blind observer, controlled trial with crossover. Participants Twenty individuals with traumatic injuries. Intervention Six-week group-based support and education program, the CarFreeMe TI delivered in community settings (intervention) and standard information related to transport options available (control). Primary Outcome Measures Community participation using a Global Positioning System device to record the location and number of outings from home. Secondary Outcome Measures CarFreeMe TI Transport Questionnaire, Community Mobility Self-efficacy Scale, quality of life measures, Modified Canadian Occupational Performance Measure for goals (importance and satisfaction), participant satisfaction survey results and researcher logs. Results Those who received the intervention were more likely to use public transport and transport services and had an improved quality of life, when compared to the control group. The intervention group also reported high levels of improvement in goal performance and satisfaction. Global Positioning System data collection was incomplete, with geolocation data unusable. There was no significant change in number/type of visits away from home. Conclusions A group-based community mobility education program promoted modes of active independent transport but did not impact on outings from home. Future research could include passive collection methods using a smartphone to record community participation. Clinical Trial Registration https://www.anzctr.org.au/, identifier: ACTRN12616001254482.
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Affiliation(s)
- Stacey George
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Department of Occupational Therapy, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Department of Rehabilitation, Aged and Palliative Care Services, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Christopher Barr
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Angela Berndt
- Department of Occupational Therapy, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Amy Nussio
- Department of Occupational Therapy, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Zoe Adey-Wakeling
- Department of Rehabilitation, Aged and Palliative Care Services, Flinders Medical Centre, Bedford Park, SA, Australia
- Department of Rehabilitation and Extended Care, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jacki Liddle
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, QLD, Australia
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Hutchinson C, Milte R, Stanley M, Duff G, Ratcliffe J. Using discrete choice experiments to elicit the service preferences of people with mild intellectual disability: An exploratory study. Health Soc Care Community 2022; 30:e1396-e1405. [PMID: 34418195 DOI: 10.1111/hsc.13547] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/14/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
The National Disability Insurance Scheme (NDIS) in Australia and other similar international movements towards consumer direction have highlighted the importance of including consumers to ensure their service preferences are operationalised. Discrete Choice Experiments (DCEs) are an established method to quantify consumer preferences. The feasibility of using DCEs with people with intellectual disability is largely untested. Consenting participants eligible for disability support services (n = 18) participated in the mixed methods exploratory study. The DCE comprised a series of choices between two hypothetical service providers offering a combination of services relating to social and economic participation (e.g. support with finding and keeping a job), with four levels of service (no service, online support, group support, one to one support). Pictographs and simplified English were used to represent the hypothetical services and levels and a 'think aloud' protocol adopted. Most participants (N = 16, 89%) completed the DCE task. The findings from the think aloud task indicated that some participants were weighing up the options and making decisions based on their goals and personal preferences. However, other participants did not focus on all presented attributes and levels when making a decision; a common 'short-cut' heuristic also observed in DCE tasks with general population participants. Further research including investigating other DCE techniques, such as best-worst scaling, would be beneficial to identify how preference-elicitation tasks can be developed and applied with people with intellectual disabilities to ensure that future service innovations are designed and administered in ways which best meet their needs and preferences.
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Affiliation(s)
- Claire Hutchinson
- School of Commerce, University of South Australia, Adelaide, South Australia, Australia
| | - Rachel Milte
- School of Commerce, University of South Australia, Adelaide, South Australia, Australia
| | - Mandy Stanley
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Gordon Duff
- National Disability Services, Sydney, New South Wales, Australia
| | - Julie Ratcliffe
- School of Commerce, University of South Australia, Adelaide, South Australia, Australia
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15
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Hutchinson C, Worley A, Khadka J, Milte R, Cleland J, Ratcliffe J. Do we agree or disagree? A systematic review of the application of preference-based instruments in self and proxy reporting of quality of life in older people. Soc Sci Med 2022; 305:115046. [PMID: 35636050 DOI: 10.1016/j.socscimed.2022.115046] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/04/2022] [Accepted: 05/14/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Quality of life is an important person-centred outcome in health and aged care settings. Due to an increasing prevalence of cognitive decline and dementia in ageing populations, a proportion of older people receiving health and aged care services may not be able to reliably assess their own quality of life, highlighting the need for proxy assessment. This systematic review sought to investigate the level of agreement between self and proxy-report of older people's quality of life using established preference-based instruments of quality of life suitable for economic evaluation. METHODS A systematic review was conducted following PRISMA guidelines. Eight databases were searched: Web of Science, Scopus, Medline, Econlit, PsychINFO, CINAHL, Ageline and Cochrane Library. Information was extracted on the instruments, population samples (including any cognitive thresholds applied), mean scores, type of proxy, and measures of inter-rater agreement. RESULTS A total of 50 studies using eight different preference-based quality of life instruments were identified. Most studies were cross-sectional (72%) with a wide variety of cognitive assessments and thresholds applied to define older participants with cognitive impairment. The most common proxies were family members, mostly spouses. The level of agreement between self and proxy-report was generally poor - irrespective of the instrument applied or type of proxy - with proxy-report generally indicating lower levels of quality of life than self-report. There was some evidence of stronger agreement on more observable quality of life domains e.g., physical health and mobility, relative to less observable domains e.g. emotional well-being. Few studies tracked self and/or proxy-report of quality of life longitudinally. CONCLUSIONS More research is needed to develop evidence to inform guidance on self-report versus proxy-report of quality of life for older people receiving health and aged care services. Until then, the collection of both self and proxy reports as complementary measures is indicated.
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Affiliation(s)
- Claire Hutchinson
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia.
| | - Anthea Worley
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Jenny Cleland
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia
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Xiao L, Yu Y, Ratcliffe J, Milte R, Meyer C, Chapman M, Chen L, Ullah S, Kitson A, De Andrade AQ, Beattie E, Brodaty H, McKechnie S, Low LF, Nguyen TA, Whitehead C, Brijnath B, Sinclair R, Voss D. Creating 'Partnership in iSupport program' to optimise family carers' impact on dementia care: a randomised controlled trial protocol. BMC Health Serv Res 2022; 22:762. [PMID: 35689281 PMCID: PMC9185883 DOI: 10.1186/s12913-022-08148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/01/2022] [Indexed: 12/03/2022] Open
Abstract
Background The majority of people with dementia are cared for by their family members. However, family carers are often unprepared for their caring roles, receiving less education and support compared with professional carers. The consequences are their reduced mental and physical health and wellbeing, and that of care recipients. This study protocol introduces the ‘Partnership in iSupport program’ that includes five interventional components: managing transitions, managing dementia progression, psychoeducation, carer support group and feedback on services. This health services research is built on family carer and dementia care service provider partnerships. The aims of the study are to evaluate the effectiveness, cost-effectiveness and family carers’ experiences in the program. Methods A multicentre randomised controlled trial will be conducted with family carers of people living with dementia from two tertiary hospitals and two community aged care providers across three Australian states. The estimated sample size is 185 family carers. They will be randomly assigned to either the intervention group or the usual care group. Outcomes are measurable improvements in quality of life for carers and people with dementia, caregiving self-efficacy, social support, dementia related symptoms, and health service use for carers and their care recipients. Data will be collected at three time points: baseline, 6 months and 12 months post-initiation of the intervention. Discussion This is the first large randomised controlled trial of a complex intervention on health and social care services with carers of people living with dementia in real-world practice across hospital and community aged care settings in three Australian states to ascertain the effectiveness, cost-effectiveness and carers’ experiences of the innovative program. We expect that this study will address gaps in supporting dementia carers in health and social care systems while generating new knowledge of the mechanisms of change in the systems. Findings will strengthen proactive health management for both people living with dementia and their carers by embedding, scaling up and sustaining the ‘Partnership in iSupport program’ in the health and social care systems. Trial registration The Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12622000199718. Registered February 4th, 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08148-2.
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Affiliation(s)
- Lily Xiao
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.
| | - Ying Yu
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Rachel Milte
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Claudia Meyer
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.,Bolton Clarke Research Institute, Melbourne, VIC, Australia.,Adjunct Research Fellow; Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia.,Honorary Associate, Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia
| | | | - Langduo Chen
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia.,Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Shahid Ullah
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Alison Kitson
- College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, 5042, Australia
| | - Andre Queiroz De Andrade
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Elizabeth Beattie
- Queensland Dementia Training Study Centre, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Sue McKechnie
- Community Services, Resthaven Incorporated, Wayville, South Australia, Australia
| | - Lee-Fay Low
- Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Bianca Brijnath
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia.,School of Allied Health, Curtin University, Bentley, West Australia, Australia
| | - Ronald Sinclair
- Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - Diana Voss
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
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17
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Crocker M, Milte R, Duff G, Lawless M, Corlis M, Ratcliffe J. Are Australians willing to pay more tax to support wage increases for aged care workers? Findings from a national survey. Australas J Ageing 2022; 41:513-521. [PMID: 35581941 DOI: 10.1111/ajag.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 03/21/2022] [Accepted: 04/20/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To explore the perceptions of the Australian public regarding Australia's aged care workforce, including their willingness to pay more tax to fund better pay and conditions for aged care workers. METHODS An online survey was developed and administered to a representative sample of Australian adults (aged ≥18 years) by age group, gender and Australian state. Survey respondents completed a series of attitudinal statements to elicit their perceptions of the value of Australia's aged care workforce and were asked to indicate their willingness to pay additional tax to fund better pay and conditions for aged care workers. Those who gave a positive response were then asked to indicate what percentage of additional tax per year they would be willing to pay to ensure better pay and conditions for aged care workers. RESULTS A total of 2033 adult respondents completed the survey. A majority (78%) of respondents either 'agreed' or 'strongly agreed' that aged care workers should be paid more. Approximately half of the respondents (50.57%) expressed a willingness to pay more tax to ensure better pay and conditions for aged care workers. The mean willingness to pay was 1.31% additional tax overall, and mean percentage additional tax values were relatively consistent across key socio-demographic indicators. CONCLUSIONS A majority of the Australian public are in favour of improving the wages and employment conditions of aged care workers. However, only one in two Australians is willing to pay more tax to ensure better pay and conditions for aged care workers.
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Affiliation(s)
- Matthew Crocker
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Gordon Duff
- Centre for Disability Research and Policy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michael Lawless
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Megan Corlis
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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18
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Milte R, Petersen J, Boylan J, Henwood T, Hunter S, Lange B, Lawless M, Torode S, Lewis LK. Prevalence and determinants of physical frailty among people living in residential aged care facilities: a large-scale retrospective audit. BMC Geriatr 2022; 22:424. [PMID: 35568811 PMCID: PMC9107174 DOI: 10.1186/s12877-022-03101-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/26/2022] [Indexed: 12/01/2022] Open
Abstract
Background Physical frailty is associated with increased risk of falls, hospitalisation and mortality. There is a dearth of information on physical frailty of older adults living in residential aged care. This study aimed to describe physical frailty in aged care residents and investigate possible determinants of frailty. Method A retrospective audit of resident records was undertaken across 14 residential aged care facilities. Data were extracted on all consenting residents who had completed measures relating to frailty (Short Physical Performance Battery SPPB; grip strength). All data of the first record of measures were extracted, resident characteristics, and the time from admission to assessment. Summary statistics were completed. Differences between sub-groups were explored (Mann-Whitney U, Kruskall-Wallis Ranked tests). Associations between variables were explored with Chi-squared and Pearson correlations. Determinants of physical frailty were determined with linear regression analyses. Alpha (2-sided) was 0.05. Results Data were extracted for 1241 residents (67% female), with a mean age of 86.0 (7.6) years. Males had a significantly lower time from admission to assessment of frailty (p ≤ 0.001). The average SPPB score was 4.1 (3.3), 75% of residents were frail and 19% pre-frail. Bivariate analyses indicated no significant relationships between grip strength and SPPB score, but significant differences for grip strength, where males were significantly stronger (males 20.2 ± 8.3 kg; females 12.4 ± 5.4 kg; p ≤ 0.001). There was a significant positive relationship between SPPB total score and grip strength, gender (p ≤ 0.001), and marital status (p = 0.049) and a negative relationship between time from admission to assessment and SPPB total score (p ≤ 0.001). There were significant negative relationships between gender (p ≤ 0.001) and age (p ≤ 0.001), and time from admission to assessment (p ≤ 0.001) with grip strength. Conclusion Older adults living in residential aged care have a high level of physical frailty which may lead to increased risk of adverse outcomes. Time in the residential aged care setting and age appear to predict physical frailty. There is a need for a consistent battery of measures to continually monitor frailty and programs to address the high levels of frailty in residential aged care.
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Affiliation(s)
- Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jasmine Petersen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jo Boylan
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Tim Henwood
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Belinda Lange
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Michael Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Stacey Torode
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
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19
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Lawless M, Wright-Simon M, Pinero de Plaza MA, Ambagtsheer R, Schultz T, Milte R, Lewis L, Newman M, Whiteway L, von Thien M, Archibald M, Kitson A. ‘My Wellbeing Journal’: Using experience-based co-design to improve caring for older adults with multimorbidity. The JHD 2022. [DOI: 10.21853/jhd.2022.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this study, we investigated whether using an accelerated experience-based co-design (EBCD) approach is an effective way to involve multiple stakeholder perspectives in the development of a creative tool to support goal setting in care planning for older adults with multimorbidity. We describe the iterative multi-stage approach of developing “My Wellbeing Journal”, an innovative tool that incorporates consumer experiences and priorities and research evidence on goal-based shared decision-making. The EBCD process ensured stakeholders were involved in every stage of the design and development of the journal. We also discuss procedural and methodological considerations for others conducting similar co-design research.
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20
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Turnbull C, Boomsma A, Milte R, Stanton TR, Hordacre B. Safety and Adverse Events following Non-invasive Electrical Brain Stimulation in Stroke: A Systematic Review. Top Stroke Rehabil 2022; 30:355-367. [PMID: 35353649 DOI: 10.1080/10749357.2022.2058294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Noninvasive electrical stimulation (ES) could have therapeutic potential in stroke recovery. However, there is no comprehensive evaluation of adverse events. This study systematically searched the literature to document frequency and prevalence of adverse events. A secondary aim was to explore associations between adverse events and ES parameters or participant characteristics.Methods: Databases were searched for studies evaluating ES in adults with stroke. All included studies were required to report on adverse events. Extracted data were: (1) study design; (2) adverse events; (3) participant characteristics; (4) ES parameters. RESULTS Seventy-five studies were included. Adverse events were minor in nature. The most frequently reported adverse events were tingling (37.3% of papers), burning (18.7%), headaches (14.7%) and fatigue (14.7%). Cathodal stimulation was associated with greater frequency of itching (p = .02), intensities of 1-2 mA with increased tingling (p = .04) and discomfort (p = .03), and current density <0.4mA/cm2 with greater discomfort (p = .03). Tingling was the most prevalent adverse event (18.1% of participants), with prevalence data not differing between active and control conditions (all p ≥ 0.37). Individual participants were more likely to report adverse events with increasing current density (r = 0.99, p = .001). Two severe adverse events were noted (a seizure and percutaneous endoscopic gastrostomy placement). CONCLUSION ES appears safe in people with stroke as reported adverse events were predominantly minor in nature. An adverse events questionnaire is proposed to enable a more comprehensive and nuanced analysis of the frequency and prevalence of adverse events.
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Affiliation(s)
- Clare Turnbull
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Aafke Boomsma
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Rachel Milte
- Health and Social Care Economics Group College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Tasha R Stanton
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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21
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Bracci EL, Milte R, Keogh JB, Murphy KJ. Developing and implementing a new methodology to test the affordability of currently popular weight loss diet meal plans and healthy eating principles. BMC Public Health 2022; 22:23. [PMID: 34991538 PMCID: PMC8734134 DOI: 10.1186/s12889-021-12447-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022] Open
Abstract
Background Weight loss diets continue to rise in popularity; however, the associated costs are seldom reported. Certain weight loss diets may be unaffordable and differ from their traditional nutrition composition to include non-conventional premium products. In contrast, healthy eating principles such as the Australian Guide to Healthy Eating (AGHE) and the Mediterranean Diet (MedDiet) place an emphasis on fresh produce and staple foods but are sometimes thought to be unaffordable. A new methodology was piloted to assess the cost of weight loss diets using seven meal plans. Methods Seven meal plans were analysed to quantify the absolute grams required of all ingredients across seven days and multiplied by the cost of the ingredient per gram to determine the total cost of each ingredient based on unit size and price. The weekly grocery shopping cost was determined through summation of all ingredients and their entire unit size to compare weekly costs. Results Weekly meal plans (absolute grams) cost between $93-193AUD. The AGHE meal plan was the least expensive and 8 Weeks to Wow was the most expensive. Weekly grocery shopping of entire units cost between $345-$625AUD, over $100AUD greater than the spending of an average Australian ($237AUD/week). Conclusions The financial feasibility for long-term sustainment of weight loss diets may be questionable for groups including low-income earners and low socioeconomic status. Further, when dietary patterns are adapted for weight loss, or followed by consumers, deviations from foundational principles tend to occur which may influence overall cost.
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Affiliation(s)
- Ella L Bracci
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, 5042, Australia
| | - Jennifer B Keogh
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Karen J Murphy
- Alliance for Research in Exercise, Nutrition and Activity, UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia.
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22
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Hutchinson C, Ratcliffe J, Cleland J, Walker R, Milte R, McBain C, Corlis M, Cornell V, Khadka J. The integration of mixed methods data to develop the quality of life - aged care consumers (QOL-ACC) instrument. BMC Geriatr 2021; 21:702. [PMID: 34911445 PMCID: PMC8672336 DOI: 10.1186/s12877-021-02614-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 11/02/2021] [Indexed: 01/01/2023] Open
Abstract
Background This paper describes the collection and integration of mixed methods data to facilitate the final selection of items for the Quality of Life – Aged Care Consumers (QOL-ACC) instrument. The aim of the wider project is to develop a preference-based quality of life instrument that can be used for quality assessment and economic evaluation. Older people have been involved at every stage of the development of the QOL-ACC to ensure that the final instrument captures their perspectives and preferences. Methods Mixed methods data was collected on draft items for the QOL-ACC instrument across six key quality of life dimensions (mobility, pain management, emotional well-being, independence, social connections, and activities). Qualitative face validity data was collected from older people (aged 66 to 100 years) living in the community and in residential aged care via semi-structured interviews (n = 59). Quantitative data was collected from older people (aged 65 to 91 years) receiving aged care services in the community via an online survey (n = 313). A traffic light pictorial approach was adopted as a practical and systematic way to categorise and present data in a meaningful way that was easy for non-academic workshop members to understand and to be able to discuss the relative merits of each draft item. Results The traffic light approach supported the involvement of consumer and aged care provider representatives in the selection of the final items. Six items were selected for the QOL-ACC instrument with one item representing each of the six dimensions. Conclusions This methodological approach has ensured that the final instrument is psychometrically robust as well as meaningful, relevant and acceptable to aged care consumers and providers. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02614-y.
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Affiliation(s)
- Claire Hutchinson
- Caring Futures Institute, Flinders University, Adelaide, Australia. .,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jenny Cleland
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Ruth Walker
- Caring Futures Institute, Flinders University, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Rachel Milte
- Caring Futures Institute, Flinders University, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Candice McBain
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation (SA Branch), Adelaide, Australia
| | | | - Jyoti Khadka
- Caring Futures Institute, Flinders University, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, Australia
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23
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Lewis LK, Henwood T, Boylan J, Hunter S, Lange B, Lawless M, Milte R, Petersen J. Re-thinking reablement strategies for older adults in residential aged care: a scoping review. BMC Geriatr 2021; 21:667. [PMID: 34847860 PMCID: PMC8638477 DOI: 10.1186/s12877-021-02627-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness). METHOD This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored. RESULTS Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness. CONCLUSIONS There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted. TRIAL REGISTRATION Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).
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Affiliation(s)
- Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Tim Henwood
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Jo Boylan
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Belinda Lange
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Michael Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jasmine Petersen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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24
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Kaambwa B, Chen G, Khadka J, Milte R, Mpundu-Kaambwa C, Woods TJ, Ratcliffe J. A preference for quality: Australian general public's willingness to pay for home and residential aged care. Soc Sci Med 2021; 289:114425. [PMID: 34673356 DOI: 10.1016/j.socscimed.2021.114425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 02/04/2023]
Abstract
In Australia and many other countries internationally, aged care services are provided to older people in their own homes or residential care facilities. The majority of these services are funded by the federal government using taxpayer contributions from the general public. However, the monetary value Australians place on aged care services, and the factors that predict this value, have not been examined. We, therefore, sought to determine the general public's willingness to pay (WTP) for aged care services and examine which factors influence this WTP. A cross-sectional contingent valuation survey was administered to a nationally representative cohort of 10,285 Australians between September and October 2020 from the general population aged 18 years and over. Respondents were asked to indicate their WTP values for satisfactory and high-quality aged care services to be provided in the future. A two-part regression model was used to explain what factors explained variation in WTP. In total, 80% (61%) of respondents were willing to pay to access satisfactory (high) quality home care (counterpart figures for residential care were 64% (45%)). On average, respondents were willing to pay between $126 and $158 ($145 and $237) per week to receive satisfactory-quality (high-quality) home care and between $333 and $520 ($308 and $680) per week for satisfactory-quality (high-quality) residential care. Respondents were willing to pay an additional $120 per week on average to access high-quality aged care. Higher WTP values were generally associated with being younger, male, recent experience with aged care through a close family member accessing aged care and ability to pay. These results suggest general public support for payment of individual co-contributions to access aged care services in the future.
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Affiliation(s)
- Billingsley Kaambwa
- Health Economics, College of Medicine & Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, South Australia, 5042, Australia.
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, 3145, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Sturt North Building, Sturt Road, Bedford Park, South Australia, 5042, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, South Australia, 5000, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Sturt North Building, Sturt Road, Bedford Park, South Australia, 5042, Australia
| | - Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Sturt North Building, Sturt Road, Bedford Park, South Australia, 5042, Australia
| | - Taylor-Jade Woods
- Health Economics, College of Medicine & Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, South Australia, 5042, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, Flinders University, Sturt North Building, Sturt Road, Bedford Park, South Australia, 5042, Australia
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25
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Stanton TR, Braithwaite FA, Butler D, Moseley GL, Hill C, Milte R, Ratcliffe J, Maher C, Tomkins-Lane C, Pulling BW, MacIntyre E, Esterman A, Stanford T, Lee H, Fraysse F, Metcalf B, Mouatt B, Bennell K. The EPIPHA-KNEE trial: Explaining Pain to target unhelpful pain beliefs to Increase PHysical Activity in KNEE osteoarthritis - a protocol for a multicentre, randomised controlled trial with clinical- and cost-effectiveness analysis. BMC Musculoskelet Disord 2021; 22:738. [PMID: 34454458 PMCID: PMC8401372 DOI: 10.1186/s12891-021-04561-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 07/12/2021] [Indexed: 12/29/2022] Open
Abstract
Background Despite well-established benefits of physical activity for knee osteoarthritis (OA), nine of ten people with knee OA are inactive. People with knee OA who are inactive often believe that physical activity is dangerous, fearing that it will further damage their joint(s). Such unhelpful beliefs can negatively influence physical activity levels. We aim to evaluate the clinical- and cost-effectiveness of integrating physiotherapist-delivered pain science education (PSE), an evidence-based conceptual change intervention targeting unhelpful pain beliefs by increasing pain knowledge, with an individualised walking, strengthening, and general education program. Methods Two-arm, parallel-design, multicentre randomised controlled trial involving 198 people aged ≥50 years with painful knee OA who do not meet physical activity guideline recommendations or walk regularly for exercise. Both groups receive an individualised physiotherapist-led walking, strengthening, and OA/activity education program via 4x weekly in-person treatment sessions, followed by 4 weeks of at-home activities (weekly check-in via telehealth), with follow-up sessions at 3 months (telehealth) and 5 and 9 months (in-person). The EPIPHA-KNEE group also receives contemporary PSE about OA/pain and activity, embedded into all aspects of the intervention. Outcomes are assessed at baseline, 12 weeks, 6 and 12 months. Primary outcomes are physical activity level (step count; wrist-based accelerometry) and self-reported knee symptoms (WOMAC Total score) at 12 months. Secondary outcomes are quality of life, pain intensity, global rating of change, self-efficacy, pain catastrophising, depression, anxiety, stress, fear of movement, knee awareness, OA/activity conceptualisation, and self-regulated learning ability. Additional measures include adherence, adverse events, blinding success, COVID-19 impact on activity, intention to exercise, treatment expectancy/perceived credibility, implicit movement/environmental bias, implicit motor imagery, two-point discrimination, and pain sensitivity to activity. Cost-utility analysis of the EPIPHA-KNEE intervention will be undertaken, in addition to evaluation of cost-effectiveness in the context of primary trial outcomes. Discussion We will determine whether the integration of PSE into an individualised OA education, walking, and strengthening program is more effective than receiving the individualised program alone. Findings will inform the development and implementation of future delivery of PSE as part of best practice for people with knee OA. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12620001041943 (13/10/2020). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04561-6.
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Affiliation(s)
- Tasha R Stanton
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.
| | - Felicity A Braithwaite
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - David Butler
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia.,NOIgroup Pty Ltd, Adelaide, South Australia
| | - G Lorimer Moseley
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Catherine Hill
- Rheumatology Department, The Queen Elizabeth Hospital, Adelaide, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Rachel Milte
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Christy Tomkins-Lane
- Department of Health and Physical Education, Mount Royal University, Calgary, Canada
| | - Brian W Pulling
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Erin MacIntyre
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Adrian Esterman
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Ty Stanford
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Rehabilitation Research in Oxford (RRIO), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Francois Fraysse
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Ben Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia
| | - Brendan Mouatt
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, G.P.O. Box 2471, Adelaide, 5001, Australia
| | - Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Victoria, Australia
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26
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Cleland J, Hutchinson C, Khadka J, Milte R, Ratcliffe J. What defines quality of care for older people in aged care? A comprehensive literature review. Geriatr Gerontol Int 2021; 21:765-778. [PMID: 34258840 DOI: 10.1111/ggi.14231] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 06/02/2021] [Accepted: 06/17/2021] [Indexed: 01/16/2023]
Abstract
The quality of the care provided to frail older people in aged care is a concern for all Australians and for the citizens of many other countries internationally. This paper summarizes the methods and findings from an Australian study commissioned by the Royal Commission into Aged Care Quality and Safety to identify and synthesize international literature relating to the quality of care in aged care. A comprehensive literature review was undertaken to search and identify the literature (grey and peer reviewed) relating to quality of care and/or person-centered care in aged care. The review identified nine key themes as salient to the quality of care experience, which include treating the older person with respect and dignity; acknowledging and supporting their spiritual, cultural, religious and sexual identity; the skills and training of the aged care staff providing care; relationships between the older person and the aged care staff; social relationships and the community; supporting the older person to make informed choices; supporting the older person's health and well-being; ensuring the delivery of safe care in a comfortable service environment; and the ability to make complaints and provide feedback to the aged care organization. In practice, particularly in the context of residential care, quality of care has traditionally been measured using clinical indicators of care quality. These findings highlight the central importance of person-centered care and care experience as fundamental tenets of the quality of aged care service delivery in Australia and internationally. Geriatr Gerontol Int 2021; 21: 765-778.
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Affiliation(s)
- Jenny Cleland
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Adelaide, South Australia, 5042, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Adelaide, South Australia, 5042, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Adelaide, South Australia, 5042, Australia.,Healthy Aging Research Consortium, Registry of Older South Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), North Terrace, Adelaide, South Australia, 5000, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Adelaide, South Australia, 5042, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Sturt Road, Adelaide, South Australia, 5042, Australia
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Smith AE, Kamm GL, Lai S, Hull MJ, Baker JR, Milte R, Ratcliffe J, Loetscher T, Keage HAD. A RE-AIM Analysis of an Intergenerational Dementia Education Program. Front Public Health 2020; 8:248. [PMID: 32719762 PMCID: PMC7347747 DOI: 10.3389/fpubh.2020.00248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: Children often have a lack of dementia understanding and poor attitudes toward people with dementia. Intergenerational programs are increasingly common, but the effects on knowledge and attitudes related to dementia are mixed, especially in the long-term (6 months). Using a RE-AIM framework, we quantitatively evaluated the effects of an educational dementia program (with and without an intergenerational program) on dementia attitudes in the short and long-term, and qualitatively, which elements of the program facilitated this change. Methods: Eighty-one children (9.63 ± 0.52 years, 35 males) from three classes participated in an 8-week dementia education program and 52 also interacted with older adults through an intergenerational experience. Program reach was measured as the percentage of children who participated in the study. The Kids Insight into Dementia Survey (KIDS) was implemented to measure dementia knowledge and attitudes: efficacy and maintenance. Qualitative interviews with all participant groups informed both adoption and implementation. Cost-benefit analysis was used as a secondary outcome measure for efficacy. Results: The program demonstrated strong levels of impact reaching 93% of school children across the three included classes. Efficacy was demonstrated by a positive change in children's dementia knowledge and attitudes immediately post program, which remained increased (as compared to baseline) 6- months post intervention; there were no differences between groups (those who interacted with older adults and those who did not). Interviews identified positive changes in children's empathy and improved community awareness. Barriers to adoption included the project scope, time constraints incurred by school terms and the management of children-to-adult ratios. Conclusions: These findings provide the first evidence that school-based dementia education improves knowledge of and attitudes toward people with dementia long-term. We demonstrated programs such as this can be successful in both primary school and wider community settings, with support from school and community partners key to the success.
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Affiliation(s)
- Ashleigh E Smith
- Alliance for Research in Exercise, Nutrition and Activity (ARENA) Research Concentration, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.,Cognitive Ageing and Impairment Neurosciences (CAIN) Research Group, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Georgina L Kamm
- Cognitive Ageing and Impairment Neurosciences (CAIN) Research Group, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Samantha Lai
- Cognitive Ageing and Impairment Neurosciences (CAIN) Research Group, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Melissa J Hull
- Alliance for Research in Exercise, Nutrition and Activity (ARENA) Research Concentration, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.,Cognitive Ageing and Impairment Neurosciences (CAIN) Research Group, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Jess R Baker
- School of Psychiatry, Liverpool Hospital, University of New South Wales, Kensington, NSW, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Tobias Loetscher
- Cognitive Ageing and Impairment Neurosciences (CAIN) Research Group, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences (CAIN) Research Group, Justice and Society, University of South Australia, Adelaide, SA, Australia
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Milte R, Ratcliffe J, Ada L, English C, Crotty M, Lannin NA. Protocol for the economic evaluation of the InTENSE program for rehabilitation of chronic upper limb spasticity. BMC Health Serv Res 2020; 20:478. [PMID: 32460773 PMCID: PMC7254740 DOI: 10.1186/s12913-020-05333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/18/2020] [Indexed: 12/03/2022] Open
Abstract
Background Assessment of the costs of care associated with chronic upper-limb spasticity following stroke in Australia and the potential benefits of adding intensive upper limb rehabilitation to botulinum toxin-A are key objectives of the InTENSE randomised controlled trial. Methods Recruitment for the trial has been completed. A total of 139 participants from 6 stroke units across 3 Australian states are participating in the trial. A cost utility analysis will be undertaken to compare resource use and costs over 12 months with health-related quality of life outcomes associated with the intervention relative to a usual care comparator. A cost effectiveness analysis with the main clinical measure of outcome, Goal Attainment Scaling, will also be undertaken. The primary outcome measure for the cost utility analysis will be the incremental cost effectiveness ratio (ICER) generated from the incremental cost of the intervention as compared to the incremental benefit, as measured in quality adjusted life years (QALYs) gained. The utility scores generated from the EQ-5D three level instrument (EQ-5D-3 L) measured at baseline, 3 months and 12 months will be utilised to calculate the incremental Quality Adjusted Life Year (QALY) gains for the intervention relative to usual care using area-under the curve methods. Discussion The results of the economic evaluation will provide evidence of the total costs of care for patients with chronic upper limb spasticity following stroke. It will also provide evidence for the cost-effectiveness of adding evidence-based movement therapy to botulinum toxin-A as a treatment, providing important information for health system decision makers tasked with the planning and provision of services.
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Affiliation(s)
- Rachel Milte
- Caring Futures Institute, Flinders University, Adelaide, South Australia, 5001, Australia.
| | - Julie Ratcliffe
- Caring Futures Institute, Flinders University, Adelaide, South Australia, 5001, Australia
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.,Rehabilitation Services, Flinders Medical Centre, Adelaide, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia.,John Walsh Centre for Rehabilitation Research, The University of Sydney, Sydney, Australia
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Ratcliffe J, Hutchinson C, Milte R, Nguyen KH, Welch A, Caporale T, Corlis M, Comans T. How do people with dementia and family carers value dementia-specific quality of life states? An explorative "Think Aloud" study. Australas J Ageing 2020; 38 Suppl 2:75-82. [PMID: 31496068 DOI: 10.1111/ajag.12646] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/24/2019] [Accepted: 02/25/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the decision-making processes applied by people with dementia and family carers participating in using health economic approaches to value dementia-specific quality of life states. METHODS People with dementia (n = 13) and family carers (n = 14) participated in valuing quality of life states using two health economic approaches: Discrete Choice Experiment (DCE) and Best Worst Scaling (BWS). Participants were encouraged to explain their reasoning using a "Think Aloud" approach. RESULTS People with dementia and family carers adopted a range of decision-making strategies including "anchoring" the presented states against current quality of life, or simplifying the decision-making by focusing on the sub-set of attributes deemed most important. Overall, there was strong evidence of task engagement for BWS and DCE. CONCLUSIONS Health economic valuation approaches can be successfully applied with people with dementia and family carers. These data can inform the assessment of benefits from their perspectives for incorporation within economic evaluation.
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Affiliation(s)
- Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kim-Huong Nguyen
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Alyssa Welch
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Tessa Caporale
- Helping Hand Aged Care, Adelaide, South Australia, Australia
| | - Megan Corlis
- Helping Hand Aged Care, Adelaide, South Australia, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
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Cleland J, Hutchinson C, Khadka J, Milte R, Ratcliffe J. A Review of the Development and Application of Generic Preference-Based Instruments with the Older Population. Appl Health Econ Health Policy 2019; 17:781-801. [PMID: 31512086 DOI: 10.1007/s40258-019-00512-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Older people (aged 65 years and over) are the fastest growing age cohort in the majority of developed countries, and the proportion of individuals defined as the oldest old (aged 80 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on health and aged care services, thus it is important to assess the cost effectiveness of interventions targeted for older people across health and aged care sectors to identify interventions with the strongest capacity to enhance older peoples' quality of life and provide value for money. Cost-utility analysis (CUA) is a form of economic evaluation that typically uses preference-based instruments to measure and value health-related quality of life for the calculation of quality-adjusted life-years (QALYS) to enable comparisons of the cost effectiveness of different interventions. A variety of generic preference-based instruments have been used to measure older people's quality of life, including the Adult Social Care Outcomes Toolkit (ASCOT); Health Utility Index Mark 2 (HUI2); Health Utility Index Mark 3 (HUI3); Short-Form-6 Dimensions (SF-6D); Assessment of Quality of Life-6 dimensions (AQoL-6D); Assessment of Quality of Life-8 dimensions (AQoL-8D); Quality of Wellbeing Scale-Self-Administered (QWB-SA); 15 Dimensions (15D); EuroQol-5 dimensions (EQ-5D); and an older person specific preference-based instrument-the Investigating Choice Experiments Capability Measure for older people (ICECAP-O). This article reviews the development and application of these instruments within the older population and discusses the issues surrounding their use with this population. Areas for further research relating to the development and application of generic preference-based instruments with populations of older people are also highlighted.
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Affiliation(s)
- Jenny Cleland
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
- Healthy Ageing Research Consortium, Registry of Older South Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
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Harrison SL, Dyer SM, Milte R, Liu E, Gnanamanickam ES, Crotty M. Alternative staffing structures in a clustered domestic model of residential aged care in Australia. Australas J Ageing 2019; 38 Suppl 2:68-74. [PMID: 31496059 DOI: 10.1111/ajag.12674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 04/11/2019] [Accepted: 04/19/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE A clustered domestic model of residential aged care has been associated with better consumer-rated quality of care. Our objective was to examine differences in staffing structures between clustered domestic and standard models. METHODS A cross-sectional study involving 541 individuals living in 17 Australian not-for-profit residential aged care homes. RESULTS Four of the homes offered dementia-specific clustered domestic models of care with higher personal care attendant (PCA) hours-per-resident-per-day (mean [SD] 2.43 [0.29] vs. 1.74 [0.46], P < 0.001), slightly higher direct care hours-per-resident-per-day (2.66 [0.35] vs. 2.58 [0.44], P = 0.006), higher staff training costs ($1492 [258] vs. $989 [928], P < 0.001) and lower registered/enrolled nurse hours-per-resident-per-day (0.23 [0.10] vs. 0.85 [0.17], P < 0.001) compared to standard models. CONCLUSIONS An Australian clustered domestic model of care had higher PCA hours, more staff training and more direct care time compared to standard models. Further research to determine optimal staffing structures within alternative models of care is warranted.
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Affiliation(s)
- Stephanie L Harrison
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne M Dyer
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Milte
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia.,Institute for Choice, University of South Australia, Adelaide, South Australia, Australia
| | - Enwu Liu
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Emmanuel S Gnanamanickam
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia.,Health Economics and Social Policy, Centre for Population Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, College of Medicine and Public Health, Flinders University, Flinders Medical Centre, Adelaide, South Australia, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
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Milte R, Huynh E, Ratcliffe J. Assessing quality of care in nursing homes using discrete choice experiments: How does the level of cognitive functioning impact upon older people's preferences? Soc Sci Med 2019; 238:112466. [PMID: 31445304 DOI: 10.1016/j.socscimed.2019.112466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 07/13/2019] [Accepted: 07/30/2019] [Indexed: 10/26/2022]
Abstract
Traditionally older people with mild to moderate cognitive impairment have been excluded from preference elicitation studies in health economics. We assessed the impact of the level of cognitive functioning on preference and scale heterogeneity in a discrete choice experiment undertaken with 126 older people living in residential aged care homes in Australia between January 2015 and February 2016. Data was analysed using conditional logit models for sub-groups of participants with mild to moderate cognitive impairment (N = 52) and without cognitive impairment (N = 74), and for the entire study sample using a heteroscedastic conditional logit regression model allowing for scale heterogeneity. The Swait-Louviere test was undertaken to formally test for differences in preference and scale between the two groups. Cognitive impairment was not significant in the scale function of the heteroscedastic conditional logit model (beta = -0.403, SE=0.341, p = 0.237). There were no statistical differences in estimated vector of preference parameters based on the presence or absence of cognitive impairment (Chi-squared = 13, 25 df, p = 0.976). Although there was evidence of a small increase in response variability with increasing cognitive impairment this did not reach statistical significance, and we were able to combine responses for people with and without cognitive impairment. Overall, the findings provide support for the more widespread inclusion of older people with mild to moderate cognitive impairment in such studies.
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Affiliation(s)
- Rachel Milte
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia; NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Department of Rehabilitation and Aged Care (RACS), Old Leighton Lodge, Hornsby Ku-ring-gai Hospital, Palmerston Road, Hornsby, 2077, New South Wales, Australia; Institute for Choice, School of Commerce, UniSA Business School, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia.
| | - Elisabeth Huynh
- Institute for Choice, School of Commerce, UniSA Business School, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia; Institute for Choice, School of Commerce, UniSA Business School, University of South Australia, GPO Box 2471, Adelaide, South Australia, 5001, Australia
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S Gnanamanickam E, M Dyer S, Milte R, Liu E, Ratcliffe J, Crotty M. Clustered domestic model of residential care is associated with better consumer rated quality of care. Int J Qual Health Care 2019; 31:419-425. [PMID: 30169780 PMCID: PMC6804479 DOI: 10.1093/intqhc/mzy181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 06/24/2018] [Accepted: 08/06/2018] [Indexed: 12/28/2022] Open
Abstract
Objective To compare consumer rated quality of care among individuals living long-term in homelike clustered domestic and standard models of residential care in Australia. Design Cross-sectional study. Setting Seventeen residential aged care facilities in four Australian states providing alternative models of care. Study participants A sample of individuals with high prevalence of cognitive impairment living in residential care for 12 months or longer, not immediately in palliative care and having a proxy available to provide consent and assist with data collection. Of 901 eligible participants, 541 consented and participated in the study. Main outcome measure Consumer rated quality of care was measured using the Consumer Choice Index–6 Dimension instrument (CCI-6D) providing a preference weighted summary score ranging from 0 to 1. The six dimensions of care time, shared-spaces, own-room, outside and gardens, meaningful activities and care flexibility were individually evaluated. Results Overall consumer rated quality of care (Mean ∆: 0.138, 95% CI 0.073–0.203 P < 0.001) was higher in clustered domestic models after adjusting for potential confounders. Individually, the dimensions of access to outside and gardens (P < 0.001) and flexibility of care (P < 0.001) were rated significantly better compared to those living in standard model of care. Conclusions Homelike, clustered domestic models of care are associated with better consumer rated quality of care, specifically the domains of access to outdoors and care flexibility, in a sample of individuals with cognitive impairment. Including consumer views on quality of care is feasible and should be standard in future evaluations of residential care.
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Affiliation(s)
- Emmanuel S Gnanamanickam
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Health Economics and Social Policy, Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia
| | - Suzanne M Dyer
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Institute for Choice, University of South Australia, Adelaide, SA, Australia
| | - Enwu Liu
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Musculoskeletal Health and Ageing Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Julie Ratcliffe
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Flinders Health Economics Group, Flinders University, Adelaide, SA, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, SA, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
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Ratcliffe J, Cameron I, Lancsar E, Walker R, Milte R, Hutchinson CL, Swaffer K, Parker S. Developing a new quality of life instrument with older people for economic evaluation in aged care: study protocol. BMJ Open 2019; 9:e028647. [PMID: 31129602 PMCID: PMC6538028 DOI: 10.1136/bmjopen-2018-028647] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The ageing of the population represents a significant challenge for aged care in Australia and in many other countries internationally. In an environment of increasing resource constraints, new methods, techniques and evaluative frameworks are needed to support resource allocation decisions that maximise the quality of life and well-being of older people. Economic evaluation offers a rigorous, systematical and transparent framework for measuring quality and efficiency, but there is currently no composite mechanism for incorporating older people's values into the measurement and valuation of quality of life for quality assessment and economic evaluation. In addition, to date relatively few economic evaluations have been conducted in aged care despite the large potential benefits associated with their application in this sector. This study will generate a new preference based older person-specific quality of life instrument designed for application in economic evaluation and co-created from its inception with older people. METHODS AND ANALYSIS A candidate descriptive system for the new instrument will be developed by synthesising the findings from a series of in-depth qualitative interviews with 40 older people currently in receipt of aged care services about the salient factors which make up their quality of life. The candidate descriptive system will be tested for construct validity, practicality and reliability with a new independent sample of older people (n=100). Quality of life state valuation tasks using best worst scaling (a form of discrete choice experiment) will then be undertaken with a representative sample of older people currently receiving aged care services across five Australian states (n=500). A multinomial (conditional) logistical framework will be used to analyse responses and generate a scoring algorithm for the new preference-based instrument. ETHICS AND DISSEMINATION The new quality of life instrument will have wide potential applicability in assessing the cost effectiveness of new service innovations and for quality assessment across the spectrum of ageing and aged care. Results will be disseminated in ageing, quality of life research and health economics journals and through professional conferences and policy forums. This study has been reviewed by the Human Research Ethics Committee of the University of South Australia and has ethics approval (Application ID: 201644).
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Affiliation(s)
- Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ian Cameron
- Rehabilitation Studies Unit, University of Sydney, Sydney, New South Wales, Australia
| | - Emily Lancsar
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ruth Walker
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Milte
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Claire Louise Hutchinson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kate Swaffer
- Dementia Alliance International, Adelaide, South Australia, Australia
| | - Stuart Parker
- Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
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Marshall S, van der Meij BS, Milte R, Collins CE, de van der Schueren MA, Banbury M, Warner MM, Isenring E. Family in Rehabilitation, Empowering Carers for Improved Malnutrition Outcomes: Protocol for the FREER Pilot Study. JMIR Res Protoc 2019; 8:e12647. [PMID: 31038466 PMCID: PMC6658316 DOI: 10.2196/12647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Interventions to improve the nutritional status of older adults and the integration of formal and family care systems are critical research areas to improve the independence and health of aging communities and are particularly relevant in the rehabilitation setting. OBJECTIVE The primary outcome aimed to determine if the FREER (Family in Rehabilitation: EmpowERing Carers for improved malnutrition outcomes) intervention in malnourished older adults during and postrehabilitation improve nutritional status, physical function, quality of life, service satisfaction, and hospital and aged care admission rates up to 3 months postdischarge, compared with usual care. Secondary outcomes evaluated include family carer burden, carer services satisfaction, and patient and carer experiences. This pilot study will also assess feasibility and intervention fidelity to inform a larger randomized controlled trial. METHODS This protocol is for a mixed-methods two-arm historically-controlled prospective pilot study intervention. The historical control group has 30 participants, and the pilot intervention group aims to recruit 30 patient-carer pairs. The FREER intervention delivers nutrition counseling during rehabilitation, 3 months of postdischarge telehealth follow-up, and provides supportive resources using a novel model of patient-centered and carer-centered nutrition care. The primary outcome is nutritional status measured by the Scored Patient-Generated Subjective Global Assessment Score. Qualitative outcomes such as experiences and perceptions of value will be measured using semistructured interviews followed by thematic analysis. The process evaluation addresses intervention fidelity and feasibility. RESULTS Recruitment commenced on July 4, 2018, and is ongoing with eight patient-carer pairs recruited at the time of manuscript submission. CONCLUSIONS This research will inform a larger randomized controlled trial, with potential for translation to health service policies and new models of dietetic care to support the optimization of nutritional status across a continuum of nutrition care from rehabilitation to home. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Number (ACTRN) 12618000338268; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374608&isReview=true (Archived by WebCite at http://www.webcitation.org/74gtZplU2). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12647.
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Affiliation(s)
- Skye Marshall
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Barbara S van der Meij
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.,Dietetics and Foodservices, Mater Health, Brisbane, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Rachel Milte
- Institute for Choice, University of South Australia, Adelaide, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
| | - Marian Ae de van der Schueren
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands.,Department of Nutrition and Dietetics, HAN University of Applied Sciences, Amsterdam, Netherlands
| | - Mark Banbury
- Northern NSW Local Health District, NSW Health, Tweed Heads, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Molly M Warner
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Elizabeth Isenring
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
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Nagpal A, Milte R, Kim SW, Hillier S, Hamilton-Bruce MA, Ratcliffe J, Koblar SA. Economic Evaluation of Stem Cell Therapies in Neurological Diseases: A Systematic Review. Value Health 2019; 22:254-262. [PMID: 30711072 DOI: 10.1016/j.jval.2018.07.878] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/13/2018] [Accepted: 07/27/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To examine economic evaluation studies of stem cell therapies (SCTs) in neurological disorders and to provide an overview of the quality of the economic evidence available on this topic. METHODS The review examined studies that performed an economic evaluation of the use of stem cells in adult patients with neurological diseases and that were published in English during the period 2007 to 2017. Data analyzed and reported included study population, disease indication, main analytical approaches for the economic analysis and perspective, key assumptions made or tested in sensitivity analyses, cost outcomes, estimates of incremental cost effectiveness, and approaches to quantifying decision uncertainty. RESULTS A total of three studies reporting on the findings of the economic evaluation of the use of SCT in stroke, Parkinson disease, and secondary progressive multiple sclerosis, respectively, were identified. All three studies conducted a cost-utility analysis using decision-analytic models and reported an incremental cost per quality-adjusted life-years gained (incremental cost-effectiveness ratio) versus standard care. These studies reported meaningful cost savings in stroke, Parkinson disease, and secondary progressive multiple sclerosis in the base-case scenarios. CONCLUSIONS Despite significant progress in clinical research in the use of SCT in neurological diseases, economic evaluation of these therapies is still at a nascent stage. Given the early stage of research inputs (clinical and cost outcomes data) into the models per se, further research is urgently needed to enable meaningful assessment of the cost effectiveness of these advanced therapies and to ensure sustainable access for population groups most likely to benefit in clinical practice.
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Affiliation(s)
- Anjali Nagpal
- Adelaide Medical School, Faculty of Health Sciences, The University of Adelaide, SAHMRI, South Australia, Australia.
| | - Rachel Milte
- Institute for Choice, University of South Australia, Adelaide, South Australia, Australia
| | - Susan W Kim
- Heart Health Theme, SAHMRI, Adelaide, South Australia, Australia
| | - Susan Hillier
- Sansom Institute for Health Research, University of South Australia, Adelaide, South Australia, Australia
| | - Monica A Hamilton-Bruce
- Adelaide Medical School, Faculty of Health Sciences, The University of Adelaide, SAHMRI, South Australia, Australia; The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; CALHN, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Julie Ratcliffe
- Institute for Choice, University of South Australia, Adelaide, South Australia, Australia
| | - Simon A Koblar
- Adelaide Medical School, Faculty of Health Sciences, The University of Adelaide, SAHMRI, South Australia, Australia; The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; CALHN, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Liu E, Dyer SM, Whitehead C, O'Donnell LK, Gnanamanickam ES, Harrison SL, Milte R, Crotty M. Patterns of medication prescription by dementia diagnosis in Australian nursing home residents: a cross-sectional study. J Pharm Pract Res 2019. [DOI: 10.1002/jppr.1457] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Enwu Liu
- Department of Rehabilitation, Aged and Extended Care; Faculty of Medicine, Nursing and Health Sciences; School of Health Sciences; Flinders University; Adelaide Australia
- NHMRC Cognitive Partnership Centre; The University of Sydney; Sydney Australia
- Mary MacKillop Institute for Health Research; Australian Catholic University; Melbourne Australia
| | - Suzanne M. Dyer
- Department of Rehabilitation, Aged and Extended Care; Faculty of Medicine, Nursing and Health Sciences; School of Health Sciences; Flinders University; Adelaide Australia
- NHMRC Cognitive Partnership Centre; The University of Sydney; Sydney Australia
| | - Craig Whitehead
- Department of Rehabilitation, Aged and Extended Care; Faculty of Medicine, Nursing and Health Sciences; School of Health Sciences; Flinders University; Adelaide Australia
- NHMRC Cognitive Partnership Centre; The University of Sydney; Sydney Australia
| | - Lisa Kouladjian O'Donnell
- NHMRC Cognitive Partnership Centre; The University of Sydney; Sydney Australia
- Kolling Institute of Medical Research; Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
| | - Emmanuel S. Gnanamanickam
- Department of Rehabilitation, Aged and Extended Care; Faculty of Medicine, Nursing and Health Sciences; School of Health Sciences; Flinders University; Adelaide Australia
- NHMRC Cognitive Partnership Centre; The University of Sydney; Sydney Australia
- Health Economics and Social Policy; Centre for Population Health Research; University of South Australia; Adelaide Australia
| | - Stephanie L. Harrison
- Department of Rehabilitation, Aged and Extended Care; Faculty of Medicine, Nursing and Health Sciences; School of Health Sciences; Flinders University; Adelaide Australia
- NHMRC Cognitive Partnership Centre; The University of Sydney; Sydney Australia
| | - Rachel Milte
- Department of Rehabilitation, Aged and Extended Care; Faculty of Medicine, Nursing and Health Sciences; School of Health Sciences; Flinders University; Adelaide Australia
- NHMRC Cognitive Partnership Centre; The University of Sydney; Sydney Australia
- Institute for Choice; University of South Australia; Adelaide Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care; Faculty of Medicine, Nursing and Health Sciences; School of Health Sciences; Flinders University; Adelaide Australia
- NHMRC Cognitive Partnership Centre; The University of Sydney; Sydney Australia
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Ratcliffe J, Hutchinson C, Milte R. Personalisation and the disability sector: What can health economics contribute to inform decision-making? Disabil Health J 2019; 12:7-10. [DOI: 10.1016/j.dhjo.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/21/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
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Milte R, Crotty M, Miller MD, Whitehead C, Ratcliffe J. Quality of life in older adults following a hip fracture: an empirical comparison of the ICECAP-O and the EQ-5D-3 L instruments. Health Qual Life Outcomes 2018; 16:173. [PMID: 30185193 PMCID: PMC6126006 DOI: 10.1186/s12955-018-1005-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023] Open
Abstract
Background The purpose of this study was to empirically compare the performance of two generic preference based quality of life instruments, EQ-5D-3 L (with a health and physical function focus) and ICECAP-O (with a wellbeing and capability focus), in a population of older Australians following hip fracture. Methods Older adults or their family member proxies (in cases of severe cognitive impairment) following surgery to repair a fractured hip were invited to take part in this cross sectional study. Inclusion criteria included an age of 60 years or older, confirmed falls-related hip fracture and those receiving current palliative care or consented to other research studies were excluded. 87 participants completed the ICECAP-O and EQ-5D-3 L instruments between one and three weeks post-surgery. Results For the hip fracture population, the mean ICECAP-O score was 0.639 (SD 0.206, n = 82) and the mean EQ-5D-3 L utility score was 0.545 (SD 0.251, n = 87). There was a statistically significant positive correlation between the ICECAP-O and EQ-5D-3 L scores (r = 0.529, p = < 0.001). Conclusions Study findings indicate significant impairments in quality of life post hip fracture. In multiple regression analyses, age and health-related QoL (measured by the EQ-5D) were significant determinants of ICECAP-O scores, while proxy respondent status, age, and capability-related QoL (measured by the ICECAP-O) were significant determinants of EQ-5D scores. Approaches to measuring and valuing quality of life in this sample, should consider the target domains of the intervention in their choice of instrument. Studies aiming to measure the impact of interventions targeting broader domains of wellbeing and QoL should consider including a broader measure of QoL in conjunction with a HRQoL measure.
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Affiliation(s)
- Rachel Milte
- Nutrition and Dietetics, Flinders University, Adelaide, SA, Australia. .,Institute for Choice, University of South Australia, GPO Box 2471, Adelaide SA, SA, 5001, Australia.
| | - Maria Crotty
- Rehabilitation, Aged, and Extended Care, Flinders University, Adelaide, SA, Australia
| | - Michelle D Miller
- Nutrition and Dietetics, Flinders University, Adelaide, SA, Australia
| | - Craig Whitehead
- Rehabilitation, Aged, and Extended Care, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- Institute for Choice, University of South Australia, GPO Box 2471, Adelaide SA, SA, 5001, Australia.,Flinders Clinical Effectiveness, Flinders University, Adelaide, SA, Australia
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Harrison SL, Kouladjian O'Donnell L, Bradley CE, Milte R, Dyer SM, Gnanamanickam ES, Liu E, Hilmer SN, Crotty M. Associations between the Drug Burden Index, Potentially Inappropriate Medications and Quality of Life in Residential Aged Care. Drugs Aging 2018; 35:83-91. [PMID: 29322470 DOI: 10.1007/s40266-017-0513-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Inappropriate polypharmacy may negatively impact the quality of life of residents in aged care facilities, but it remains unclear which medications may influence this reduced quality of life. OBJECTIVE The objective of this study was to examine whether the Drug Burden Index and potentially inappropriate medications were associated with quality of life in older adults living in residential care with a high prevalence of cognitive impairment and dementia. METHODS We conducted cross-sectional analyses of 541 individuals recruited from 17 residential aged care facilities in Australia in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Quality of life was measured using the EuroQol Five Dimensions Questionnaire (a measure of generic quality of life) and the Dementia Quality of Life Questionnaire completed by the participant or a proxy. RESULTS In the 100 days prior to recruitment, 83.1% of the participants received at least one anticholinergic or sedative medication included in the Drug Burden Index and 73.0% received at least one potentially inappropriate medication according to the Beers Criteria. Multi-level linear models showed there was a significant association between a higher Drug Burden Index and lower quality of life according to the EuroQol Five Dimensions Questionnaire [β (standard error): - 0.034 (0.012), p = 0.006] after adjustment for potential confounding factors. Increasing numbers of potentially inappropriate medications were also associated with lower EuroQol Five Dimensions Questionnaire scores [- 0.030 (0.010), p = 0.003] and Dementia Quality of Life Questionnaire-Self-Report-Utility scores [- 0.020 (0.009), p = 0.029]. Exposure to both Drug Burden Index-associated medications and potentially inappropriate medications was associated with lower Dementia Quality of Life Questionnaire-Self-Report-Utility scores [- 0.034 (0.017), p = 0.049]. CONCLUSION Exposure to anticholinergic and sedative medications and potentially inappropriate medications occurred in over three-quarters of a population of older adults in residential care and was associated with a lower quality of life.
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Affiliation(s)
- Stephanie L Harrison
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia. .,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.
| | - Lisa Kouladjian O'Donnell
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Clare E Bradley
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Infection and Immunity-Aboriginal Health, SAHMRI, Adelaide, 5001, SA, Australia
| | - Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Institute for Choice, University of South Australia, Adelaide, 5001, SA, Australia
| | - Suzanne M Dyer
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - Emmanuel S Gnanamanickam
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - Enwu Liu
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, 3001, VIC, Australia
| | - Sarah N Hilmer
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation building, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
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Milte R, Ratcliffe J, Chen G, Crotty M. What Characteristics of Nursing Homes Are Most Valued by Consumers? A Discrete Choice Experiment with Residents and Family Members. Value Health 2018; 21:843-849. [PMID: 30005757 DOI: 10.1016/j.jval.2017.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 11/01/2017] [Accepted: 11/04/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To generate a scoring algorithm weighted on the preferences of consumers for assessing the quality of care in nursing homes (i.e., aged care homes or institutions) in six key domains. METHODS A discrete choice experiment was undertaken with residents of nursing homes (n = 126) or family member proxies (n = 416) in cases where severe cognitive impairment precluded resident participation. Analysis was undertaken using conditional and mixed logit regression models to determine preferences for potential attributes. RESULTS The findings indicate that all six attributes investigated were statistically significant factors for participants. Feeling at home in the resident's own room was the most important characteristic to both residents and family members. Care staff being able to spend enough time with residents, feeling at home in shared spaces, and staff being very flexible in care routines were also characteristics identified as important for both groups. The results of the Swait-Louviere test rejected the null hypothesis that the estimated parameters between residents and family members were the same, indicating that data from these two groups could not be pooled to generate a single weighted scoring algorithm for the Consumer Choice Index-Six Dimension instrument. Preferences were therefore encapsulated to generate scoring algorithms specific to residents and family members. CONCLUSIONS This study provides important insights into the characteristics of nursing home care that are most valued by consumers. The Consumer Choice Index-Six Dimension instrument may be usefully applied in the evaluation, planning, and design of future services.
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Affiliation(s)
- Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia; Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia; Institute for Choice, University of South Australia, Adelaide, South Australia, Australia.
| | - Julie Ratcliffe
- Institute for Choice, University of South Australia, Adelaide, South Australia, Australia; Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia
| | - Gang Chen
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia; Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia; Cognitive Decline Partnership Centre, University of Sydney, Sydney, New South Wales, Australia
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Gnanamanickam ES, Dyer SM, Milte R, Harrison SL, Liu E, Easton T, Bradley C, Bilton R, Shulver W, Ratcliffe J, Whitehead C, Crotty M. Direct health and residential care costs of people living with dementia in Australian residential aged care. Int J Geriatr Psychiatry 2018; 33:859-866. [PMID: 29292541 PMCID: PMC6032872 DOI: 10.1002/gps.4842] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/27/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This analysis estimates the whole-of-system direct costs for people living with dementia in residential care by using a broad health and social care provision perspective and compares it to people without dementia living in residential care. METHODS Data were collected from 541 individuals living permanently in 17 care facilities across Australia. The annual cost of health and residential care was determined by using individual resource use data and reported by the dementia status of the individuals. RESULTS The average annual whole-of-system cost for people living with dementia in residential care was approximately AU$88 000 (US$ 67 100) per person in 2016. The cost of residential care constituted 93% of the total costs. The direct health care costs were comprised mainly of hospital admissions (48%), pharmaceuticals (31%) and out-of-hospital attendances (15%). While total costs were not significantly different between those with and without dementia, the cost of residential care was significantly higher and the cost of health care was significantly lower for people living with dementia. CONCLUSION This study provides the first estimate of the whole-of-system costs of providing health and residential care for people living with dementia in residential aged care in Australia using individual level health and social care data. This predominantly bottom-up cost estimate indicates the high cost associated with caring for people with dementia living permanently in residential care, which is underestimated when limited cost perspectives or top-down, population costing approaches are taken.
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Affiliation(s)
- Emmanuel S. Gnanamanickam
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityBedford ParkSAAustralia,NHMRC Cognitive Decline Partnership CentreThe University of SydneySydneyNSWAustralia
| | - Suzanne M. Dyer
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityBedford ParkSAAustralia,NHMRC Cognitive Decline Partnership CentreThe University of SydneySydneyNSWAustralia
| | - Rachel Milte
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityBedford ParkSAAustralia,NHMRC Cognitive Decline Partnership CentreThe University of SydneySydneyNSWAustralia,Institute for ChoiceUniversity of South AustraliaAdelaideSAAustralia
| | - Stephanie L. Harrison
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityBedford ParkSAAustralia,NHMRC Cognitive Decline Partnership CentreThe University of SydneySydneyNSWAustralia
| | - Enwu Liu
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityBedford ParkSAAustralia,NHMRC Cognitive Decline Partnership CentreThe University of SydneySydneyNSWAustralia,Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneVICAustralia
| | - Tiffany Easton
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityBedford ParkSAAustralia,NHMRC Cognitive Decline Partnership CentreThe University of SydneySydneyNSWAustralia
| | - Clare Bradley
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityBedford ParkSAAustralia,NHMRC Cognitive Decline Partnership CentreThe University of SydneySydneyNSWAustralia,Infection and Immunity‐Aboriginal HealthSAHMRIAdelaideSAAustralia
| | - Rebecca Bilton
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityBedford ParkSAAustralia,NHMRC Cognitive Decline Partnership CentreThe University of SydneySydneyNSWAustralia
| | - Wendy Shulver
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityBedford ParkSAAustralia,NHMRC Cognitive Decline Partnership CentreThe University of SydneySydneyNSWAustralia
| | - Julie Ratcliffe
- NHMRC Cognitive Decline Partnership CentreThe University of SydneySydneyNSWAustralia,Institute for ChoiceUniversity of South AustraliaAdelaideSAAustralia
| | - Craig Whitehead
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityBedford ParkSAAustralia,NHMRC Cognitive Decline Partnership CentreThe University of SydneySydneyNSWAustralia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended CareFlinders UniversityBedford ParkSAAustralia,NHMRC Cognitive Decline Partnership CentreThe University of SydneySydneyNSWAustralia
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Harrison SL, Milte R, Bradley C, Inacio M, Crotty M. The acceptability of participating in data linkage research: research with older Australians. Aust N Z J Public Health 2018; 42:497-498. [PMID: 29896924 DOI: 10.1111/1753-6405.12797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Stephanie L Harrison
- Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia.,Registry of Older South Australians, South Australian Health and Medical Research Institute
| | - Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia.,Institute for Choice, University of South Australia
| | - Clare Bradley
- Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia.,Infection & Immunity - Aboriginal Health, South Australian Health and Medical Research Institute
| | - Maria Inacio
- Registry of Older South Australians, South Australian Health and Medical Research Institute.,Sansom Institute for Health Research, University of South Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, South Australia
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Dyer SM, Liu E, Gnanamanickam ES, Milte R, Easton T, Harrison SL, Bradley CE, Ratcliffe J, Crotty M. Clustered domestic residential aged care in Australia: fewer hospitalisations and better quality of life. Med J Aust 2018; 208:433-438. [DOI: 10.5694/mja17.00861] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 02/06/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Suzanne M Dyer
- Flinders University, Adelaide, SA
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW
| | - Enwu Liu
- Flinders University, Adelaide, SA
- Mary MacKillop Institute for Health Research, Melbourne, VIC
| | - Emmanuel S Gnanamanickam
- Flinders University, Adelaide, SA
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW
| | - Rachel Milte
- Flinders University, Adelaide, SA
- Institute for Choice, University of South Australia Business School, Adelaide, SA
| | - Tiffany Easton
- Flinders University, Adelaide, SA
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW
| | - Stephanie L Harrison
- Flinders University, Adelaide, SA
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW
| | - Clare E Bradley
- Flinders University, Adelaide, SA
- South Australian Health and Medical Research Institute, Adelaide, SA
| | - Julie Ratcliffe
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW
- Institute for Choice, University of South Australia Business School, Adelaide, SA
| | - Maria Crotty
- Flinders University, Adelaide, SA
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW
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Easton T, Milte R, Crotty M, Ratcliffe J. An empirical comparison of the measurement properties of the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U for older people in residential care. Qual Life Res 2018; 27:1283-1294. [PMID: 29305782 PMCID: PMC5891554 DOI: 10.1007/s11136-017-1777-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to empirically compare the measurement properties of self-reported and proxy-reported (in cases of severe cognitive impairment) generic (EQ-5D-5L) and condition-specific (DEMQOL-U and DEMQOL-Proxy-U) preference-based HRQoL instruments in residential care, where the population is characterised by older people with high rates of cognitive impairment, dementia and disability. METHODS Participants were recruited from seventeen residential care facilities across four Australian states. One hundred and forty-three participants self-completed the EQ-5D-5L and the DEMQOL-U while three hundred and eight-seven proxy completed (due to the presence of severe dementia) the EQ-5D-5L and DEMQOL-Proxy-U. The convergent validity of the outcome measures and known group validity relative to a series of clinical outcome measures were assessed. RESULTS Results satisfy convergent validity among the outcome measures. EQ-5D-5L and DEMQOL-U utilities were found to be significantly correlated with each other (p < 0.01) as were EQ-5D-5L and DEMQOL-Proxy-U utilities (p < 0.01). Both self-reported and proxy-reported EQ-5D-5L utilities demonstrated strong known group validity in relation to clinically recognised thresholds of cognition and physical functioning, while in contrast neither DEMQOL-U nor DEMQOL-Proxy-U demonstrated this association. CONCLUSIONS The findings suggest that the EQ-5D-5L, DEMQOL-U and DEMQOL-Proxy-U capture distinct aspects of HRQoL for this population. The measurement and valuation of HRQoL form an essential component of economic evaluation in residential care. However, high levels of cognitive impairment may preclude self-completion for a majority. Further research is needed to determine cognition thresholds beyond which an individual is unable to reliably self-report their own health-related quality of life.
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Affiliation(s)
- Tiffany Easton
- Flinders Health Economics Group, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, NSW, Australia
| | - Rachel Milte
- Institute for Choice, Business School, University of South Australia, Adelaide, SA, Australia
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, NSW, Australia
| | - Maria Crotty
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, NSW, Australia
- Rehabilitation, Aged and Extended Care, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- Institute for Choice, Business School, University of South Australia, Adelaide, SA, Australia.
- NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, University of Sydney, Sydney, NSW, Australia.
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Harrison SL, Bradley C, Milte R, Liu E, Kouladjian O’Donnell L, Hilmer SN, Crotty M. Psychotropic medications in older people in residential care facilities and associations with quality of life: a cross-sectional study. BMC Geriatr 2018; 18:60. [PMID: 29478410 PMCID: PMC6389148 DOI: 10.1186/s12877-018-0752-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/19/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Psychotropic medications have been associated with many adverse outcomes in older people living in residential care. Home-like models of residential care may be preferable to traditional models of care and we hypothesized that this model may impact on the prevalence of psychotropic medications. The objectives were to: 1) examine associations between psychotropic medications and quality of life in older adults living in residential care facilities with a high prevalence of cognitive impairment and dementia and 2) determine if there was a difference in prevalence of psychotropic medications in facilities which provide a small group home-like model of residential care compared to a 'standard model' of care. METHODS Participants included 541 residents from 17 residential aged care facilities in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Cross-sectional analyses were completed to examine the above objectives. Quality of life was measured with the dementia quality of life questionnaire (DEMQOL) and the EQ-5D-5L completed by the resident or a proxy. RESULTS Overall, 70.8% (n = 380) of the population had been prescribed/dispensed at least one psychotropic medication in the 100 days prior to recruitment. An increased number of psychotropic medications was associated with lower quality of life according to DEMQOL-Proxy-Utility scores (β (SE): - 0.012 (0.006), p = 0.04) and EQ-5D-5L scores (- 0.024 (0.011), p = 0.03) after adjustment for resident-level and facility-level characteristics. Analysis of the individual classes of psychotropic medications showed antipsychotics were associated with lower DEMQOL-Proxy-Utility scores (- 0.030 (0.014), p = 0.03) and benzodiazepines were associated with lower EQ-5D-5L scores (- 0.059 (0.024), p = 0.01). Participants residing in facilities which had a home-like model of residential care were less likely to be prescribed psychotropic medications (OR (95% CI): 0.24 (0.12, 0.46), p < 0.001). CONCLUSIONS An increased number of psychotropic medications were associated with lower quality of life scores. These medications have many associated adverse effects and the use of these medications should be re-examined when investigating approaches to improve quality of life for older people in residential care. Home-like models of residential care may help to reduce the need for psychotropic medications, but further research is needed to validate these findings.
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Affiliation(s)
- Stephanie L. Harrison
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
| | - Clare Bradley
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Infection & Immunity – Aboriginal Health, SAHMRI, PO Box 11060, Adelaide, SA 5001 Australia
| | - Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Institute for Choice, University of South Australia, GPO Box 2471, Adelaide, SA 5001 Australia
| | - Enwu Liu
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000 Australia
| | - Lisa Kouladjian O’Donnell
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - Sarah N. Hilmer
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
- Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, Adelaide, SA 5042 Australia
- NHMRC Cognitive Decline Partnership Centre, The University of Sydney, Sydney, NSW Australia
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Harrison SL, Kouladjian O'Donnell L, Milte R, Dyer SM, Gnanamanickam ES, Bradley C, Liu E, Hilmer SN, Crotty M. Costs of potentially inappropriate medication use in residential aged care facilities. BMC Geriatr 2018; 18:9. [PMID: 29325531 PMCID: PMC5765623 DOI: 10.1186/s12877-018-0704-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 01/01/2018] [Indexed: 01/25/2023] Open
Abstract
Background The potential harms of some medications may outweigh their potential benefits (inappropriate medication use). Despite recommendations to avoid the use of potentially inappropriate medications (PIMs) in older adults, the prevalence of PIM use is high in different settings including residential aged care. However, it remains unclear what the costs of these medications are in this setting. The main objective of this study was to determine the costs of PIMs in older adults living in residential care. A secondary objective was to examine if there was a difference in costs of PIMs in a home-like model of residential care compared to an Australian standard model of care. Methods Participants included 541 participants from the Investigation Services Provided in the Residential Environment for Dementia (INSPIRED) Study. The INSPIRED study is a cross-sectional study of 17 residential aged care facilities in Australia. 12 month medication costs were determined for the participants and PIMs were identified using the 2015 updated Beers Criteria for older adults. Results Of all of the medications dispensed in 1 year, 15.9% were PIMs and 81.4% of the participants had been exposed to a PIM. Log-linear models showed exposure to a PIM was associated with higher total medication costs (Adjusted β = 0.307, 95% CI 0.235 to 0.379, p < 0.001). The mean proportion (±SD) of medication costs that were spent on PIMs in 1 year was 17.5% (±17.8) (AUD$410.89 ± 479.45 per participant exposed to a PIM). The largest PIM costs arose from proton-pump inhibitors (34.4%), antipsychotics (21.0%) and benzodiazepines (18.7%). The odds of incurring costs from PIMs were 52% lower for those residing in a home-like model of care compared to a standard model of care. Conclusions The use of PIMs for older adults in residential care facilities is high and these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes. Adopting a home-like model of residential care may be associated with reduced prevalence and costs of PIMs. Electronic supplementary material The online version of this article (10.1186/s12877-018-0704-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S L Harrison
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia. .,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.
| | - L Kouladjian O'Donnell
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - R Milte
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Institute for Choice, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - S M Dyer
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - E S Gnanamanickam
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - C Bradley
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Infection & Immunity - Aboriginal Health, SAHMRI, PO Box 11060, Adelaide, SA, 5001, Australia
| | - E Liu
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - S N Hilmer
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - M Crotty
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
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Milte R, Ratcliffe J, Chen G, Miller M, Crotty M. Taste, choice and timing: Investigating resident and carer preferences for meals in aged care homes. Nurs Health Sci 2018; 20:116-124. [PMID: 29314590 PMCID: PMC6635740 DOI: 10.1111/nhs.12394] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/16/2017] [Accepted: 09/18/2017] [Indexed: 01/09/2023]
Abstract
There has been little empirical investigation of the preferences of people living in aged care homes for food services. The aim of the present study was to elicit consumer preferences and their willingness to pay for food service in aged care homes. Current residents or their family members were invited to take part in the discrete choice experiment questionnaire administered via interview. Of the 109 eligible residents and 175 eligible family members approached for consent 121 (43%) participated, including 43 residents. Participant preferences were influenced by food taste, choice in relation to serving size, timing of meal selection, visual appeal, and additional cost. Participants indicated they would be willing to pay an additional $24 (US$18.42) per week for food which tasted excellent and $8 (US$6.14) per week to have choice in serving sizes. The study found that respondents were willing to pay a premium to receive food that met their expectations of taste, and for a high level of control over serving sizes, which has implications for the funding and provision of food and dining in long-term care in the future.
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Affiliation(s)
- Rachel Milte
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia.,National Health and Medical Research Council, Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia.,Institute for Choice, University of South Australia, Adelaide, South Australia, Australia
| | - Julie Ratcliffe
- Institute for Choice, University of South Australia, Adelaide, South Australia, Australia.,Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia
| | - Gang Chen
- Flinders Health Economics Group, Flinders University, Adelaide, South Australia, Australia
| | - Michelle Miller
- Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia.,National Health and Medical Research Council, Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia
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Milte R, Ratcliffe J, Chen G, Crotty M. CONSUMER QUALITY INDEX—NURSING HOME VERSION: MEASURING CONSUMER-FOCUSED QUALITY OF CARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R. Milte
- Flinders University, Adelaide, South Australia, Australia,
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia
| | - J. Ratcliffe
- Flinders University, Adelaide, South Australia, Australia,
| | - G. Chen
- Flinders University, Adelaide, South Australia, Australia,
| | - M. Crotty
- Flinders University, Adelaide, South Australia, Australia,
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia
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50
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Harrison S, Bradley C, Milte R, Liu E, Kouladjian O’Donnell L, Hilmer S, Crotty M. PSYCHOTROPIC MEDICATIONS AND QUALITY OF LIFE IN RESIDENTIAL AGED CARE FACILITIES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S. Harrison
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- Flinders University, Adelaide, South Australia, Australia
| | - C. Bradley
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- Flinders University, Adelaide, South Australia, Australia
| | - R. Milte
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- Flinders University, Adelaide, South Australia, Australia
| | - E. Liu
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- Flinders University, Adelaide, South Australia, Australia
| | - L. Kouladjian O’Donnell
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- University of Sydney, Sydney, New South Wales, Australia,
| | - S.N. Hilmer
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- University of Sydney, Sydney, New South Wales, Australia,
| | - M. Crotty
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- Flinders University, Adelaide, South Australia, Australia
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