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Trinca V, Wu SA, Dakkak H, Iraniparast M, Cammer A, Lengyel C, O'rourke HM, Rowe N, Slaughter SE, Carrier N, Quiring S, Harvie R, Keller H. Characteristics Associated with Relationship-Centred and Task-Focused Mealtime Practices in Older Adult Care Settings. CAN J DIET PRACT RES 2024:1-10. [PMID: 38572747 DOI: 10.3148/cjdpr-2023-023] [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: 04/05/2024]
Abstract
Purpose: To assess care home and staff characteristics associated with task-focused (TF) and relationship-centred care (RCC) mealtime practices prior to the COVID-19 pandemic.Methods: Staff working in Canadian and American care homes were invited to complete a 23-item online survey assessing their perceptions of mealtime care, with one item assessing 26 potential care practices from the Mealtime Relational Care Checklist (relationship-centred = 15; task-focused = 11) reported to occur in the home prior to the pandemic. Multivariate linear regression evaluated staff and care home characteristics associated with mealtime practices.Results: Six hundred and eighty-six respondents completed all questions used in this analysis. Mean TF and RCC mealtime practices were 4.89 ± 1.99 and 9.69 ± 2.96, respectively. Staff age was associated with TF and RCC practices with those 40-55 years reporting fewer TF and those 18-39 years reporting fewer RCC practices. Those providing direct care were more likely to report TF practices. Dissatisfaction with mealtimes was associated with more TF and fewer RCC practices. Homes that were not making changes to promote RCC pre-pandemic had more TF and fewer RCC practices. Newer care homes were associated with more RCC, while small homes (≤49 beds) had more TF practices.Conclusions: Mealtime practices are associated with staff and home factors. These factors should be considered in efforts to improve RCC practices in Canadian homes.
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Affiliation(s)
- Vanessa Trinca
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
| | - Sarah A Wu
- School of Nursing, University of British Columbia, Vancouver, BC
| | - Hana Dakkak
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
| | - Maryam Iraniparast
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK
| | - Christina Lengyel
- Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB
| | - Hannah M O'rourke
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB
| | - Natalie Rowe
- Faculty of Creative Industries, School of Design, Fanshawe College, London, ON
| | - Susan E Slaughter
- College of Health Sciences, Faculty of Nursing, University of Alberta, Edmonton, AB
| | - Natalie Carrier
- Faculté des sciences de la santé et des services communautaires, Université de Moncton, Moncton, NB
| | | | - Ruth Harvie
- Department of Human Nutrition, St. Francis Xavier University, Antigonish, NS
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON
- Schlegel-UW Research Institute for Aging, Waterloo, ON
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O'Shea MC, Barrett C, Corones-Watkins K, Foo J, Maloney S, Bauer J, Palermo C, Kellett U, Williams LT. Dietetics student contribution to addressing malnutrition in residential aged care facilities. Nutr Diet 2024. [PMID: 38409632 DOI: 10.1111/1747-0080.12864] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/17/2023] [Accepted: 12/30/2023] [Indexed: 02/28/2024]
Abstract
AIMS To test a model of malnutrition screening and assessment conducted by dietetics students on placement in residential aged care facilities. The secondary aim was to identify possible facilitators and barriers to the implementation of the model. METHOD The type 1 hybrid effectiveness-implementation trial study design and reporting outcomes were developed using the Consolidated Framework for Implementation Research. An innovative placement model was developed, where students on voluntary placement visited three residential aged care facilities to identify residents at risk of malnutrition using currently available screening tools for older people. Students completed malnutrition assessments for all residents using the subjective global assessment tool. RESULTS Thirty-two students participated; 31 completed all three sessions, with malnutrition screening completed for 207 residents and malnutrition assessment for 187 residents (July and September 2022). Based on the subjective global assessment, 31% (n = 57) of residents were mildly/moderately malnourished, and 3% (n = 5) were severely malnourished. The Innovation Domain of the Framework was the most important consideration before implementation. CONCLUSION Whilst previous research documented student learning opportunities in residential aged care facilities, this study provides the first available evidence of the direct contribution students can make to the health of aged care residents through malnutrition screening and assessment. The model enables students to conduct malnutrition screening and assessment feasibly and efficiently in facilities that do not routinely collate and act on these data. With a limited nursing aged care workforce to undertake this vital task, the potential role of student dietitians to fulfil this role must be considered.
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Affiliation(s)
- Marie-Claire O'Shea
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Clare Barrett
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
| | | | - Jonathan Foo
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Stephen Maloney
- School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Judy Bauer
- School of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Claire Palermo
- School of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia
| | - Ursula Kellett
- School of Nursing & Midwifery, Griffith University, Queensland, Australia
| | - Lauren T Williams
- School of Health Sciences and Social Work, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
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Findlay L, Kellett R, Lubbe S, Wand AP. Pathways to community living in practice: Local development and adaptation within an older peoples mental health service. Australas Psychiatry 2023; 31:824-829. [PMID: 37950838 DOI: 10.1177/10398562231211140] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2023]
Abstract
OBJECTIVE To describe the local adaptation of the Pathways to Community Living (PCLI) program in an Older Peoples Mental Health (OPMH) service to guide other services. METHOD A retrospective observational study was conducted. Data were obtained from service planning meetings and newly developed documents, Clinical Advisory Committee meetings, and OPMH PCLI database. RESULTS The PCLI program was adapted for the local OPMH service through development of an assessment template, creating a Memorandum of Understanding with a partner Residential Aged Care Facility (RACF) and establishing processes for collaboration and regular review. Between 2019 and March 2023, 20 mental health consumers were referred to the OPMH PCLI program. Their demographic and clinical characteristics are described. CONCLUSIONS Adaptation of the PCLI program for OPMH consumers required consideration of specific older adult needs to develop a bespoke plan for assessment and partnership with the PCLI-funded RACF. The development phase and ongoing processes for review facilitated engagement of key stakeholders across health and RACF sectors, highlighting issues with consumer engagement. Similar models could be used by other health services to implement the PCLI in their local context.
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Affiliation(s)
- Lillian Findlay
- Older Peoples Mental Health, Sydney Local Health District, C/O Camperdown Community Health Centre, Sydney, Australia
| | - Rowena Kellett
- Older Peoples Mental Health, Sydney Local Health District, C/O Camperdown Community Health Centre, Sydney, Australia
| | - Sean Lubbe
- Older Peoples Mental Health, Sydney Local Health District, C/O Camperdown Community Health Centre, Sydney, Australia; Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Anne Pf Wand
- Older Peoples Mental Health, Sydney Local Health District, C/O Camperdown Community Health Centre, New South Wales, Australia
- Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, University of New South Wales, Australia
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Bloomfield K, Wu Z, Boyd M, Broad JB, Hikaka J, Peri K, Bramley D, Tatton A, Calvert C, Higgins AM, Connolly MJ. Changes in hospitalisation rates in older people before and after moving to a retirement village. Australas J Ageing 2023; 42:660-667. [PMID: 37036833 DOI: 10.1111/ajag.13197] [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: 09/08/2022] [Revised: 01/31/2023] [Accepted: 03/12/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES An increasing proportion of older people live in Retirement Villages ('villages'). This population cites support for health-care issues as one reason for relocation to villages. Here, we examine whether relocation to villages is associated with a decline in hospitalisations. METHODS Retrospective, before-and-after observational study. SETTING Retirement villages, Auckland, New Zealand. PARTICIPANTS 466 cognitively intact village residents (336 [72%] female); mean (SD) age at moving to village was 73.9 (7.7) years. Segmented linear regression analysis of an interrupted time-series design was used. MAIN OUTCOME MEASURES all hospitalisations for 18 months pre- and postrelocation to village. SECONDARY OUTCOME acute hospitalisations during the same time periods. RESULTS The average hospitalisation rate (per 100 person-years) was 44.9 (95% confidence interval [CI] = 36.3-55.6) 18-10 months before village relocation, 58.9 (95% CI = 48.3-72.0) 9-1 months before moving, 47.9 (95% CI = 38.8-59.1) 1-9 months after moving and 62.4 (95% CI = 51.2-76.0) 10-18 months after moving. Monthly average hospitalisation rate (per 100 person-years) increased before relocation to village by an average of 1.2 (95% CI = 0.01-1.57, p = .04) per month from 18 to 1 month before moving, and there was a change in the level of the monthly average hospitalisation rate immediately after relocation (mean difference [MD] = -18.4 per 100 person-years, 95% CI = -32.8 to -4.1, p = .02). The trend change after village relocation did not differ significantly from that before moving. CONCLUSIONS Although we cannot reliably claim causality, relocation to a retirement village is, for older people, associated with a significant but non-sustained reduction in hospitalisation.
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Affiliation(s)
- Katherine Bloomfield
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna Hikaka
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Waitematā District Health Board, Auckland, New Zealand
| | - Annie Tatton
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Cheryl Calvert
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Ann-Marie Higgins
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
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5
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Gullick D, Islam MR. Exploring avoidable presentations from residential aged care facilities to the emergency department of a large regional Australian hospital. Aust J Rural Health 2023. [PMID: 36961100 DOI: 10.1111/ajr.12980] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVES The study aimed at determining the factors that contributed to older people presenting from residential aged care facilities (RACFs) to the emergency department (ED) of a regional Victorian hospital located in MM3 regional area. METHODS Appropriateness of transfer was assessed based on predefined criteria, and associated costs for each presentation were calculated. DESIGN The study carried out a retrospective review of records between July and December 2021. Data were extracted in a MS Excel spreadsheet and transferred to STATA 15.0 for analysis. SETTING Large regional health service in Victoria. PARTICIPANTS Residential aged care facilities residents presenting to the ED. MAIN OUTCOME MEASURES Was transfer appropriate or avoidable, costs associated with avoidable transfer, characteristics of the patient and circumstances relating to presentation to hospital. RESULTS A total of 448 presentations were recorded, and 85% of residents were >75 years of age. More than 60% of presentations occurred during weekends or after hours, with the most common reason being falls (31.9%). Over half (55.6%) of all presentations were avoidable which incurred a cost of $777 200 in 6 months. In multiple logistic regression, higher ED presentations were observed in residents with no prior GP assessment (OR: 1.47, 95% CI: 1.02-2.11). CONCLUSIONS Necessary interventions such as preventing falls and increasing primary care access along with improving the quality of advance care directives (ACD) may reduce RACF transfers to the regional ED. To the best of our knowledge, this is the first paper of this kind that provides new data from an Australian rural and regional perspective and adds value to the growing body of knowledge in the intersection of aged care and acute emergency care.
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Affiliation(s)
- David Gullick
- Goulburn Valley Health, Graham Street, Shepparton, Victoria, 3630, Australia
| | - Md Rafiqul Islam
- Goulburn Valley Health, Graham Street, Shepparton, Victoria, 3630, Australia
- School of Rural Health, La Trobe University, Shepparton, Victoria, 3630, Australia
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, 3630, Australia
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Bott A, Meyer C, Hickson L, Pachana NA. "It's Huge, in a Way." Conflicting Stakeholder Priorities for Managing Hearing Impairment for People Living with Dementia in Residential Aged Care Facilities. Clin Gerontol 2022; 45:844-858. [PMID: 32807024 DOI: 10.1080/07317115.2020.1805537] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aims of this study were to a) explore the impact of hearing impairment on people living with dementia in residential aged care facilities (RACFs) and b) investigate management of hearing impairment for this population. METHODS A descriptive qualitative approach, consisting of semi-structured interviews, was conducted with 23 participants across four stakeholder groups (audiologists, care staff, family members and individuals with dementia and hearing impairment living in RACFs). RESULTS Thematic analysis revealed an overarching theme of "different priorities for managing hearing impairment" that emerged from the data. Audiologists and care staff prioritized different practices for managing hearing impairment: audiologists emphasized hearing aids and care staff emphasized communication strategies. Care staff also identified that current management of hearing impairment was sub-optimal as they do not prioritize managing it. CONCLUSIONS Residents with dementia and hearing impairment living in RACFs are not receiving optimal hearing management. Further research is required to understand the factors that influence this. CLINICAL IMPLICATIONS Changes in practices of both care staff and audiologists are required to improve hearing impairment management for this population.
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Affiliation(s)
- Anthea Bott
- The HEARing Cooperative Research Centre, Melbourne, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Carly Meyer
- The HEARing Cooperative Research Centre, Melbourne, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Louise Hickson
- The HEARing Cooperative Research Centre, Melbourne, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
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Ding J, Johnson CE, Auret K, Ritson D, Masarei C, Chua D, Licqurish S, Mitchell G, Cook A. Comparison of end-of-life care for people living in home settings versus residential aged care facilities: A nationwide study among Australian general practitioners. Health Soc Care Community 2022; 30:91-101. [PMID: 33825245 DOI: 10.1111/hsc.13375] [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: 04/29/2020] [Revised: 10/30/2020] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
We have little knowledge of differences in end-of-life care between home settings and residential aged care facilities (RACFs) where people spend most of their last year of life. This study aimed to compare end-of-life care between home settings and RACFs from the perspective of Australian general practitioners (GPs). A descriptive study was conducted with 62 GPs from Western Australia, Queensland and Victoria. Participants were asked to provide reports on end-of-life care of decedents in their practice using a validated clinic-based data collection process developed by our team between September 2018 and August 2019. Of the 213 reported expected deaths, 66.2% mainly lived at home in the last year of life. People living at home were more likely to die at a younger age (median 77 vs. 88, p < 0.001), to be male (51.1% vs. 33.3%, p = 0.01) and to die of cancer (53.9% vs. 4.2%, p < 0.001) compared to those in RACFs. There were no significant differences between the two patient groups for seven out of the eight assessed symptoms, except nausea. GPs' perceived roles in caring for patients and levels of their involvement in provision of common palliative care services were comparable between the two groups. The usual accommodation setting was most frequently considered the preferred place of death in both groups. However, more home residents ended up dying in hospital compared to RACF residents. There were significantly higher frequencies of end-of-life discussions (ORs ranged 5.46-9.82 for all topic comparisons) with GPs associated with people living at home versus RACFs. One opportunity for improved care is through promoting greater involvement of GPs in end-of-life discussions with RACF residents and staff. In general, more Australians could potentially remain at home until death if provided with greater access to essential specialist palliative care services and supportive services in home settings.
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Affiliation(s)
- Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Claire E Johnson
- Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, NSW, Australia
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
- Supportive and Palliative Care, Eastern Health, Melbourne, VIC, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, The University of Western Australia, Albany, WA, Australia
| | - Dianne Ritson
- The Val Lishman Health Foundation, Bunbury, WA, Australia
| | | | - David Chua
- Primary Care Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Sharon Licqurish
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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Pearson R, Mullan J, Dijkmans-Hadley B, Halcomb E, Bonney A. Medical care in Australian residential aged care: Perspectives of residents, family, nurses and general practitioners. Health Soc Care Community 2021; 29:e279-e287. [PMID: 33761182 DOI: 10.1111/hsc.13352] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/13/2020] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
The importance of residential aged care facility (RACF)'s medical care is growing, driven by world-wide demographic trends in ageing populations. Despite this, there is a paucity of research into this care delivery from the perspective of those most involved. This study aimed to identify the enablers of and barriers to satisfactory RACF medical care by focusing on the general practitioner (GP) visit in the experience of residents, their family, registered nurses (RNs) and GPs. A multi-site case study was conducted at four purposively chosen RACFs in rural and regional New South Wales, Australia. Data derived from semi-structured interviews with 35 randomly selected aforementioned stakeholders and conducted in 2017 were evaluated using thematic, specifically framework analysis. The study's first key finding was related to the care team and to care recipients. It was evident that the quality of the RN-GP interprofessional collaboration was important for satisfactory care delivery. However, the care team was observed to additionally include RACF care staff and family members. Families were also in need of care. The study's second key finding was related to continuity of care. The interpersonal continuity of care provided by the existing GP continuing a new resident's care was beneficial. Informational continuity of care was found to be important but often disrupted by patient's information being initially unavailable, then fragmented and stored in different places. Medication management systems when accessed were poorly organised, time consuming and complex. This research suggests two useful new paradigms for residential aged care. The first is a re-envisaging of the resident care team to include the RN, GP, family and care staff, and those needing care to include residents and family. Secondly, care teams informed by interpersonal and informational continuity of care, and satisfactory resident care appears inextricably and positively linked.
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Affiliation(s)
- Russell Pearson
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Illawarra and Southern Practice Based Research Network (ISPRN), University of Wollongong, Wollongong, NSW, Australia
| | - Judy Mullan
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Illawarra and Southern Practice Based Research Network (ISPRN), University of Wollongong, Wollongong, NSW, Australia
| | - Bridget Dijkmans-Hadley
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Elizabeth Halcomb
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Andrew Bonney
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
- Illawarra and Southern Practice Based Research Network (ISPRN), University of Wollongong, Wollongong, NSW, Australia
- Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
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9
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Karim KMR, Tasnim T, Shams SD, Zaher MA, Mamun S. Mini Nutritional Assessment and physical function of older people in residential aged care facility, Bangladesh. Nutr Health 2021; 28:443-452. [PMID: 34250851 DOI: 10.1177/02601060211030119] [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: 11/16/2022]
Abstract
BACKGROUND Malnutrition may decrease physical function and exacerbate health conditions and thus have a negative effect on health-related quality of life of older people. AIM The study was aimed at evaluating the extent of malnutrition, physical function and other associated risk factors for the older persons (>65 years) living in the residential aged care facilities in Bangladesh. METHODS A cross-sectional study was performed with a sample of 200 older people in various residential aged care facilities in Dhaka, Bangladesh. Nutritional status was evaluated using the Mini Nutritional Assessment. A structured questionnaire was used to assess the socioeconomic condition, dietary diversity, functional ability and other related risk factors for malnutrition. RESULTS According to the Mini Nutritional Assessment, 33.5% of participants living in residential aged care facilities were malnourished and 52.5% were at risk of malnutrition. Dietary diversity score differs significantly (p<0.001) among malnourished (3.78 ± 0.45), at risk of malnutrition (4.46 ± 0.98) and well-nourished (4.75 ± 1.11) groups. Twenty-five percent of the study participants reported limitations in mobility and 26.5% reported limitations in activities of daily living. Females were more vulnerable in terms of malnutrition and physical function than males. Mini Nutritional Assessment score is significantly correlated (p<0.05) with several risk factors for malnutrition such as body mass index, education level, meal, protein consumption, dietary diversity score, weight loss, reduced food intake, mobility and activities of daily living of the older people. CONCLUSIONS The study reaffirms that a high rate of malnutrition and risk of malnutrition is prevalent among aged care residents, who need special attention and may benefit from individualized nutrition interventions.
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Affiliation(s)
| | - Tasmia Tasnim
- Department of Nutrition and Food Engineering, 130058Daffodil International University, Bangladesh
| | - Sabrin Deeba Shams
- Institute of Nutrition and Food Science, 95324University of Dhaka, Bangladesh
| | | | - Sumaiya Mamun
- Institute of Nutrition and Food Science, 95324University of Dhaka, Bangladesh
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Viray P, Low Z, Sinnappu R, Harvey PA, Brown S. Residential aged care facility COVID-19 outbreaks and magnitude of spread among residents: observations from a Victorian residential in-reach service. Intern Med J 2021; 51:99-101. [PMID: 33572024 PMCID: PMC8014598 DOI: 10.1111/imj.15143] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
There is a paucity of Australian literature exploring the spread of COVID-19 among residents living in residential aged care facilities (RACF). In this case series of COVID-19 outbreaks in six RACF, we collected data on the cumulative proportion of residents who tested positive for COVID-19 within 21 days of the index case being identified. We describe the observations of a Residential In-Reach service within these six RACF and found that rapid cohorting strategies, personal protective equipment availability and adequacy of use, embedded infection control staff, and adequate outbreak preparedness plans may have influenced the differences observed between RACF in the containment and minimisation of the spread of COVID-19 amongst residents.
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Affiliation(s)
- Paul Viray
- Northern Health Epping, Austin Health, Melbourne, Victoria, Australia
| | - Zi Low
- Northern Health Epping, Melbourne, Victoria, Australia
| | | | | | - Sandra Brown
- Northern Health Epping, Melbourne, Victoria, Australia
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Aquilanti L, Santarelli A, Mascitti M, Procaccini M, Rappelli G. Dental Care Access and the Elderly: What Is the Role of Teledentistry? A Systematic Review. Int J Environ Res Public Health 2020; 17:E9053. [PMID: 33291719 DOI: 10.3390/ijerph17239053] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 01/10/2023]
Abstract
A high level of unmet oral health needs is very common among elderly people. In a society that is getting older and that has been hit so hard by the coronavirus pandemic, the development of new strategies aimed at enhancing general and oral health status should be crucial in order to promote healthy aging. The aim of this systematic review is to assess the feasibility of Teledentistry in communities or in a domiciliary setting where elderly people live. A structured and systematic research was performed on the major electronic databases for studies published in English until 30 June 2020: the PubMed, Cochrane Library, Web of Science, Scopus, and CINAHL databases. A total of 13 articles were identified through database searching using combinations of keywords. Out of 13 papers, eight abstracts were reviewed to assess if they were coherent with the aim of the study, and full texts were retrieved. After abstract reviews, seven articles were selected for closer inspection. Of these, six were assessed for eligibility. Four papers were aimed at assessing patients and health practitioners experiences about Teledentistry, three studies reported a cost analysis and cost description of Teledentistry in residential aged care facilities, and two studies investigated the feasibility and accuracy of Teledentistry for diagnosis dental pathology. The implementation of Teledentistry in residential aged care facilities and in home-assistance programs could be a viable tool for the management of oral care in people who cannot access dental care.
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Eshetie TC, Roberts G, Nguyen TA, Gillam MH, Maher D, Kalisch Ellett LM. Potentially inappropriate medication use and related hospital admissions in aged care residents: The impact of dementia. Br J Clin Pharmacol 2020; 86:2414-2423. [PMID: 32374041 DOI: 10.1111/bcp.14345] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/10/2020] [Accepted: 04/28/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS To determine the prevalence of potentially inappropriate medication (PIM) use at hospital admission and discharge, and the contribution to hospital admission among residential aged care facility residents with and without dementia. METHODS We conducted a secondary analysis using data from a multihospital prospective cohort study involving consecutively admitted older adults, aged 75 years or older, who were taking 5 or more medications prior to hospital admission and discharged to a residential aged care facility in South Australia. PIM use was identified using the 2015 Screening Tool for Older Persons' Prescription and 2019 Beers criteria. An expert panel of clinicians with geriatric medicine expertise evaluated the contribution of PIM to hospital admission. RESULTS In total, 181 participants were included, the median age was 87.5 years and 54.7% were female. Ninety-one (50.3%) had a diagnosis of dementia. Participants with dementia had fewer PIMs, according to at least 1 of the 2 screening criteria, than those without dementia, at admission (dementia: 76 [83.5%] vs no dementia: 84 [93.3%], P = .04) and discharge (78 [85.7%] vs 83 [92.2%], P = .16). PIM use was causal or contributory to the admission in 28.1% of study participants (n = 45) who were taking at least 1 PIM at admission. CONCLUSIONS Over 80% of acutely admitted older adults took PIMs at hospital admission and discharge and for over a quarter of these people the admissions were attributable to PIM use. Hospitalisation presents an opportunity for comprehensive medication reviews, and targeted interventions that enhance such a process could reduce PIM use and related harm.
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Affiliation(s)
- Tesfahun C Eshetie
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Greg Roberts
- Pharmacy Department, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Tuan A Nguyen
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Marianne H Gillam
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Dorsa Maher
- Pharmacy Department, Flinders Medical Centre, Bedford Park, South Australia, Australia.,School of Pharmacy and Medical Science, University of South Australias, Adelaide, South Australia, Australia
| | - Lisa M Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
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Dai Y, Zhao J, Li S, Zhao C, Gao Y, Johnson CE. Caregivers' Dementia Knowledge and Care Approach in Residential Aged Care Facilities in China. Am J Alzheimers Dis Other Demen 2020; 35:1533317520937096. [PMID: 33089701 PMCID: PMC10624015 DOI: 10.1177/1533317520937096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the dementia knowledge and care approach used by caregivers in residential aged care facilities (RACFs) in China. METHOD A cross-sectional survey of 785 caregivers from a random sample of 34 RACFs in China. Caregivers' knowledge and care approach were assessed using the Chinese version of the Dementia Knowledge Assessment Tool 2 and Advanced Dementia Care Questionnaire. RESULTS The majority of caregivers showed limited knowledge of dementia and tended not to adopt a person-centered approach to care. Educational level, dementia care training, and years of work experience were positively associated with dementia knowledge. Educational level and years of work experience were also associated with a person-centered approach to care. CONCLUSIONS This study provides insight into the care available to people with dementia in RACFs in China. The results suggest dementia care education programs as well as person-centered care training are urgently needed for caregivers in China.
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Affiliation(s)
- Yunyun Dai
- Nursing School of 74716Guilin Medical University, Guilin, China
| | - Jia Zhao
- Nursing School of 74716Guilin Medical University, Guilin, China
| | - Shenmei Li
- Nursing School of 74716Guilin Medical University, Guilin, China
| | - Chaochao Zhao
- Public Health School of 74716Guilin Medical University, Guilin, China
| | - Yan Gao
- Nursing School of 74716Guilin Medical University, Guilin, China
| | - Claire Elizabeth Johnson
- Monash Nursing and Midwifery, 2541Monash University, Melbourne, Victoria, Australia
- Supportive and Palliative Care, Eastern Health, Melbourne, Victoria, Australia
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Kalisch Ellett LM, Kassie GM, Pratt NL, Kerr M, Roughead EE. Prevalence and Duration of Use of Medicines Recommended for Short-Term Use in Aged Care Facility Residents. Pharmacy (Basel) 2019; 7:pharmacy7020055. [PMID: 31174405 PMCID: PMC6631023 DOI: 10.3390/pharmacy7020055] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 01/16/2023] Open
Abstract
Background: Multiple studies have assessed the appropriateness of the use of medicines for nursing home residents; however, few have included duration of use in their assessment. The aim of this study was to assess the level and duration of use of medications recommended for short-term use in residents of aged care facilities in Australia. Methods: Australian Government Department of Veterans’ Affairs (DVA) administrative claims data were used for this study. Veterans eligible for all health services subsidised by DVA were followed for one year from 1 July 2015 to 30 June 2016. The number of days covered for each medicine was calculated by multiplying the number of prescriptions dispensed during the year by the pack duration for the medicine. The pack duration was calculated by dividing the quantity supplied at each dispensing by the usual number of doses per day in older people according to Australian prescribing guidelines. The proportion of patients using each medicine and the number of days covered during the study period were determined. Results: 14, 237 residents met the inclusion criteria. One in five participants were dispensed antipsychotics, and the median duration of use was 180 days in the one-year period. More than one-third were dispensed a benzodiazepine, and the median duration of use was 240 days in the year. Half were dispensed an opioid analgesic with a median duration of use of 225 days in the year. Fifty-two percent were dispensed proton pump inhibitors with a median duration of use of 360 days in the year. A quarter received an antibiotic recommended for the management of urinary tract infection, with a median duration of use of 14 days in the year. Conclusion: Long-term use of antipsychotics, benzodiazepines, opioid analgesics and proton pump inhibitors is common in aged care residents. Ensuring appropriate duration of use for these medicines is necessary to reduce risk of harm.
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Affiliation(s)
- Lisa M Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Gizat M Kassie
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Nicole L Pratt
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Mhairi Kerr
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
| | - Elizabeth E Roughead
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA 5001, Australia.
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15
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Nguyen KH, Seaman K, Saunders R, Williams E, Harrup-Gregory J, Comans T. Benefit-cost analysis of an interprofessional education program within a residential aged care facility in Western Australia. J Interprof Care 2019; 33:619-627. [PMID: 30822181 DOI: 10.1080/13561820.2019.1577808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/27/2022]
Abstract
Interprofessional education (IPE) programs in residential aged care facilities (RACF) contributes to the care of older adults whilst providing an environment for students to learn and practise in an interprofessional manner. Clinical placements are provided by RACF through funding and support from universities in collaboration with the RACF. Conducting a benefit-cost analysis (BCA) can determine the sustainability of a clinical placement program such as an IPE program but there is limited research reporting the economic aspects of clinical placements even though it is a university and government priority. This study provides a benefit-cost analysis of an interprofessional education program offered by a residential aged care provider in Western Australia. Analysis using a BCA methodology was conducted to provide information about the level and distribution of the costs and benefits from different analytical perspectives over the three-year period of the IPE program. The analysis showed that the program was highly beneficial from an economic efficiency viewpoint, even though it did not present a financial gain for the aged care provider. The benefits accrued mainly to students in terms of increased education and skill, and to residents in terms of health outcomes and quality of life, while the cost was mostly incurred by the care provider. An IPE program in a RACF is a valuable educational learning experience for students and is also socially beneficial for residents and the broader health sector. For IPE programs in aged care to be sustainable, they require the development of collaborative partnerships with external funding.
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Affiliation(s)
- Kim-Huong Nguyen
- Center for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,NHMRC's Cognitive Decline Partnership Center, University of Sydney, Sydney, Australia.,Health Service Strategy and Planning, Metro North Hospital and Health Services, Queensland Health, Brisbane, Australia
| | - Karla Seaman
- Brightwater Care Group, Osborne Park, Australia.,School of Nursing & Midwifery, Edith Cowan University, Joondalup, Australia
| | - Rosemary Saunders
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Australia
| | | | | | - Tracy Comans
- Center for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,NHMRC's Cognitive Decline Partnership Center, University of Sydney, Sydney, Australia.,Health Service Strategy and Planning, Metro North Hospital and Health Services, Queensland Health, Brisbane, Australia
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Abstract
This study aimed to determine the specific correlation between indoor air temperature and agitation of nursing home residents with dementia. Agitated behaviors of 21 residents, living in 1 nursing home, were assessed for a 10-month period using the Cohen-Mansfield Agitation Inventory (CMAI). The CMAI Total Frequency scores were found to increase significantly when indoor average temperatures deviated from 22.6°C. In addition, cumulative exposure to temperatures higher than 26°C and lower than 20°C was linearly correlated with CMAI Total Frequency scores. Results showed that agitated behaviors not only affected the person manifesting them but were found to be disruptive for other residents and the delivery of care. Agitation can, therefore, be potentially reduced by limiting the range of indoor air temperature variations, and aged care providers should ensure that a thermally comfortable environment is provided in nursing homes to enhance comfort and well-being of all occupants.
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Affiliation(s)
- Federico Tartarini
- Sustainable Buildings Research Centre (SBRC), University of Wollongong, Wollongong, New South Wales, Australia
| | - Paul Cooper
- Sustainable Buildings Research Centre (SBRC), University of Wollongong, Wollongong, New South Wales, Australia
| | - Richard Fleming
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marijka Batterham
- School of Mathematics and Applied Statistics (SMAS), University of Wollongong, Wollongong, New South Wales, Australia
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Kallianis V, Joubert L, Gorman S, Posenelli S, Lethborg C. "Unexpected and Distressing": Understanding and Improving the Experience of Transferring Palliative Care Inpatients to Residential Care. J Soc Work End Life Palliat Care 2017; 13:193-204. [PMID: 28569654 DOI: 10.1080/15524256.2017.1331180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The survival of patients with advanced cancer, coupled with the increased presence of end-stage chronic illnesses in an aging population, is leading to a demand in palliative care. Due to the ongoing need for acute-pain and symptom control in hospice/palliative care units, few are able to offer long-stay admission for those whose symptoms have stabilized. When a patient no longer requires specialist palliative care services, transfer from an inpatient palliative care facility may then be necessary. A core component of the role of palliative-care social workers involves working with patients and their families/carers when the care pathway shifts and the option of residential aged care facility (RACF) needs to be considered. This research explored several issues, including the impact of this transition on the patient and their families and on the interdisciplinary health care team treating the patient. An investigation was undertaken to identify concerns and barriers regarding the transition from hospice care to RACF and opportunities were highlighted to improve clinical practice in this area. A tripartite approach was adopted conducting face-to-face interviews with patients, their families/carers, and health care professionals. Members of the interdisciplinary team were interviewed and social workers working in similar inpatient palliative-care facilities undertook telephone interviews to gauge their experiences. A thematic analysis discerned a number of themes highlighting the impact of this transition on key stakeholders and incorporated recommendations to improve or best manage this process. The research has highlighted the difficulties that patients/families encounter in this transition, as well as the emphases of protecting the integrity of the patient and family. This is achieved by holding open and ongoing dialogue, particularly through family meetings and working in collaboration with the patient, the family, and the team. Understanding the experience and impact of this transition on key stakeholders is helpful in building up a knowledge base and to ensure a more effective relationship occurs. This research incorporated the voices of terminally ill patients, families, and members of the health care team in order to understand their views and recommendations for best managing the transition from a hospice/inpatient palliative-care facility to a RACF. This enables their input to have some real impetus in clinical practice and service delivery.
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Affiliation(s)
- Voula Kallianis
- a Social Work , St Vincent's Hospital , Melbourne , Kew , Australia
| | - Lynette Joubert
- b Social Work , University of Melbourne , Parkville, Melbourne , Australia
| | - Sue Gorman
- c St Vincents Hospital , Melbourne , Fitzroy , Australia
| | - Sonia Posenelli
- b Social Work , University of Melbourne , Parkville, Melbourne , Australia
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Hutchinson A, Rawson H, O'Connell B, Walker H, Bucknall T, Forbes H, Ostaszkiewicz J, Ockerby C. Tri-focal Model of Care Implementation: Perspectives of Residents and Family. J Nurs Scholarsh 2016; 49:33-43. [PMID: 27871120 PMCID: PMC5299456 DOI: 10.1111/jnu.12269] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 06/12/2016] [Revised: 08/11/2016] [Accepted: 10/03/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To explore residents' and family members' perceptions of partnership-centered long-term care (LTC) associated with implementation of the Tri-focal Model of Care. The Model promotes partnership-centered care, evidence-based practice, and a positive environment. Its implementation is supported by a specifically designed education program. METHODS The Model was implemented over approximately 12 months in seven LTC facilities in Victoria, Australia. A qualitative exploratory-descriptive approach was used. Data were collected using individual and focus group interviews with residents and family members prior to and following implementation of the Model. Data were analyzed thematically. FINDINGS Prior to implementation of the Model, residents described experiencing a sense of disempowerment, and emphasized the importance of communication, engagement, and being a partner in the staff-resident care relationship. Following implementation, residents reported experiencing improved partnership approaches to care, although there were factors that impacted on having a good experience. Family members described a desire to remain involved in the resident's life by establishing good communication and rapport with staff. They acknowledged this was important for partnership-centered care. Following implementation, they described experiencing a partnership with staff, giving them confidence to assist staff and be included in decisions about the resident. CONCLUSIONS The Tri-focal Model of Care can enable residents, family members, and staff to be partners in resident care in LTC settings. CLINICAL RELEVANCE With an ageing population, an increasing demand for complex, individualized LTC exists. Delivery of high-quality LTC requires a strategy to implement a partnership-centered approach, involving residents, family members, and staff.
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Affiliation(s)
- Alison Hutchinson
- Lambda Pi-at-Large, Professor of Nursing, Deakin University, Geelong, Australia - Centre for Quality and Patient Safety Research, School of Nursing and Midwifery; Chair in Nursing, Centre for Nursing Research - Deakin University & Monash Health Partnership, Melbourne, Australia
| | - Helen Rawson
- Research Fellow, Deakin University, Geelong, Australia - Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Centre for Nursing Research - Deakin University & Monash Health Partnership, Melbourne, Australia
| | - Beverly O'Connell
- Dean and Professor, College of Nursing, Rady, Faculty of Health Sciences; University of Manitoba, Canada and Honorary Professor, Deakin University, Melbourne, Australia
| | - Helen Walker
- Research Manager, Centre for Research in Assessment and Digital Learning, Portfolio of the Deputy Vice-Chancellor, Deakin University, Melbourne, Australia
| | - Tracey Bucknall
- Xi Omicron, Associate Head of School (Research), Professor of Nursing, Deakin University, Geelong, Australia - Centre for Quality and Patient Safety Research, School of Nursing and Midwifery; Foundational Chair of Nursing, Alfred Health, Melbourne, Australia
| | - Helen Forbes
- Associate Head of School (Teaching & Learning), Associate Professor of Nursing, Deakin University, Geelong, Australia - Centre for Quality and Patient Safety Research, School of Nursing and Midwifery, Melbourne, Australia
| | - Joan Ostaszkiewicz
- Research Fellow, Deakin University, Geelong, Australia - Centre for Quality and Patient Safety Research School of Nursing and Midwifery, Melbourne, Australia
| | - Cherene Ockerby
- Research Assistant, Centre for Nursing Research - Deakin University & Monash Health Partnership, Melbourne, Australia
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Shin HY, Gadzhanova S, Roughead EE, Ward MB, Pont LG. The use of antipsychotics among people treated with medications for dementia in residential aged care facilities. Int Psychogeriatr 2016; 28:977-82. [PMID: 26775538 DOI: 10.1017/S1041610215002434] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Antipsychotic agents have limited efficacy for Behavioral and Psychological Symptoms of Dementia (BPSD) and there are concerns about their safety. Despite this, they are frequently used for the management of BPSD. This study aimed to assess the use of antipsychotics among people on anti-dementia medicines in Australian residential aged care facilities. METHODS Data were obtained from an individual patient unit dose packaging database covering 40 residential aged care facilities in New South Wales, Australia. Residents supplied an anti-dementia medicine between July 2008 and June 2013 were included. Prevalence of concurrent antipsychotic use was established. Incident antipsychotic users between January 2009 and December 2011 were identified. We examined initial antipsychotic dose, maximum titrated doses, type and duration of antipsychotic use, and compared use with Australian guidelines. RESULTS There were 291 residents treated with anti-dementia medicines, 129 (44%) of whom received antipsychotics concomitantly with an anti-dementia medicine. Among the 59 incident antipsychotic users, risperidone (73%) was the most commonly used antipsychotic agent. Amongst the risperidone initiators, 43% of patients had initial doses greater than 0.5 mg/day and 6% of patients exceeded 2.0 mg/day for their maximum dose. 53% of concomitant users received daily treatment for greater than six months. CONCLUSIONS Our study using records of individual patient unit dose supply, which represents the intended medication consumption schedule, shows high rates of concurrent use of antipsychotics and anti-dementia medicines and long durations of use. The use of antipsychotics in patients with dementia needs to be carefully monitored to improve patient outcomes.
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Jacobson J, Gomersall JS, Campbell J, Hughes M. Carers' experiences when the person for whom they have been caring enters a residential aged care facility permanently: a systematic review. ACTA ACUST UNITED AC 2015; 13:241-317. [PMID: 26455857 DOI: 10.11124/jbisrir-2015-1955] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 09/20/2014] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 10/31/2022]
Abstract
BACKGROUND Primary research, including qualitative research, as well as experts working in social services and aged care have identified the mixed feelings carers experience when the person they have been caring for is admitted into a residential aged care facility permanently. They have raised the importance of understanding these experiences as a means to implementing policies and programs that enhance carers' well-being. This systematic review was motivated by the need to use evidence to inform effective and feasible interventions to support carers, and the absence of a systematic review synthesizing the qualitative evidence on how carers experience this transition. OBJECTIVES The objective of this qualitative systematic review was to identify and synthesize the evidence on the experiences of carers of older people when the person they had been providing care for is admitted permanently into a residential aged care facility, and to draw recommendations from the synthesis of the evidence on these experiences to enhance policy and programming aimed at supporting affected caregivers. INCLUSION CRITERIA TYPES OF PARTICIPANTS All carers of people who had experienced the person they had been caring for at home being moved into a residential aged care facility permanently. PHENOMENA OF INTEREST Experiences of the caregiver of the older person when the person they have been caring for at home is admitted into a residential aged care facility permanently. TYPES OF STUDIES: The review considered qualitative studies, including but not limited to designs such as phenomenology, grounded theory, ethnography and action research. TYPES OF OUTCOMES: The outcomes are in the form of synthesized findings pertaining to carers' experiences when the person they have been caring for is admitted into a residential aged care facility permanently. SEARCH STRATEGY A comprehensive search of leading databases which are sources of qualitative published and unpublished studies was conducted between 18 September 2013 and 10 November 2013. The search considered studies reported in English and published from the database inception to 10 November 2013. METHODOLOGICAL QUALITY Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA EXTRACTION Data were extracted from identified papers using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. The data extracted included descriptive details about the phenomena of interest, populations and study methods. DATA SYNTHESIS The Joanna Briggs Institute meta-aggregative approach for synthesizing qualitative evidence was used. Research findings were pooled using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Study findings that were supported by the data in primary studies were organized into categories on the basis of similarity of meaning. These categories were then subjected to a meta-synthesis to produce a set of synthesized findings. RESULTS Fourteen studies matched the inclusion criteria and were included in the review. From these 14 studies a total of 71 study findings about how carers experience the transition when the person they have been caring for is TRUNCATED AT 500 WORDS.
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Affiliation(s)
- Janelle Jacobson
- Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia
| | - Judith Streak Gomersall
- Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia.,Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange, Faculty of Health Sciences, University of Adelaide, Australia
| | - Jared Campbell
- Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia
| | - Mark Hughes
- School of Arts and Social Sciences, Southern Cross University, Gold Coast, Australia
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