Future hospital service utilisation in older adults living in long-term residential aged care or the community hospitalised with a fall-related injury

Risk Factors Associated with Falls in Older Adults with Dementia and Alzheimer's Diseases among Older Adults in the United States

Objective

This study aimed to examine the risk of fall, fall injury, and fall numbers among older adults with dementia and Alzheimer diseases. Additionally, this study explored the relationship of falls by medication use of neurodegenerative diseases.

Methods

The survey data from the years 2020 of Health and Retirement Study Consumption and Activities Mail Survey (HRS CAMS) was used. The HRS CAMS includes information of demographic characteristics, fall information, and medical background including dementia and Alzheimer diseases, and medication record. A regression model was used to test whether neurodegenerative diseases and medications was associated with fall risk factors.

Results

The sample (n = 8782) was predominately female (54.7%) and white (60.7%) with a mean age of 70.4 years. When controlled for covariates, the findings show 10 percent higher risk of fall for elderly people with dementia and Alzheimer. People with dementia were 9% more likely to have higher risk of injury by fall and those with dementia and Alzheimer's had more than 7 times of higher chance of a higher number of falls. Using Alzheimer's prescription was associated with lower 90% lower risk of fall than controls.

Conclusions

Dementia and Alzheimer diseases are significant risk factor for falls in older adults. This study suggests that older adults with neurodegenerative diseases have higher risk, and needs more regular medical checkups to decrease the risk of fall.

The roles and functions of future hospitals in health promotion: A systematic review in Iran

As a main pillar of the health and social welfare system, hospitals affect the public health status in two ways: (1) Prevention, treatment, and rehabilitation services and (2) external effects on society and the environment. The present study aimed to identify the roles and functions of future hospitals in the world. The present study was a systematic review in which all studies about the roles and functions of future hospitals in different countries with a time limit of 2000 to August 2021 were extracted from foreign databases, including PubMed, Cochrane, Scopus, and Web of Science, and search engine, Google Scholar, as well as Persian databases, including Magiran, SID, and Iran Medex. We utilized the STROBE checklists for quantitative studies and SRQR checklists for qualitative studies to critique and evaluate the quality of qualitative studies. We then extracted their results and classified the content according to the main and subtopics. A total of 16 articles met the inclusion criteria of the present study. Hospitals can play four roles: stand-alone, dominant, collaborative, and partner. Findings were classified into six general groups: the role and mission of future hospitals, the way of providing care, funding, staff and patients, technology and information of future hospitals, and the challenges and barriers of current hospitals. Health service policy-makers need to pay special attention to technological innovations and advances as well as changes in the roles and functions of hospitals and seek to turn the threats arising from external changes into opportunities for better hospital performances.

Linking health service utilisation and mortality data-unravelling what happens after fall-related paramedic care

BACKGROUND

A randomised controlled trial implemented and evaluated a new model of care for non-transported older fallers to prevent future falls and unplanned health service use. This current study uses linked data to evaluate the effects of the intervention beyond the initial 12-month study period.

METHOD

Study data from an established cohort of 221 adults were linked to administrative data from NSW Ambulance, Emergency Department Data Collection, Admitted Patient Data Collection and Registry of Births, Deaths and Marriages evaluating health service use at 12, 24 and 36 months following randomisation including time to event (health service utilisation) and mortality. Negative binomial and Cox's proportional hazard regression were performed to capture the impact of the study between groups and adherence status.

RESULTS

At 36 months follow-up, 89% of participants called an ambulance, 87% attended the Emergency Department and 91% were admitted to hospital. There were no significant differences in all-cause health service utilisation between the control and intervention group (IG) at 12, 24 and 36 months follow-up. Fall-related health service use was significantly higher within the IG at 12 (IRR:1.40 (95%CI:1.01-1.94) and 24 months (IRR:1.43 (95%CI:1.05-1.95)). Medication use, impaired balance and previous falls were associated with subsequent health service use. Over 40% of participants died by the follow-up period with risk of death lower in the IG at 36 months (HR:0.64, 95%CI:0.45-0.91).

CONCLUSION

Non-transported fallers have a high risk of future health service use for fall and other medical-related reasons. Interventions which address this risk need to be further explored.

Injury-Related Emergency Department Presentations Among Residential Aged Care Residents in Victoria, Australia

OBJECTIVE

This study aimed to quantify and describe the characteristics of emergency department (ED) injury presentations and subsequent hospital admissions among residents of residential aged-care facilities (RACFs) in Victoria, Australia between 2008 and 2018.

METHODS

This study comprised a single jurisdiction population-based study of consecutive injury-related ED presentations of RACFs residents using the Victorian Emergency Minimum Dataset (VEMD).

RESULTS

The rate of ED injury presentations per 100,000 population decreased by .8% per year over 10 years (P = .03); however, the rate per 100,000 RACF bed days increased by .6% per year (P = .05). The proportion of presentations subsequently admitted to hospital increased 4.0% per year (P<.0001). The majority of presentations were due to falls (82.5%), with fracture(s) being the most common injury type (34.0%).

DISCUSSION

The increased rate of ED visits and hospital admissions in RACFs residents highlights the need to design specialized emergency care services and/or provide better direct access to hospital care for this vulnerable population.

Examining trajectories of hospital readmission in older adults hospitalised with hip fracture from residential aged care and the community

Hip fracture trajectories have not been examined for older adults in aged care or living in the community. Trajectories of health care use were defined by distinct predictive factors. These results can inform the development of targeted strategies to reduce health service use following hip fracture.

OBJECTIVE

To examine hospital service use trajectories of older adults who were hospitalised for hip fracture and living in a residential aged care facility (RACF) or the community, and to identify factors predictive of trajectory group membership. These findings may inform future programmes aimed at reducing unexpected hospitalisations and subsequently reduce health care costs.

METHODS

A group-based trajectory analysis of hospitalisations was conducted for adults aged ≥ 65 years hospitalised for hip fracture during 2008-2009 in New South Wales, Australia. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived for RACF and community-dwelling older adults based on the number of subsequent hospital admissions following the index hip fracture. Multinomial logistic regression examined predictors of trajectory group membership for subsequent hospital admissions.

RESULTS

There were 5752 hip fracture hospitalisations, with two-thirds of hip fractures occurring in community-dwellers. Key predictors of trajectory group membership for both RACF residents and community-dwellers were age group, sex, hospital length of stay and cognitive impairment. Assistance with activities of daily living and complex health care needs were also predictive of group membership in RACF residents. Location of residence and time to move to a RACF were additional predictors of group membership for community-dwellers.

CONCLUSION

Health service use trajectories differed for RACF residents and community-dwellers; however, there were similar patient characteristics that defined trajectory group membership. Low users of hospital services living in RACFs or the community included older adults with generally unfavourable health conditions, potentially indicating that palliative care or advanced care directives and community-care initiatives, respectively, have played a part in the lowered frequency of rehospitalisation.

Factors impacting hospital avoidance program utilisation in the care of acutely unwell residential aged care facility residents

Background

An existing hospital avoidance program, the Aged Care Rapid Response Team (ARRT), rapidly delivers geriatric outreach services to acutely unwell or older people with declining health at risk of hospitalisation. The aim of the current study was to explore health professionals’ perspectives on the factors impacting ARRT utilisation in the care of acutely unwell residential aged care facility residents.

Methods

Semi-structured interviews were conducted with two Geriatricians, two ARRT Clinical Nurse Consultants, an ED-based Clinical Nurse Specialist, and an Extended Care Paramedic. Interview questions elicited views on key factors regarding care decisions and care transitions for acutely unwell residential aged care facility residents. Thematic analysis was undertaken to identify themes and sub-themes from interviews.

Results

Analysis of interviews identified five overarching themes affecting ARRT utilisation in the care of acutely unwell residents: (1) resident care needs; (2) family factors; (3) enabling factors; (4) barriers; and (5) adaptability and responsiveness to the COVID-19 pandemic.

Conclusion

Various factors impact on hospital avoidance program utilisation in the care of acutely unwell older aged care facility residents. This information provides additional context to existing quantitative evaluations of hospital avoidance programs, as well as informing the design of future hospital avoidance programs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06575-1.

Comparison of health service use trajectories of residential aged care residents reviewed by a hospital avoidance program versus usual care

OBJECTIVE

To compare health service use trajectories of residential aged care facility (RACF) residents reviewed by the Aged Care Rapid Response Team (ARRT) to RACF residents who received usual care.

METHODS

A retrospective group-based trajectory analysis of RACF residents aged ≥65 years who were reviewed by ARRT during 1 July 2015 to 30 June 2016 was conducted. Health service use trajectories were followed for two years to 30 June 2018 and compared to RACF residents aged ≥65 years who lived in the same Local Health District and received usual care.

RESULTS

There were 2,245 ARRT-reviewed resident hospitalisations and 11,892 usual care resident hospital admissions during 2015-16. Trajectory analysis categorised ARRT-reviewed residents into four groups and usual care residents into three groups. Age, comorbid health conditions and dementia were predictors of group membership in both ARRT-reviewed RACF residents and usual care RACF residents. Additionally, gender predicted group membership in ARRT-reviewed RACF residents and fall-related injuries predicted group membership in usual care RACF residents.

CONCLUSION

The identification of health service use trajectories assists in understanding hospital use by older RACF residents and may offer guidance in the design of prevention measures, including hospital avoidance programs.