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Potter K, Etherton-Beer C. Using residential aged care data to understand natural deaths. J Prim Health Care 2023; 15:184-185. [PMID: 37390025 DOI: 10.1071/hc22146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/19/2023] [Indexed: 07/02/2023] Open
Affiliation(s)
- Kathleen Potter
- Ryman Healthcare, Airport Business Park, 92 Russley Road, Christchurch 8140, New Zealand
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Tatton A, Wu Z, Bloomfield K, Boyd M, Broad JB, Calvert C, Hikaka J, Peri K, Higgins AM, Connolly MJ. The prevalence and intensity of pain in older people living in retirement villages in Auckland, New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4280-e4292. [PMID: 35543587 DOI: 10.1111/hsc.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/26/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
Chronic pain is common in older people. However, little is known about how pain is experienced in residents of retirement villages ('villages'), and how pain intensity and associations are experienced in relation to characteristics of residents and village living. We thus aimed to examine pain levels, prevalence and associated factors in village residents. The current paper is a cross-sectional analysis of baseline data from the 'Older People in Retirement Villages' study in Auckland, New Zealand. Between July 2016 and August 2018, 578 village residents were interviewed face-to-face by gerontology nurse specialists, using interRAI Community Health Assessment (CHA) and customised survey. We used a validated pain scale and multivariable logistic regression analyses adjusted for pre-specified confounders. Residents' median age was 82 years; 420 (73%) were female; 270 (47%) exhibited/reported daily pain, and in 11% this was severe. After controlling for confounders, daily pain was positively associated with self-reported arthritis (OR = 3.88, 95% CI = 2.57-5.87), poor/fair self-reported health (OR = 3.19, 95% CI = 1.29-7.93), having no health clinic on-site (OR = 1.76, 95% CI = 1.10-2.83), and minimal fatigue (diminished energy but completes normal day-to-day activities) (OR = 1.77, 95% CI = 1.11-2.81). Similar associations were observed for levels of pain. We conclude that levels of pain and prevalence of daily pain are high in village residents. Self-reported arthritis, self-reported poor/fair health, no health clinic on-site and minimal fatigue are all independently associated with a higher risk of daily pain and with levels of pain. This study suggests potential opportunities for villages to better provide on-site support to decrease prevalence and severity of pain for their residents, and thus potentially increase wellbeing and quality-of-life, though as we cannot prove causality, more research is needed.
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Affiliation(s)
- Annie Tatton
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Katherine Bloomfield
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Cheryl Calvert
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Kathy Peri
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Ann-Marie Higgins
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
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Bloomfield K, Wu Z, Broad JB, Tatton A, Calvert C, Hikaka J, Boyd M, Peri K, Bramley D, Higgins AM, Connolly MJ. Factors associated with healthcare utilization and trajectories in retirement village residents. J Am Geriatr Soc 2021; 70:754-765. [PMID: 34910296 DOI: 10.1111/jgs.17602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/01/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To study healthcare utilization and trajectories, and associated factors, in older adults in retirement villages (RVs), also known as continuing care retirement communities. METHODS Prospective cohort study of 578 cognitively intact residents from 34 RVs in Auckland, New Zealand (NZ). MEASUREMENT InterRAI-Community Health Assessment (includes core items that may trigger functional supplement (FS) completion in those with higher needs, and generates clinical assessment protocols (CAPs) in those with potential unmet needs). OUTCOMES time to acute hospitalization, long-term care (LTC), and death during average 2.5 years follow-up. RESULTS Three hundred seven (53%) residents had acute hospitalizations, 65 (11%) moved to LTC, and 51 (9%) died over a mean of 2.5 years. Factors associated with increased risk of acute hospitalization included CAP-falls (high risk) triggered, number of comorbidities, not having left RV in 2 weeks prior, moderate/severe hearing impairment, CAP-cardiorespiratory conditions triggered, acute hospitalization in year prior and age, with significant hazard ratios (HR) ranging between 1.03 and 2.90. Factors associated with reduced risk of hospitalization included other (non-NZ) European ethnicity (HR 0.73, 95% CI 0.55-0.98, p = 0.04), presence of on-site clinic (HR 0.62, 95% CI 0.45-0.85, p = 0.003), no influenza vaccination (HR 0.56, 95% CI 0.38-0.83, p = 0.004). Factors associated with LTC transition included FS triggered (HR 3.84, 95% CI 1.92-7.66, p < 0.001), CAP-instrumental activities of daily living (IADL) (HR 2.62, 95% CI 1.22-5.62, p = 0.01), CAP-social relationship triggered (HR 2.00, 95% CI 1.13-3.55, p = 0.02), and age (HR 1.13, 95% CI 1.07-1.18 p < 0.001). Factors associated with mortality included number of comorbidities (HR 3.75, 95% CI 1.54-9.10, p = 0.004 for 3-5 comorbidities), CAP-IADL triggered (HR 3.05, 95% CI 1.30-7.16, p = 0.01), and age (HR 1.11, 95% CI 1.05-1.18, p < 0.001). CONCLUSION A large proportion of cognitively intact RV residents are admitted to hospital in mean 2.5 years of follow-up. Multiple factors were associated with acute hospitalization risk. On-site clinics were associated with reduced risk and should be considered in RV development.
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Affiliation(s)
- Katherine Bloomfield
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Cheryl Calvert
- Community and Long Term Conditions, Auckland District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Ann-Marie Higgins
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
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Abstract
OBJECTIVES The number of older people choosing to relocate to retirement villages (RVs) is increasing rapidly. This choice is often a way to decrease social isolation while still living independently. Loneliness is a significant health issue and contributes to overall frailty, yet RV resident loneliness is poorly understood. Our aim is to describe the prevalence of loneliness and associated factors in a New Zealand RV population. DESIGN A resident survey was used to collect demographics, social engagement, loneliness, and function, as well as a comprehensive geriatric assessment (international Resident Assessment Instrument [interRAI]) as part of the "Older People in Retirement Villages Study." SETTING RVs, Auckland, New Zealand. PARTICIPANTS Participants included RV residents living in 33 RVs (n = 578). MEASUREMENTS Two types of recruitment: randomly sampled cohort (n = 217) and volunteer sample (n = 361). Independently associated factors for loneliness were determined through multiple logistic regression with odds ratios (ORs). RESULTS Of the participants, 420 (72.7%) were female, 353 (61.1%) lived alone, with the mean age of 81.3 years. InterRAI assessment loneliness (yes/no question) was 25.8% (n = 149), and the resident survey found that 37.4% (n = 216) feel lonely sometimes/often/always. Factors independently associated with interRAI loneliness included being widowed (adjusted OR 8.27; 95% confidence interval [CI] 4.15-16.48), being divorced/separated/never married (OR 4.76; 95% CI 2.15-10.54), poor/fair quality of life (OR 3.37; 95% CI 1.43-7.94), moving to an RV to gain more social connections (OR 1.55; 95% CI 0.99-2.43), and depression risk (medium risk: OR 2.58, 95% CI 1.53-4.35; high risk: OR 4.20, 95% CI 1.47-11.95). CONCLUSION A considerable proportion of older people living in RVs reported feelings of loneliness, particularly those who were without partners, at risk of depression and decreased quality of life and those who had moved into RVs to increase social connections. Early identification of factors for loneliness in RV residents could support interventions to improve quality of life and positively impact RV resident health and well-being.
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Joseph Connolly M, Hikaka J, Bloomfield K, Broad J, Wu Z, Boyd M, Peri K, Calvert C, Tatton A, Higgins AM, Bramley D. Research in the retirement village community-The problems of recruiting a representative cohort of residents in Auckland, New Zealand. Australas J Ageing 2021; 40:177-183. [PMID: 33594804 DOI: 10.1111/ajag.12898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Retirement villages are semi-closed communities, access usually being gained via village managers. This paper explores issues recruiting a representative resident cohort, as background to a study of residents, to acquire sociodemographic, health and disability data and trial an intervention designed to improve outcomes. METHODS We planned approaching all Auckland/Waitematā District villages and, via managers, contacting residents ('letter-drop'; 'door-knocks'). In 'small' villages (n ≤ 60 units), we planned contacting all residents, randomly selecting in 'larger' villages. We excluded those with doubtful or absent legal capacity. RESULTS We approached managers of 53 of 65 villages. Thirty-four permitted recruitment. Some prohibited 'letter-drops' and/or 'door-knocks'. Hence, we recruited volunteers (23 villages) via meetings, posters, newsletters and word-of-mouth, that is representative sampling obtained from 11/34 villages. We recruited 578 residents (median age = 82 years; 420 = female; 217:361 sampled:volunteers), finding differences in baseline parameters of sampled vs. volunteers. CONCLUSION Due to organisational/managers' policy, and national legislation restrictions, our sample does not represent our intended population well. Researchers should investigate alternative data sources, for example electoral rolls and censuses.
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Affiliation(s)
- Martin Joseph Connolly
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Waitematā District Health Board, Auckland, New Zealand
| | - Katherine Bloomfield
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
| | - Joanna Broad
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand
| | - Michal Boyd
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand.,School of Nursing, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Cheryl Calvert
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand
| | - Annie Tatton
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
| | - Ann-Marie Higgins
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand
| | - Dale Bramley
- Waitematā District Health Board, Auckland, New Zealand
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Peri K, Broad JB, Hikaka J, Boyd M, Bloomfield K, Wu Z, Calvert C, Tatton A, Higgins AM, Bramley D, Connolly MJ. Study protocol: older people in retirement villages. A survey and randomised trial of a multi-disciplinary invention designed to avoid adverse outcomes. BMC Geriatr 2020; 20:247. [PMID: 32680465 PMCID: PMC7367387 DOI: 10.1186/s12877-020-01640-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 07/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background There is increasing interest among older people in moving into retirement villages (RVs), an attractive option for those seeking a supportive community as they age, while still maintaining independence. Currently in New Zealand there is limited knowledge of the medical, service supports, social status and needs of RV residents. The objective of this study is to explore RV facilities and services, the health and functional status of RV residents, prospectively study their healthcare trajectories and to implement a multidisciplinary team intervention to potentially decrease dependency and impact healthcare utilization. Methods All RVs located in two large district health boards in Auckland, New Zealand were eligible to participate. This three-year project comprised three phases: The survey phase provided a description of RVs, residents’ characteristics and health and functional status. RV managers completed a survey of size, facilities and recreational and healthcare services provided in the village. Residents were surveyed to establish reasons for entry to the village and underwent a Gerontology Nurse Specialist (GNS) assessment providing details of demographics, social engagement, health and functional status. The cohort study phase examines residents’ healthcare trajectories and adverse outcomes, over three years. The final phase is a randomised controlled trial of a multidisciplinary team intervention aimed to improve health outcomes for more vulnerable residents. Residents who triggered potential unmet health needs during the assessment in the survey phase were randomised to intervention or usual care groups. Multidisciplinary team meetings included the resident and support person, a geriatrician or gerontology nurse practitioner, GNS, pharmacist and General Practitioner. The primary outcome of the randomised controlled trial will be first acute hospitalization. Secondary outcomes include all acute hospitalizations, long-term care admissions, and all-cause mortality. Discussion This paper describes the study protocol of this complex study. The study aims to inform policies and practices around health care services for residents in retirement villages. The results of this trial are expected early 2020 with publication subsequently. Trial registration Australia and New Zealand Clinical Trials Registry: ACTRN12616000685415. Registered 25.5.2016. Universal Trial Number (UTN): U111–1173-6083.
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Affiliation(s)
- K Peri
- School of Nursing, University of Auckland, Private Bag 92 019, Auckland, 1142, New Zealand
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - J Hikaka
- Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - M Boyd
- School of Nursing, University of Auckland, Private Bag 92 019, Auckland, 1142, New Zealand.,Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - Z Wu
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - C Calvert
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Auckland District Health Board, Private Bag 92 024, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - A Tatton
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - A-M Higgins
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - D Bramley
- Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - M J Connolly
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand. .,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.
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Rahman MM, Byles JE. Trajectories of Long-Term Residential Care Needs Among Older Australian Women: A Cohort Study Using Linked Data. J Am Med Dir Assoc 2019; 21:786-792.e2. [PMID: 31668738 DOI: 10.1016/j.jamda.2019.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/08/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Older women are more likely than men to enter residential aged care (RAC) and generally stay longer. We aimed to identify and examine their trajectories of care needs over time in RAC across 3 fundamental care needs domains, including activities of daily living (ADL), behavior, and complex health care. DESIGN Population-based longitudinal cohort study. SETTING RAC facilities in Australia. PARTICIPANTS A total of 3519 participants from the 1921-1926 birth cohort of the Australian Longitudinal Study on Women's Health (ALSWH), who used permanent RAC between 2008 and 2014. METHODS We used data from the Aged Care Funding Instrument, National Death Index, and linked ALSWH survey. Participants' care needs in the 3 domains were followed every 6 months up to 60 months from the date of admission to RAC. Trajectories of care needs over time were identified using group-based multitrajectory modeling. RESULTS Five distinct trajectory groups were identified, with large variation in the combinations of levels of care needs over time. Approximately 28% of residents belonged to the "high dependent-behavioral and complex need" group, which had high care needs in all 3 domains over time, whereas around one-third of residents (31%) were included in 2 trajectory groups ("less dependent-low need" and "less dependent-increasing need"), which had low or low to medium care needs over time. More than two-fifths of residents (41%) comprised 2 trajectory groups ("high dependent-complex need" and "high dependent-behavioral need"), which had medium to high care needs in 2 domains. Higher age at admission to RAC and multiple morbidities were associated with increased odds of being a member of the high dependent-complex need group than the less dependent-increasing need group. CONCLUSIONS AND IMPLICATIONS Identification of the differential trajectories of care needs among older women in RAC will help to better understand the circumstances of their changing care needs over time. This will facilitate appropriate care planning and service delivery for RAC residents, who are mostly older women.
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Affiliation(s)
- Md Mijanur Rahman
- Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Australia; Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle, Australia; Department of Statistics, Comilla University, Bangladesh.
| | - Julie E Byles
- Priority Research Centre for Generational Health and Ageing, The University of Newcastle, Australia; Centre for Clinical Epidemiology and Biostatistics, The University of Newcastle, Australia
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Connolly MJ, Broad JB, Bish T, Zhang X, Bramley D, Kerse N, Bloomfield K, Boyd M. Reducing emergency presentations from long-term care: A before-and-after study of a multidisciplinary team intervention. Maturitas 2018; 117:45-50. [PMID: 30314560 DOI: 10.1016/j.maturitas.2018.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/20/2018] [Accepted: 08/31/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The complexity of care required by many older people living in long-term care (LTC) facilities poses challenges that can lead to potentially avoidable referrals to a hospital emergency department (ED). The Aged Residential Care Intervention Project (ARCHIP) ran an implementation study to evaluate a multidisciplinary team (MDT) intervention supporting LTC facility staff to decrease potentially avoidable ED presentations by residents. METHODS ARCHIP (conducted in 21 facilities [1,296 beds] with previously noted high ED referral rates) comprised clinical coaching for LTC facility staff by a gerontology nurse specialist (GNS) and an MDT (facility senior nurse, resident's general practitioner, GNS, geriatrician, pharmacist) review of selected high-risk residents' care-plans. A before-after repeated measures analysis was conducted for 9 months before and 9 months after intervention commencement (a 29-month period because of staggered facility enrolment). Modelling was adjusted for time trend, seasonality, facility size, and cluster effect. RESULTS ED admission rate ratio post- versus pre-intervention was 0.75 (95% C.I. 0.63, 0.89, p-value = 0.0008), a 25% reduction in ED presentations post-intervention. A sensitivity model used a shorter, staggered time period centred on intervention start (9 months pre-intervention and 9 months post-intervention) for each facility, and a four-level categorical intervention variable testing intervention effect over time. The sensitivity test showed a 24% reduction in ED presentations in months 1-3 post-intervention (p-value = 0.07), a 34% reduction in months 4-6 (p-value = 0.01), and a 32% reduction in ED presentations in months 7-9 (p-value = 0.03). However, when the higher ED referral rates for 3 months immediately pre-intervention were modelled, the impact of the intervention on ED presentation rates reverted almost to previous levels. KEY CONCLUSIONS A GNS-led MDT outreach intervention, targeted at selected conditions, decreases avoidable ED admissions of high-risk residents from selected facilities.
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Affiliation(s)
- M J Connolly
- Department of Geriatric Medicine, University of Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand.
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, New Zealand
| | - T Bish
- Waitemata District Health Board, Auckland, New Zealand
| | - X Zhang
- Department of Geriatric Medicine, University of Auckland, New Zealand
| | - D Bramley
- Waitemata District Health Board, Auckland, New Zealand
| | - N Kerse
- School of Population Health, University of Auckland, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand
| | - M Boyd
- Department of Geriatric Medicine, University of Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand; School of Nursing, University of Auckland, New Zealand
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Forbes V, Harvey C, Meyer A. Nurse practitioners in aged care settings: a study of general practitioners’ and registered nurses’ views. Contemp Nurse 2018; 54:220-231. [DOI: 10.1080/10376178.2018.1484258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Vicki Forbes
- Eastern Institute of Technology (Hawke’s Bay), 501 Gloucester St, Taradale, Napier 4112, New Zealand
| | - Clare Harvey
- School of Nursing, Midwifery, and Social Sciences, Central Queensland University, Mackay Campus, Mackay, QLD, AUS 4740, Australia
| | - Alannah Meyer
- Eastern Institute of Technology (Hawke’s Bay), 501 Gloucester St, Taradale, Napier 4112, New Zealand
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Broad JB, Lumley T, Ashton T, Davis PB, Boyd M, Connolly MJ. Transitions to and from long-term care facilities and length of completed stay: Reuse of population-based survey data. Australas J Ageing 2017; 36:E1-E7. [PMID: 28319325 DOI: 10.1111/ajag.12378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This article estimates length of completed stay and resident transitions for RAC residents over 12 months in Auckland. METHODS Data from a census-type survey of nursing home residents (n = 6816) were linked with national mortality data. Transitions described include entry to residential aged care (RAC), movement between RAC facilities and deaths. RESULTS When reweighted for missing data and adjusted for length bias, an estimated 9676 residents (95% CI 8368-10 985) used care over a 12-month period. Half of new residents entered RAC via an acute hospital. Median survival was 2.0 years; 17% died within 3 months, and 23% survived over 5 years. CONCLUSION Cross-sectional survey data, when appropriately adjusted for length-biased sampling, enable estimates of period prevalence and transition probabilities that are useful for simulation studies. Given population ageing and the costs of ongoing care, these results can inform policy and planning for long-term care needs of older people.
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Affiliation(s)
- Joanna B Broad
- Freemasons' Department of Geriatric Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Toni Ashton
- Health Systems, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Peter B Davis
- COMPASS Research Centre, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Freemasons' Department of Geriatric Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,School of Nursing, University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
| | - Martin J Connolly
- Freemasons' Department of Geriatric Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Waitemata District Health Board, Auckland, New Zealand
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Borotkanics R, Rowe C, Georgiou A, Douglas H, Makeham M, Westbrook J. Changes in the profile of Australians in 77 residential aged care facilities across New South Wales and the Australian Capital Territory. AUST HEALTH REV 2017; 41:613-620. [DOI: 10.1071/ah16125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/07/2016] [Indexed: 11/23/2022]
Abstract
Objective Government expenditure on and the number of aged care facilities in Australia have increased consistently since 1995. As a result, a range of aged care policy changes have been implemented. Data on demographics and utilisation are important in determining the effects of policy on residential aged care services. Yet, there are surprisingly few statistical summaries in the peer-reviewed literature on the profile of Australian aged care residents or trends in service utilisation. Therefore, the aim of the present study was to characterise the demographic profile and utilisation of a large cohort of residential aged care residents, including trends over a 3-year period. Methods We collected 3 years of data (2011–14) from 77 residential aged care facilities and assessed trends and differences across five demographic and three service utilisation variables. Results The median age at admission over the 3-year period remained constant at 86 years. There were statistically significant decreases in separations to home (z = 2.62, P = 0.009) and a 1.35% increase in low care admissions. Widowed females made up the majority (44.75%) of permanent residents, were the oldest and had the longest lengths of stay. One-third of permanent residents had resided in aged care for 3 years or longer. Approximately 30% of residents were not born in Australia. Aboriginal residents made up less than 1% of the studied population, were younger and had shorter stays than non-Aboriginal residents. Conclusion The analyses revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. There have been several changes in aged care policy over the decades. The analyses outlined herein illustrate how community, health services and public health data can be used to inform policy, monitor progress and assess whether intended policy has had the desired effects on aged care services. What is known about the topic? Characterisation of permanent residents and their utilisation of residential aged care facilities is poorly described in the peer-reviewed literature. Further, publicly available government reports are incomplete or characterised using incomplete methods. What does this paper add? The analyses in the present study revealed a clear demographic profile and consistent pattern of utilisation of aged care facilities. The most significant finding of the study is that one-third of permanent residents had resided in an aged care facility for ≥3 years. These findings add to the overall picture of residential aged care utilisation in Australia. What are the implications for practitioners? The analyses outlined herein illustrate how community, health services and public health data can be utilised to inform policy, monitor progress and assess whether or not intended policy has had the desired effects on aged care services.
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Ndukwe HC, Nishtala PS, Wang T, Tordoff JM. Quality use of antipsychotic medicines inresidential aged care facilities in New Zealand. J Prim Health Care 2016. [PMID: 29530158 DOI: 10.1071/hc15054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Antipsychotic medicines are used regularly or when required in residential aged care facilities to treat symptoms of dementia, but have been associated with several adverse effects. AIM The aim of this study was to examine 'quality use' of antipsychotic medicines in residential aged care facilities in New Zealand, by surveying nurse managers. METHODS A cross-sectional survey was mailed to 318 nurse managers working in a nationally representative sample of aged care facilities. A purpose-developed, pre-tested, 22-item structured questionnaire was used to explore practice related to the quality use of antipsychotic medicines. RESULTS Overall, 31.4% of nurse managers responded to the survey. They mostly (88%) had ≥ 1 year's relevant work experience and 83% of facilities provided care for those within the range of 21 to 100 residents. Respondents reported that staff education on dementia management occurred early in employment. Two-thirds of participants reported non-pharmacological interventions were commonly used for managing challenging behaviours, while less than half (45%) cited administering antipsychotic medicine. Respondents reported 'managing behavioural symptoms' (81%) as one of the main indications for antipsychotic use. Frequently identified adverse effects of antipsychotic medicines were drowsiness or sedation (64%) and falls (61%). Over 90% reported general practitioners reviewed antipsychotic use with respect to residents' target behaviour 3-monthly, and two-thirds used an assessment tool to appraise residents' behaviour. DISCUSSION Staff education on dementia management soon after employment and resident 3-monthly antipsychotic medicine reviews were positive findings. However, a wider use of behavioural assessment tools might improve the care of residents with dementia and the quality use of antipsychotic medicines.
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Affiliation(s)
| | | | - Ting Wang
- Department of Mathematics and Statistics, University of Otago, New Zealand
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King A, Boyd M, Dagley L. Use of a screening tool and primary health care gerontology nurse specialist for high-needs older people. Contemp Nurse 2016; 53:23-35. [DOI: 10.1080/10376178.2016.1257920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anna King
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, The University of Auckland, Auckland, New Zealand
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Frey R, Boyd M, Foster S, Robinson J, Gott M. What's the diagnosis? Organisational culture and palliative care delivery in residential aged care in New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:450-462. [PMID: 25808936 DOI: 10.1111/hsc.12220] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 06/04/2023]
Abstract
Organisational culture has been shown to impact on resident outcomes in residential aged care (RAC). This is particularly important given the growing number of residents with high palliative care needs. The study described herein (conducted from January 2013 to March 2014) examined survey results from a convenience sample of 46 managers, alongside interviews with a purposively selected sample of 23 bereaved family members in order to explore the perceptions of organisational culture within New Zealand RAC facilities in one large urban District Health Board. Results of the Organisational Culture Assessment Instrument (OCAI) completed by managers indicated a preference for a 'Clan' and the structured 'Hierarchy' culture. Bereaved family interviews emphasised both positive and negative aspects of communication, leadership and teamwork, and relationship with residents. Study results from both managers' OCAI survey scores and next of kin interviews indicate that while the RAC facilities are culturally oriented towards providing quality care for residents, they may face barriers to adopting organisational processes supportive of this goal.
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Affiliation(s)
- Rosemary Frey
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - Sue Foster
- Waitemata District Health Board, Auckland, New Zealand
| | - Jackie Robinson
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Merryn Gott
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Boyd M, Broad JB, Zhang TX, Kerse N, Gott M, Connolly MJ. Hospitalisation of older people before and after long-term care entry in Auckland, New Zealand. Age Ageing 2016; 45:558-63. [PMID: 27055876 DOI: 10.1093/ageing/afw051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 02/09/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION global population projections forecast large growth in demand for long-term care (LTC) and acute hospital services for older people. Few studies report changes in hospitalisation rates before and after entry into LTC. This study compares hospitalisation rates 1 year before and after LTC entry. METHODS the Older Persons' Ability Level (OPAL) study was a 2008 census-type survey of LTC facilities in Auckland, New Zealand. OPAL resident hospital admissions and deaths were obtained from routinely collected national databases. RESULTS all 2,244 residents (66% = female) who entered LTC within 12 months prior to OPAL were included. There were 3,363 hospitalisations, 2,424 in 12 months before and 939 in 12 months after entry, and 364 deaths. In the 6 to 12 months before LTC entry, the hospitalisation rate/100 person-years was 67.3 (95% confidence interval [CI] 62.5-72.1). Weekly rates then rose steeply to over 450/100 person-years in the 6 months immediately before LTC entry. In the 6 months after LTC entry, the rate fell to 49.1 (CI 44.9-53.3; RR 0.73 (CI 0.65-0.82, P < 0.0001)) and decreased further 6 to 12 months after entry to 41.1 (CI 37.1-45.1; rate ratio [RR] 0.61 (CI 0.54-0.69, P < 0.0001)). CONCLUSIONS increased hospitalisations a few months before LTC entry suggest functional and medical instability precipitates LTC entry. New residents utilise hospital beds less frequently than when at home before that unstable period. Further research is needed to determine effective interventions to avoid some hospitalisations and possibly also LTC entry.
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16
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Connolly MJ, Broad JB, Boyd M, Zhang TX, Kerse N, Foster S, Lumley T, Whitehead N. The 'Big Five'. Hypothesis generation: a multidisciplinary intervention package reduces disease-specific hospitalisations from long-term care: a post hoc analysis of the ARCHUS cluster-randomised controlled trial. Age Ageing 2016; 45:415-20. [PMID: 27021357 DOI: 10.1093/ageing/afw037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/15/2016] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION long-term care (LTC) residents have higher hospitalisation rates than non-LTC residents. Rapid decline may follow hospitalisations, hence the importance of preventing unnecessary hospitalisations. Literature describes diagnosis-specific interventions (for cardiac failure, ischaemic heart disease, chronic obstructive pulmonary disease, stroke, pneumonia-termed 'big five' diagnoses), impacting on hospitalisations of older community-dwellers, but few RCTs show reductions in acute admissions from LTC. METHODS LTC facilities with higher than expected hospitalisations were recruited for a cluster-randomised controlled trial (RCT) of facility-based complex, non-disease-specific, 9-month intervention comprising gerontology nurse specialist (GNS)-led staff education, facility benchmarking, GNS resident review and multidisciplinary discussion of residents selected using standard criteria. In this post hoc exploratory analysis, the outcome was acute hospitalisations for 'big five' diagnoses. Re-randomisation analyses were used for end points during months 1-14. For end points during months 4-14, proportional hazards models are adjusted for within-facility clustering. RESULTS we recruited 36 facilities with 1,998 residents (1,408 female; mean age 82.9 years); 1,924 were alive at 3 months. The intervention did not impact overall rates of acute hospitalisations or mortality (previously published), but resulted in fewer 'big five' admissions (RR = 0.73, 95% CI = 0.54-0.99; P = 0.043) with no significant difference in the rate of other acute admissions. When considering events occurring after 3 months (only), the intervention group were 34.7% (HR = 0.65; 95% CI = 0.49-0.88; P = 0.005) less likely to have a 'big five' acute admission than controls, with no differences in likelihood of acute admissions for other diagnoses (P = 0.96). CONCLUSIONS this generic intervention may reduce admissions for common conditions which the literature shows are impacted by disease-specific admission reduction strategies.
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Affiliation(s)
- Martin J Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand Waitemata District Health Board, Auckland, New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand Waitemata District Health Board, Auckland, New Zealand Department of Nursing, University of Auckland, Auckland, New Zealand
| | - Tony Xian Zhang
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Susan Foster
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand Waitemata District Health Board, Auckland, New Zealand
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Noeline Whitehead
- Department of Nursing, University of Auckland, Auckland, New Zealand
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McGilton KS, Bowers BJ, Heath H, Shannon K, Dellefield ME, Prentice D, Siegel EO, Meyer J, Chu CH, Ploeg J, Boscart VM, Corazzini KN, Anderson RA, Mueller CA. Recommendations From the International Consortium on Professional Nursing Practice in Long-Term Care Homes. J Am Med Dir Assoc 2015; 17:99-103. [PMID: 26712302 DOI: 10.1016/j.jamda.2015.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
In response to the International Association of Gerontology and Geriatrics' global agenda for clinical research and quality of care in long-term care homes (LTCHs), the International Consortium on Professional Nursing Practice in Long Term Care Homes (the Consortium) was formed to develop nursing leadership capacity and address the concerns regarding the current state of professional nursing practice in LTCHs. At its invitational, 2-day inaugural meeting, the Consortium brought together international nurse experts to explore the potential of registered nurses (RNs) who work as supervisors or charge nurses within the LTCHs and the value of their contribution in nursing homes, consider what RN competencies might be needed, discuss effective educational (curriculum and practice) experiences, health care policy, and human resources planning requirements, and to identify what sustainable nurse leadership strategies and models might enhance the effectiveness of RNs in improving resident, family, and staff outcomes. The Consortium made recommendations about the following priority issues for action: (1) define the competencies of RNs required to care for older adults in LTCHs; (2) create an LTCH environment in which the RN role is differentiated from other team members and RNs can practice to their full scope; and (3) prepare RN leaders to operate effectively in person-centered care LTCH environments. In addition to clear recommendations for practice, the Consortium identified several areas in which further research is needed. The Consortium advocated for a research agenda that emphasizes an international coordination of research efforts to explore similar issues, the pursuit of examining the impact of nursing and organizational models, and the showcasing of excellence in nursing practice in care homes, so that others might learn from what works. Several studies already under way are also described.
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Affiliation(s)
- Katherine S McGilton
- Toronto Rehabilitation Institute-UHN, Toronto, ON, Canada; Lawrence S. Bloomberg of Nursing, University of Toronto, Toronto, ON, Canada.
| | | | - Hazel Heath
- Division of Nursing, School of Health Sciences, City University London, London, England, UK
| | - Kay Shannon
- Auckland University of Technology, Auckland, New Zealand
| | | | - Dawn Prentice
- Department of Nursing, Brock University, St. Catharines, ON, Canada
| | - Elena O Siegel
- Betty Irene Moore School of Nursing at UC Davis, UC Davis Health System, Sacramento, CA
| | - Julienne Meyer
- Division of Nursing, School of Health Sciences, City University London, London, England, UK
| | - Charlene H Chu
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jenny Ploeg
- School of Health and Life Sciences and Community Services, Conestoga College, Kitchener, ON, Canada
| | - Veronique M Boscart
- School of Health and Life Sciences and Community Services, Conestoga College, Kitchener, ON, Canada
| | - Kirsten N Corazzini
- School of Nursing, Duke University Centre for the Study of Aging and Human Development, Durham, NC
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Jaye C, Hale B, Butler M, McKechnie R, Robertson L, Simpson J, Tordoff J, Young J. One of us: Stories from two New Zealand rest homes. J Aging Stud 2015; 35:135-43. [PMID: 26568223 DOI: 10.1016/j.jaging.2015.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/25/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
Abstract
In this article we explore the ways in which two aged residential care facilities in New Zealand construct and present themselves through the stories told by those who live and work in them. Ethnographic field notes and interviews were analysed using an immersion/crystallization method consistent with a narrative gerontology framework. Woven into residents' stories about their lives in the facility were tales of earlier lives and identities, immigration, occupations, marriage, tragedies and medical emergencies. Care workers, nursing staff and managers talked about vocation, the ethos and values of the institution and the importance that both staff and residents felt a sense of belonging and 'being one of us.' These stories, 'talk into reality' the aged residential care facility as a particular kind of rest home, in which residents feel 'at home'. In addition, as researchers who brought our own stories to the project, we actively contributed to the construction of each institution as a certain kind of facility.
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Affiliation(s)
- Chrystal Jaye
- University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - Beatrice Hale
- University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Mary Butler
- Otago Polytechnic, PO Box 1910, Dunedin 9054, New Zealand
| | - Roz McKechnie
- University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | | | - Jean Simpson
- University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - June Tordoff
- University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Jessica Young
- University of Otago, PO Box 56, Dunedin 9054, New Zealand
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Heppenstall CP, Broad JB, Boyd M, Hikaka J, Zhang X, Kennedy J, Connolly MJ. Medication use and potentially inappropriate medications in those with limited prognosis living in residential aged care. Australas J Ageing 2015; 35:E18-24. [PMID: 26416493 DOI: 10.1111/ajag.12220] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To compare the prevalence in residential aged care (RAC) of preventative and potentially inappropriate medications (PIMs) in those who died within 12 months versus those alive after 12 months. METHODS Firstly, a cross-sectional survey of 6196 people living in RAC in Auckland. Secondly, a research physician searched electronic hospital records in one District Health Board for a sub-sample (n = 222) of these residents. Classes of medications and dates of death were obtained from the Ministry of Health databases. Those who died versus those alive at 12 months were compared. RESULTS Over half of the 6196 participants received antihypertensives and/or antiplatelet agents. Cardiovascular preventative medications were significantly more common in those who died within 12 months. Seventy percent in high-level care received psychotropics. PIMs were commonly used. CONCLUSIONS Use of preventative medications is common in RAC, especially during the last year of life. Psychotropics are very commonly used, despite being potentially inappropriate.
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Affiliation(s)
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Joanna Hikaka
- Aged Residential Care, Inpatient Pharmacy, Waitemata District Health Board, Auckland, New Zealand
| | - Xian Zhang
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Julia Kennedy
- School of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand.,Department of Geriatric Medicine, Waitemata District Health Board, Auckland, New Zealand
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20
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Kerse N, Teh R, Moyes SA, Broad J, Rolleston A, Gott M, Kepa M, Wham C, Hayman K, Jatrana S, Adamson A, Lumley T. Cohort Profile: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ). Int J Epidemiol 2015; 44:1823-32. [DOI: 10.1093/ije/dyv103] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Heppenstall CP, Broad JB, Boyd M, Gott M, Connolly MJ. Progress towards predicting 1-year mortality in older people living in residential long-term care. Age Ageing 2015; 44:497-501. [PMID: 25652076 DOI: 10.1093/ageing/afu206] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 09/11/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND frail older people living in residential long-term care (LTC) have limited life expectancy. Identifying those with poor prognosis may improve management and facilitate transition to a palliative approach to care. OBJECTIVE to develop methods for predicting mortality in LTC. DESIGN a population-based cohort study. SETTING LTC facilities, Auckland, New Zealand. SUBJECTS five hundred randomly selected older people in a census-type survey of those living in LTC in 2008. METHODS mortality data were obtained from New Zealand Ministry of Health. Two methods for assessing mortality risk were developed using demographic, functional and health service information: (i) two geriatricians blinded to identifying data and to mortality, independently reviewed survey, medications and pre-survey hospitalisations data, and grouped residents according to perceived risk of death within 12 months; (ii) multivariate logistic regression model used the same survey and medication items as the geriatricians. RESULTS for the geriatricians' assessment, each quintile of perceived risk was associated with a significant increase in mortality (P < 0.001). Area under the curve (AUC) for both physicians was 0.64. The logistic regression model included age, gender, assistance with feeding and requiring night attention, all variables which are easily available from LTC records. AUC for the model was 0.70, but when validated against the entire OPAL cohort, it was 0.65. When either or both geriatrician and the model together predicted high risk of death, 1-year mortality was >50%. CONCLUSION two methods with the potential to identify older people with limited prognosis are described. Use of these methods allowed identification of over half of those who died within 12 months.
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Affiliation(s)
- Claire Patricia Heppenstall
- Department of Medicine, University of Otago, Christchurch, 1st Floor, Princess Margaret Hopital, PO Box 800, Christchurch 8140, New Zealand
| | - Joanna B Broad
- Freemasons Department of Geriatric Medicine, University of Auckland, Auckland 0740, New Zealand
| | - Michal Boyd
- Freemasons Department of Geriatric Medicine, University of Auckland, Auckland 0740, New Zealand Waitemata District Health Board, Auckland, New Zealand Department of Nursing, University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- Department of Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Freemasons Department of Geriatric Medicine, University of Auckland, Auckland 0740, New Zealand Waitemata District Health Board, Auckland, New Zealand
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Viana BDM, Bicalho MAC, Moraes EN, Romano-Silva MA. Twenty-four-year demographic trends of a Brazilian long-term care institution for the aged. J Am Med Dir Assoc 2014; 16:174.e1-6. [PMID: 25533146 DOI: 10.1016/j.jamda.2014.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 11/14/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objectives of this study were to assess demographic trends of a long-term care institution (LTCI) for the aged throughout 24 years and to discuss the results considering regulations and demographic, socioeconomic, and epidemiological changes in Brazil during this period. METHODS We assessed administrative data of 394 residents of a Brazilian LTCI between January 1, 1990, and December 31, 2013. We calculated age at admission, age at death, length of stay (LOS), and median age of the residents on December 31 for each year from 1990 to 2013. Annual mortality index and total number of admissions and discharges also were analyzed. We used the Jonckheere-Terpstra trend test and 1-way ANOVA for statistical analysis. RESULTS We observed a significant statistical increased trend of the mean age at admission, of the median age of the residents, and of the median LOS throughout the period. There was no increased or decreased trend of the median age at death. CONCLUSIONS The increased trend of the mean age at admission and the median age of the residents may reflect improvements in health, socioeconomic status, life expectancy, and the development of protective regulations for older adults in Brazil. The increased trend of the median LOS may reflect the aforementioned improvements, but we expect a future inversion of this trend due to the admission of older, sicker, and more functionally dependent elderly individuals.
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Affiliation(s)
- Bernardo de Mattos Viana
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil; Núcleo de Geriatria e Gerontologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil.
| | - Maria Aparecida Camargos Bicalho
- Núcleo de Geriatria e Gerontologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil; Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil
| | - Edgar Nunes Moraes
- Núcleo de Geriatria e Gerontologia, Hospital das Clínicas da Universidade Federal de Minas Gerais, Brasil; Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil
| | - Marco Aurélio Romano-Silva
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil; Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, Brasil
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Boyd M, Armstrong D, Parker J, Pilcher C, Zhou L, McKenzie-Green B, Connolly MJ. Do gerontology nurse specialists make a difference in hospitalization of long-term care residents? Results of a randomized comparison trial. J Am Geriatr Soc 2014; 62:1962-7. [PMID: 25283552 DOI: 10.1111/jgs.13022] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Residents of long-term care facilities have highly complex care needs and quality of care is of international concern. Maintaining resident wellness through proactive assessment and early intervention is key to decreasing the need for acute hospitalization. The Residential Aged Care Integration Program (RACIP) is a quality improvement intervention to support residential aged care staff and includes on-site support, education, clinical coaching, and care coordination provided by gerontology nurse specialists (GNSs) employed by a large district health board. The effect of the outreach program was evaluated through a randomized comparison of hospitalization 1 year before and after program implementation. The sample included 29 intervention facilities (1,425 residents) and 25 comparison facilities (1,128 residents) receiving usual care. Acute hospitalization rate unexpectedly increased for both groups after program implementation, although the rate of increase was significantly less for the intervention facilities. The hospitalization rate after the intervention increased 59% for the comparison group and 16% for the intervention group (rate ratio (RR) = 0.73, 95% confidence interval (CI) = 0.61-0.86, P < .001). Subgroup analysis showed a significantly lower rate change for those admitted for medical reasons for the intervention group (13% increase) than the comparison group (69% increase) (RR = 0.67, 95% CI = 0.56-0.82, P < .001). Conversely, there was no significant difference in the RR for surgical admissions between the intervention and comparison groups (RR = 1.0, 95% CI = 0.68-1.46, P = .99). The integration of GNS expertise through the RACIP intervention may be one approach to support staff to provide optimal care and potentially improve resident health.
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Affiliation(s)
- Michal Boyd
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand; School of Nursing, University of Auckland, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand
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Connolly MJ, Boyd M, Broad JB, Kerse N, Lumley T, Whitehead N, Foster S. The Aged Residential Care Healthcare Utilization Study (ARCHUS): a multidisciplinary, cluster randomized controlled trial designed to reduce acute avoidable hospitalizations from long-term care facilities. J Am Med Dir Assoc 2014; 16:49-55. [PMID: 25239019 DOI: 10.1016/j.jamda.2014.07.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/01/2014] [Accepted: 07/09/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities. DESIGN Cluster randomized controlled trial. SETTING RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control. PARTICIPANTS A total of 1998 residents of 18 intervention facilities and 18 control facilities. INTERVENTION A facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria. MAIN OUTCOME MEASURES Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months. RESULTS The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85-1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76-1.61; P = .62). CONCLUSIONS This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging. Australian and New Zealand Clinical Trials Registry (ACTRN12611000187943).
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Affiliation(s)
- Martin J Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand.
| | - Michal Boyd
- Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand; Department of Nursing, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | | | - Susan Foster
- Freemasons' Department of Geriatric Medicine, University of Auckland, Takapuna, Auckland, New Zealand
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Broad JB, Ashton T, Lumley T, Boyd M, Kerse N, Connolly MJ. Selecting long-term care facilities with high use of acute hospitalisations: issues and options. BMC Med Res Methodol 2014; 14:93. [PMID: 25052433 PMCID: PMC4118262 DOI: 10.1186/1471-2288-14-93] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 06/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper considers approaches to the question "Which long-term care facilities have residents with high use of acute hospitalisations?" It compares four methods of identifying long-term care facilities with high use of acute hospitalisations by demonstrating four selection methods, identifies key factors to be resolved when deciding which methods to employ, and discusses their appropriateness for different research questions. METHODS OPAL was a census-type survey of aged care facilities and residents in Auckland, New Zealand, in 2008. It collected information about facility management and resident demographics, needs and care. Survey records (149 aged care facilities, 6271 residents) were linked to hospital and mortality records routinely assembled by health authorities. The main ranking endpoint was acute hospitalisations for diagnoses that were classified as potentially avoidable. Facilities were ranked using 1) simple event counts per person, 2) event rates per year of resident follow-up, 3) statistical model of rates using four predictors, and 4) change in ranks between methods 2) and 3). A generalized mixed model was used for Method 3 to handle the clustered nature of the data. RESULTS 3048 potentially avoidable hospitalisations were observed during 22 months' follow-up. The same "top ten" facilities were selected by Methods 1 and 2. The statistical model (Method 3), predicting rates from resident and facility characteristics, ranked facilities differently than these two simple methods. The change-in-ranks method identified a very different set of "top ten" facilities. All methods showed a continuum of use, with no clear distinction between facilities with higher use. CONCLUSION Choice of selection method should depend upon the purpose of selection. To monitor performance during a period of change, a recent simple rate, count per resident, or even count per bed, may suffice. To find high-use facilities regardless of resident needs, recent history of admissions is highly predictive. To target a few high-use facilities that have high rates after considering facility and resident characteristics, model residuals or a large increase in rank may be preferable.
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Affiliation(s)
- Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, C/- WDHB, Box 93503, Takapuna, Auckland 0740, New Zealand.
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Villela EL, Sakai P, Almeida MR, Moura EG, Faintuch J. Endoscopic gastrostomy replacement tubes: Long-term randomized trial with five silicone commercial models. Clin Nutr 2014; 33:221-5. [DOI: 10.1016/j.clnu.2013.04.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 03/26/2013] [Accepted: 04/17/2013] [Indexed: 02/08/2023]
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Broad JB, Ashton T, Lumley T, Connolly MJ. Reports of the proportion of older people living in long-term care: a cautionary tale from New Zealand. Aust N Z J Public Health 2014; 37:264-71. [PMID: 23731110 DOI: 10.1111/1753-6405.12069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Population ageing is driving many countries to review health and social care policies. For many, an important component is residential long-term care (LTC). This study uses New Zealand to ascertain the extent different reports provide consistent and accurate estimates of LTC use. METHODS We searched for available cross-sectional information about use of LTC by people aged 65 years or over in NZ's population since 1988. In addition, for one geographic region, Auckland, we compared research survey data at three time-points with the nearest census estimates. RESULTS Fifty-eight national-level estimates (census, subsidy payments and population surveys) were found. Since 2000, estimates of the proportion of older people reportedly living in long-term care ranged from 3.4% to 9.2%. Comparisons with Auckland studies demonstrated improved reporting in the 2006 census. CONCLUSION Estimates of the proportion of people living in residential LTC varied widely. OECD reports, often used for cross-national comparisons, were particularly inconsistent. IMPLICATIONS While estimates of the proportion of people living in residential LTC in NZ are inconsistent, improvements are evident in census and subsidy data. Reconciling new data with previous reports prior to publication may reduce variations in reporting. Improved reliability will assist understanding of within-country trends and international comparisons, and better inform decisions shaping health services for older people.
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Affiliation(s)
- Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, New Zealand.
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McLean C, Kerse N, Moyes SA, Ng T, Lin SYS, Peri K. Recruiting older people for research through general practice: the Brief Risk Identification Geriatric Health Tool trial. Australas J Ageing 2013; 33:257-63. [PMID: 24520915 DOI: 10.1111/ajag.12058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To describe successful methods of recruitment and identify practice characteristics related to increased recruitment of older people for a randomised controlled trial. METHODS General practices in three regions of New Zealand and community-dwelling patients aged 75+ were recruited for the Brief Risk Identification Geriatric Health Tool trial. General practitioners (GPs) were faxed invitations with telephone follow-up. Reply-paid cards with telephone follow-up were used to invite older people. GP and practice characteristics were examined in relationship to recruitment rate. RESULTS During 2007-2008, 158 of 438 GPs (36%) in 60 of 116 practices approached (52%) were recruited. Regional variation was marked and 3893 of 8308 invited (49%) older people were recruited. The GP's length of time at the practice and training in New Zealand was associated with recruitment success. CONCLUSIONS Despite variability in practice recruitment, a reasonably large and representative sample of older people was recruited through general practices.
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Affiliation(s)
- Christine McLean
- Department of General Practice and Primary Health Care, School of Population Health, University of Auckland, Auckland, New Zealand
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Connolly MJ, Broad JB, Boyd M, Kerse N, Gott M. Residential aged care: The de facto hospice for New Zealand's older people. Australas J Ageing 2013; 33:114-20. [DOI: 10.1111/ajag.12010] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Martin J Connolly
- Freemasons' Department of Geriatric Medicine; University of Auckland; Auckland New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine; University of Auckland; Auckland New Zealand
| | - Michal Boyd
- Freemasons' Department of Geriatric Medicine; University of Auckland; Auckland New Zealand
| | - Ngaire Kerse
- Department of General Practice; School of Population Health; University of Auckland; Auckland New Zealand
| | - Merryn Gott
- School of Nursing; University of Auckland; Auckland New Zealand
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Aged Residential Care Health Utilisation Study (ARCHUS): a randomised controlled trial to reduce acute hospitalisations from residential aged care. BMC Geriatr 2012; 12:54. [PMID: 22974314 PMCID: PMC3489701 DOI: 10.1186/1471-2318-12-54] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 09/05/2012] [Indexed: 11/17/2022] Open
Abstract
Background For residents of long term care, hospitalisations can cause distress and disruption, and often result in further medical complications. Multi-disciplinary team interventions have been shown to improve the health of Residential Aged Care (RAC) residents, decreasing the need for acute hospitalisation, yet there are few randomised controlled trials of these complex interventions. This paper describes a randomised controlled trial of a structured multi-disciplinary team and gerontology nurse specialist (GNS) intervention aiming to reduce residents’ avoidable hospitalisations. Methods/Design This Aged Residential Care Healthcare Utilisation Study (ARCHUS) is a cluster- randomised controlled trial (n = 1700 residents) of a complex multi-disciplinary team intervention in long-term care facilities. Eligible facilities certified for residential care were selected from those identified as at moderate or higher risk of resident potentially avoidable hospitalisations by statistical modelling. The facilities were all located in the Auckland region, New Zealand and were stratified by District Health Board (DHB). Intervention The intervention provided a structured GNS intervention including a baseline facility needs assessment, quality indicator benchmarking, a staff education programme and care coordination. Alongside this, three multi-disciplinary team (MDT) meetings were held involving a geriatrician, facility GP, pharmacist, GNS and senior nursing staff. Outcomes Hospitalisations are recorded from routinely-collected acute admissions during the 9-month intervention period followed by a 5-month follow-up period. ICD diagnosis codes are used in a pre-specified definition of potentially reducible admissions. Discussion This randomised-controlled trial will evaluate a complex intervention to increase early identification and intervention to improve the health of residents of long term care. The results of this trial are expected in early 2013. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN 12611000187943
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Boyd M, Bowman C, Broad JB, Connolly MJ. International comparison of long-term care resident dependency across four countries (1998-2009): a descriptive study. Australas J Ageing 2012; 31:233-40. [PMID: 23252981 DOI: 10.1111/j.1741-6612.2011.00584.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To describe an international comparison of dependency of long-term care residents. METHODS All Auckland aged care residents were surveyed in 1998 and 2008 using the 'Long-Term Care in Auckland' instrument. A large provider of residential aged care, Bupa-UK, performed a similar but separate functional survey in 2003, again in 2006 (including UK Residential Nursing Home Association facilities), and in 2009 which included Bupa facilities in Spain, New Zealand and Australia. The survey questionnaires were reconciled and functional impairment rates compared. RESULTS Of almost 90,000 residents, prevalence of dependent mobility ranged from 27 to 47%; chronic confusion, 46 to 75%; and double incontinence, 29 to 49%. Continence trends over time were mixed, chronic confusion increased, and challenging behaviour decreased. CONCLUSION Overall functional dependency for residents is high and comparable internationally. Available trends over time indicate increasing resident dependency signifying care required for this population is considerable and possibly increasing.
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Affiliation(s)
- Michal Boyd
- Freemasons' Department of Geriatric Medicine, Faculty of Medicine and Health Sciences, The University of Auckland, New Zealand.
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