Case management the panacea for aged care

The importance of trauma-informed care (TIC) within residential aged care (RAC) settings has been increasingly recognised. TIC would ensure that older people who have experienced trauma over their lifetime have their needs better understood and accommodated. This scoping review examined the extent to which TIC has been applied within RAC settings. A scoping review was conducted according to Cochrane recommendations and the PRISMA-ScR checklist. A systematic search of six databases (Embase, Emcare, CENTRAL, CINAHL, PsychInfo and Medline) was performed in July 2022 and March 2023 and peer-reviewed primary research, in English and involved RAC staff or residents (aged 65years and over) providing or receiving TIC were eligible for inclusion. Studies focused on trauma intervention, assessment, screening, or treatment were excluded. Thematic synthesis was performed to extract themes relating to trauma-informed practice, barriers and enablers to TIC, and outcomes from the application of TIC approaches. Five articles were included. There was little evidence of the implementation of TIC interventions in RAC settings. Only one study examined the application of a TIC framework in a RAC setting. However, there was some evidence that approaches that consider resident's experience of trauma have emerged from practice experience and been used in RAC as an extension of person-centred care. Whilst trauma-informed approaches to resident care are emerging through practice experience, and despite policy recommendations to do so, there is little evidence that formal TIC interventions or frameworks have been applied to RAC internationally. This study highlights a gap in research and practice and makes several recommendations for further research and implementation of TIC in RAC.

Objectives: This study examined knowledge of late-life depression among staff working in residential and community aged care settings, as well as their previous training in caring for older people with depression. Method: A sample of 320 aged care staff (mean age = 42 years) completed a survey questionnaire. Participants included direct care staff, registered nurses and Care Managers from nursing and residential homes and community aged care services. Results: Less than half of the participating aged care staff had received any training in depression, with particularly low rates in residential care. Although aware of the importance of engaging with depressed care recipients and demonstrating moderate knowledge of the symptoms of depression, a substantial proportion of staff members saw depression as a natural consequence of bereavement, aging or relocation to aged care. Conclusion: Experience in aged care appears to be insufficient for staff to develop high levels of knowledge of depression. Specific training in depression is recommended for staff working in aged care settings in order to improve the detection and management of late-life depression, particularly among direct carers, who demonstrated least knowledge of this common disorder.

Review question/objective The qualitative and quantitative objective of this review is to scope the extant knowledge about family involvement in decision making for people with dementia living in residential aged care. More specifically, the review question/s are: •Who are the decision makers for people with dementia living in residential care? •What is the experience of decision making for family members in the residential care setting? •What are the barriers or facilitators to decision making by families? •What is the impact of decision making processes on family members? •What is the impact of collaborative decision making with family on the person with dementia? • What processes or strategies do family decision-makers use? Inclusion criteria Types of participants This review will consider studies that include people with dementia who are living in residential aged care, their families and care staff. For the purpose of this review, the definition of “dementia” is not restricted to any specific diagnosis, stage or degree of severity. There is no age limit on participants included, provided they are living in residential aged care. Care staff may include any and all types of staff involved in providing care to people with dementia in residential aged care, including but not limited to nursing staff, medical staff and direct care staff. Types of intervention(s)/phenomena of interest This review will consider both quantitative and qualitative studies that investigate involvement of family members in decision making for people with dementia in a residential aged care setting. For this systematic review, decision making for people with dementia in a residential aged care setting refers to decisions relating to the physical, psychosocial, spiritual and emotional domains of care, for example decisions relating to advance care planning, decisions regarding clinical care, decisions regarding end-of-life care, and decisions regarding leisure and lifestyle. Types of outcomes This review will consider studies that investigate or discuss who the decision makers are in care for people with dementia and how decisions are made, what processes assist families in decision making and what are the barriers or facilitators to collaborative decision making by families, as well as the impact of decision making processes on family members and the impact of collaborative decision making with family on the person with dementia. The review will explicitly exclude studies that are solely concerned with decisions about whether to enter residential aged care or decisions regarding financial issues; however where this data forms part of a larger study, the study may be included but this data will not be extracted.

BackgroundThe feasibility and benefits of a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (Group Aged Care Exercise + GAIT (GrACE + GAIT)) in the residential aged care (RAC) setting was investigated as very little peer-reviewed research has been conducted in relation to exercise programmes of this duration in this cohort.MethodsA quasi-experimental study design consisting of two groups (control and exercise) explored a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (GrACE + GAIT) in two RAC facilities in Northern New South Wales, Australia. A total of 42 adults consented to participate from a total of 68 eligible residents (61.7%). The primary outcome measures were feasibility and sustainability of the exercise programme via intervention uptake, session adherence, attrition, acceptability and adverse events. Secondary measures included gait speed and the spatio-temporal parameters of gait, handgrip muscle strength and sit to stand performance.ResultsTwenty-three residents participated in the exercise intervention (mean (SD) 85.4 (8.1) years, 15 females) and 19 in the control group (87.4 (6.6) years 13 females). Exercise adherence was 79.3%, with 65% of exercise participants attending ≥70% of the sessions; 100% of those originally enrolled completed the programme and strongly agreed with the programme acceptability. Zero exercise-related adverse events were reported. ANCOVA results indicated that post-intervention gait speed significantly increased (p < 0.001) with an 18.8% increase in gait speed (m/s).DiscussionThe GrACE + GAIT programme was shown to be feasible and significantly improve adults living in RAC facilities gait speed, handgrip strength and sit to stand performance. These results suggest that the GrACE + GAIT programme is suitable for use in the RAC sector and that it has the potential to reduce disability and improve function and quality of life of the residents.

This scoping review will identify and map the available literature on virtual care for chronic wound management in residential aged care settings. Chronic wounds are an underacknowledged public health issue with substantial health and economic costs. These wounds, which do not heal in a timely manner, are common in residential aged care settings. While evidence-based wound care is essential for better outcomes, access is challenging in residential aged care settings. Emerging virtual care interventions have improved access to evidence-based wound care; however, little is known about the current use of such interventions in residential aged care settings. This review will include adults with chronic wounds living in residential aged care across diverse geographic locations. The review will consider virtual care for chronic wounds, with a particular focus on intervention type and frequency, as well as barriers and enablers of use. The proposed review will be conducted in accordance with the JBI methodology for scoping reviews and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). MEDLINE (Ovid), CINAHL (EBSCOhost), Embase (Ovid), AgeLine, IEEE Xplore, and ACM digital library will be searched for relevant literature, with no limitations on language or date of publication. The World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and the US National Institutes of Health Ongoing Trials Register will be searched for gray literature. Title, abstract, and full-text screening will be conducted by 2 reviewers independently. Data will be extracted using a reviewer-developed tool, and a narrative summary will accompany the tabulated results. OSF https://osf.io/j97bt.

Background: Food regulations exist to protect older people in residential aged care, leading to the restriction of potentially hazardous foods. The impacts of malnutrition, resident centred care and the importance of maintaining individual autonomy for older people are well documented. By contrast, there is scant literature describing residents’ perceptions of food regulations and food risks in the residential aged care setting. Aims: The aim of this study is to explore resident perceptions of food choice and food restrictions in residential aged care. Methods: Using a qualitative, hermeneutic phenomenological design, semi-structured interviews were conducted with six participants recruited from two residential aged care facilities. Interviews were audio-taped, transcribed verbatim and thematically analysed. Results: The following key themes emerged in this study: participants were largely unaware of food regulations and risks, yet expressed the desire to make their own choices. Participants provided contradictory accounts of their experiences with food in residential aged care, which emphasises the ongoing challenge of meeting individual preferences. Conclusion: These themes warrant further investigation, particularly in relation to the impact of food regulations on food choice and the meaning of risk to older people in residential aged care. This research provides new insight into the perceptions of residents regarding their individual autonomy and independence against legislated risk minimization strategies.Impact statementThis article raises the issue of risk taking and food choices from the perspective of residents in a residential aged care facility.

This paper aims to discuss the implementation of a 'community of practice' model of clinical teaching into four residential aged care facilities. There is increasing international evidence that aged care is a burgeoning health issue, particularly in developed countries. Recruitment and retention of nurses is problematic in residential aged care. Nursing students maintain negative perceptions of aged care and dislike clinical placements in that area. Additionally, supporting students in residential aged care is difficult considering the staffing mix of skilled/unskilled staff. Innovative educational strategies are needed to manage the increasing shortages of clinical placements for nursing students in all clinical areas. Staff experiences were elicited through four focus groups onsite at the residential aged care facility where students had been placed, one year after implementation of a 'communities of practice' clinical model. Data analysis used a qualitative, thematic approach. The staff in the residential aged care facilities expressed that work was involved in supporting students in the workplace, but that the additional workload was a valuable investment. Staff in residential aged care see working with students as a local investment, where students' fresh eyes, recent knowledge and questioning behaviours are a worthy investment of staff time and effort. Staff also valued the investment in the future, where working with students now creates future nurses sensitive to aged care issues. In a 'communities of practice' model of clinical experience for students, there are benefits for staff as well as students. The implementation of this clinical model in residential aged care was relatively low in cost, a benefit in this sector and has the potential to address the critical issues of recruitment and retention.

Objective My Therapy is an allied health guided, co-designed rehabilitation self-management program for residents of aged care facilities. This study aimed to determine the feasibility of implementing My Therapy in a residential aged care setting. Methods This observational study was conducted on a 30-bed wing, within a 90-bed metropolitan residential aged care facility, attached to a public health service, in Victoria, Australia. Staff and resident data were collected prospectively over 6 weeks (staff focus groups, patient surveys, and audits) to evaluate the feasibility domains of acceptability , reach and demand , practicality , integration , limited efficacy testing and adaptations . Results Twenty-six residents and five allied health staff (physiotherapy and occupational therapy) participated. My Therapy was acceptable to residents (survey) and staff (focus groups). Via initial My Therapy discussions between the resident and the therapists, to determine goals and resident preferences, My Therapy reached 26 residents (n = 26/26, 100% program reach ), with 15 residents subsequently receiving a rehabilitation program (n = 15/26, 58% program demand ). The remaining 11 residents did not participate due to resident preference or safety issues (n = 11/26, 42%). Collecting physical function outcome measures for limited efficacy testing was practical , and the cost of My Therapy was AUD$6 per resident per day, suggesting financial integration may be possible. Several adaptations were required, due to limited allied health staff, complex resident goal setting and program co-design. Conclusion My Therapy has the potential to improve the rehabilitation reach of allied health services in residential aged care. While introducing this low-cost intervention is feasible, adaptations were required for successful implementation.

BackgroundResidential aged care facilities (RACF) have high mortality rates, yet multifaceted challenges, including complexity of clinical needs, care fragmentation, staffing capacity and access to palliative care supports, impact on the...

To explore patient experience of chronic wound care across diverse models of outpatient wound care delivery. Chronic wounds represent a significant personal, family and healthcare system burden. Evidence suggests specialist wound clinics are more effective and less expensive, however, most outpatient wound care is delivered by general community nurses. There is little understanding of how patients experience diverse models of wound care delivery and the subsequent impact on their capacity to adapt to imbalances in their internal/external environment. Descriptive, qualitative study. Eighteen patients with chronic wounds from three wound services were engaged in semi-structured interviews. Initial inductive analysis was refined deductively using Levine's Conservation Model. Chronic wounds lead to imbalances and subsequent adaptions in energy conservation and personal, social and structural integrity. Nursing process and wound care system responses suggest specialist wound clinics provide access to the right person and care at the right time, with less care variation. The community nursing model is most effective with a small team of nurses and a documented care plan, with specialist wound nurse oversight. Residential aged care facilities emerged as important sites for wound care delivery revealing higher variance in care and less specialist wound oversight. The application of Levine's conservation model provides a theoretical understanding and important insights into the patient experience of nurse and system elements across diverse models of wound care delivery. Specialist oversight by expert wound nurses with the capacity for medical specialist referral is the cornerstone of good wound care. A frequently reviewed wound care plan and skill development for nurses in primary, aged care and community settings are vital. Shared care between specialist and primary care should include evidence-based pain assessment, clear referral pathways, collaborative relationships, telehealth capacity, patient-held wound plans and upskilling of frontline clinicians.

Place of death, specifically the percentage who die in hospital or residential aged care, is largely unreported. This paper presents a cross-national comparison of location of death information from published reports and available data. Reports of deaths occurring in hospitals, residential aged care facilities, and other locations for periods since 2001 were compiled. Over 16 million deaths are reported in 45 populations. Half reported 54 % or more of all deaths occurred in hospitals, ranging from Japan (78 %) to China (20 %). Of 21 populations reporting deaths of older people, a median of 18 % died in residential aged care, with percentages doubling with each 10-year increase in age, and 40 % higher among women. This place of death study includes more populations than any other known. In many populations, residential aged care was an important site of death for older people, indicating the need to optimise models of end-of-life care in this setting. For many countries, more standardised reporting of place of death would inform policies and planning of services to support end-of-life care.

Since 2012, Australia has been undertaking major aged care reforms, moving from a previously service provider-focussed approach to a more consumer-oriented policy direction. There is limited research examining consumer perspectives of residential care in the reform environment particularly with respect to both clients and their families. This study explores the lived experiences of clients and families in residential aged care facilities amid the reform implementation process. Using a qualitative descriptive research methodology, individual interviews were conducted with clients and family members (n=10) about their expectations and experiences of residential care. Participants were drawn from two not-for-profit aged care providers. Two broad themes emerged: (i) entering residential aged care and related issues, with subthemes including reasons for entering, decision-making processes, choice of provider/facility and impact of entering care facilities; and (ii) expectations and experiences of care delivery, with subthemes including issues of staffing, service provision, communication and awareness of living in or through the reform environment. The discrepancy between the experiences of care delivered and expectations of initial and changing care needs being met was a major concern. This study presents a snapshot of the expectations and experiences of both the client and the family cohorts in residential care under the reform conditions. Adequately addressing the relational and interpersonal elements of care delivery is critical in fulfilling the reforms' consumer-oriented objectives.

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.

Introduction Mitigating occupational stress for professional dementia caregivers in residential aged care facilities is critical to workforce sustainability, care quality, health, and economic burden. This study examines the evidence to understand how occupational stress is experienced and how it may be mitigated by interventions. Methods A systematic review of CINAHL, PsycINFO, PubMed and MEDLINE databases was conducted to identify original research published in English between 1995 and March 2023. Two reviewers screened search results. Quality was appraised using the Downs and Black Checklist, CASP and MMAT. Framework synthesis was used to synthesise data. Results 52 studies were eligible for the review from 1,121 aged care facilities and involving 16,372 caregivers. Data synthesis resulted in a Conceptual Ecosystem of Professional Dementia Caregivers’ Experience of Occupational Stress in Residential Aged Care Settings, which proposes a complex and active system with dependent factors. Stress is experienced psychologically, physically and relationally. Activators and mediators of stress occur every day and as singular events. Interventions that address multiple factors simultaneously appear most effective. Conclusion Professional caregiver occupational stress is systems-based and complex. Interventions are recommended that prevent stress activating events, reduce constant stress activators, and increase constant stress mediators. Practical implications are discussed.

BackgroundFalls are a major socio-economic problem among residential aged care (RAC) populations resulting in high rates of injury including hip fracture. Guidelines recommend that multifactorial prevention strategies are implemented but these require translation into clinical practice. A community of practice (CoP) was selected as a suitable model to support translation of the best available evidence into practice, as it could bring together like-minded people with falls expertise and local clinical knowledge providing a social learning opportunity in the pursuit of a common goal; falls prevention. The aims of this study were to evaluate the impact of a falls prevention CoP on its membership; actions at facility level; and actions at organisation level in translating falls prevention evidence into practice.MethodsA convergent, parallel mixed methods evaluation design based on a realist approach using surveys, audits, observations and semi-structured interviews. Participants were 20 interdisciplinary staff nominating as CoP members between Nov 2013-Nov 2015 representing 13 facilities (approximately 780 beds) of a RAC organisation. The impact of the CoP was evaluated at three levels to identify how the CoP influenced the observed outcomes in the varying contexts of its membership (level i.), the RAC facility (level ii.) and RAC organisation (level iii.).ResultsStaff participating as CoP members gained knowledge and awareness in falls prevention (p < 0.001) through connecting and sharing. Strategies prioritised and addressed at RAC facility level culminated in an increase in the proportion of residents supplemented with vitamin D (p = 0.002) and development of falls prevention education. At organisation level a falls policy reflecting preventative evidence-based guidelines and a new falls risk assessment procedure with aligned management plans were written, modified and implemented. A key disenabling mechanism identified by CoP members was limited time to engage in translation of evidence into practice whilst enabling mechanisms included proactive behaviours by staff and management.ConclusionsInterdisciplinary staff participating in a falls prevention CoP gained connectivity and knowledge and were able to facilitate the translation of falls prevention evidence into practice in the context of their RAC facility and RAC organisation. Support from RAC organisational and facility management to make the necessary investment in staff time to enable change in falls prevention practice is essential for success.