Clare Eileen Bradley

Direct health and residential care costs of people living with dementia in Australian residential aged care

This analysis estimates the whole‐of‐system direct costs for people living with dementia in residential care by using a broad health and social care provision perspective and compares it to people without dementia living in residential care.

Clustered domestic residential aged care in Australia: fewer hospitalisations and better quality of life

Objective: To compare the outcomes and costs of clustered domestic and standard Australian models of residential aged care.

Struggling to maintain individuality – Describing the experience of food in nursing homes for people with dementia

PURPOSE OF THE STUDY To describe the food and dining experience of people with cognitive impairment and their family members in nursing homes. DESIGN AND METHODS Interviews and focus groups with people with cognitive impairment and their family members (n=19). Thematic analysis was undertaken using NVivo10 data analysis software package to determine key themes. RESULTS The main themes identified tracked a journey for people with cognitive impairment in nursing homes, where they initially sought to have their individual needs and preferences recognised and heard, expressed frustration as they perceived growing barriers to receiving dietary care which met their preferences, and ultimately described a deterioration of the amount of control and choice available to the individual with loss of self-feeding ability and dysphagia. IMPLICATIONS Further consideration of how to incorporate individualised dietary care is needed to fully implement person-centred care and support the quality of life of those receiving nursing home care.

Association of cardiovascular system medications with cognitive function and dementia in older adults living in nursing homes in Australia

Objective To examine associations between cardiovascular system medication use with cognition function and diagnosis of dementia in older adults living in nursing homes in Australia. Methods As part of a cross-sectional study of 17 Australian nursing homes examining quality of life and resource use, we examined the association between cognitive impairment and cardiovascular medication use (identified using the Anatomical Therapeutic Classification System) using general linear regression and logistic regression models. People who were receiving end of life care were excluded. Results Participants included 541 residents with a mean age of 85.5 years (± 8.5), a mean Psychogeriatric Assessment Scale–Cognitive Impairment (PAS-Cog) score of 13.3 (± 7.7), a prevalence of cardiovascular diseases of 44% and of hypertension of 47%. Sixty-four percent of participants had been diagnosed with dementia and 72% had received cardiovascular system medications within the previous 12 months. Regression models demonstrated the use of cardiovascular medications was associated with lower (better) PAS-Cog scores [Coefficient (β) = −3.7; 95% CI: −5.2 to −2.2; P < 0.0001] and a lower probability of a dementia diagnosis (OR = 0.44; 95% CI: 0.26 to 0.75, P = 0.0022). Analysis by subgroups of medications showed cardiac therapy medications (C01), beta blocking agents (C07), and renin-angiotensin system agents (C09) were associated with lower PAS-Cog scores (better cognition) and lower dementia diagnosis probability. Conclusions This analysis has demonstrated an association between greater cardiovascular system medication use and better cognitive status among older adults living in nursing homes. In this population, there may be differential access to health care and treatment of cardiovascular risk factors. This association warrants further investigation in large cohort studies.

Evaluating the quality of care received in long-term care facilities from a consumer perspective: development and construct validity of the Consumer Choice Index – Six Dimension instrument

ABSTRACT The Consumer Choice Index – Six Dimension (CCI-6D) is a new instrument designed specifically to evaluate the quality of care received in long-term care from a consumer perspective. This study aims to demonstrate the construct validity of the CCI-6D. Older residents living in long-term care facilities and proxy family carers (where severely impaired cognition precluded resident consent) participated as consumers of long-term care. Data collected included the CCI-6D instrument, quality of life, physical function and characteristics of the care facility. Relationships between these variables and the CCI-6D dimensions were assessed and analysed through chi-squared and Kruskal–Wallis tests to assess the construct validity of each dimension. Of 430 eligible consumers, a total of 253 completed the questionnaire, of whom 68 (27%) were residents and 185 (73%) were informal carer proxy participants. There was strong evidence of construct validity of the dimensions relating to adequacy of individual care time, access to outside and gardens, access to meaningful activities and flexibility of care. There was more moderate evidence of validity of the home-like own room and shared spaces items, which may be in part due to difficulty in identifying strong discriminatory variables for comparison with these items. The results also indicate a strong association between ‘processes’ of care delivery (as measured by the CCI-6D) and quality of life of care recipients.

Trends in hospitalised injuries due to falls by older people, Australia 1999–2007

Rates of serious injury due to falls in some Australian jurisdictions appear to have increased over time despite a reduction in the rate of hospitalised hip fracture (eg, Dowling & Finch 2009). The Australian Institute of Health and Welfares National Injury Surveillance Unit has undertaken analysis of national rates of hospitalised fall injuries for the period 1999–2007 to try to understand this conundrum. Age-standardised rates of hospitalised fall injury cases for Australians aged 65 years and older have increased significantly since 1999. The greatest increases are noted for males, the oldest old (85+ years) and residents of aged care facilities. In contrast, rates of hip fracture due to falls have significantly decreased. Here, the greatest reductions are noted for females, the younger old (6574 years) and people living independently at home. Our findings confirm differential trends in age-adjusted rates of hospitalised injuries due to falls by older Australians at the national level. The utility of further investigations using only de-identified hospital data is limited however. Future research should utilise Australias increasing capacity for person-based data linkage. State-based linkage systems are well-placed to generate novel information about falls by older people. For example, studies using person-linked data may explain our observation of increased rates of injurious falls for older males; certain co-morbidities or underutilisation of interventions may be contributing to increased falls risk for men. Similarly, data-linkage studies may reveal why rates of hip fracture have reduced for community-dwelling older people but not for residents of aged care facilities.