Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study

ObjectivesTo: (1) examine the 90-day incidence of unplanned hospitalisation and emergency department (ED) presentations after residential aged care facility (RACF) entry, (2) examine individual-related, facility-related, medication-related, system-related and healthcare-related predictors of these outcomes and (3) create individual risk profiles.DesignRetrospective cohort study using the Registry of Senior Australians. Fine-Gray models estimated subdistribution HRs and 95% CIs. Harrell’s C-index assessed risk models’ predictive ability.Setting and participantsIndividuals aged ≥65 years old entering a RACF as permanent residents in three Australian states between 1 January 2013 and 31 December 2016 (N=116 192 individuals in 1967 RACFs).Predictors examinedIndividual-related, facility-related, medication-related, system and healthcare-related predictors ascertained at assessments or within 90 days, 6 months or 1 year prior to RACF entry.Outcome measures90-day unplanned hospitalisation and ED presentation post-RACF entry.ResultsThe cohort median age was 85 years old (IQR 80–89), 62% (N=71 861) were women, and 50.5% (N=58 714) had dementia. The 90-day incidence of unplanned hospitalisations was 18.0% (N=20 919) and 22.6% (N=26 242) had ED presentations. There were 34 predictors of unplanned hospitalisations and 34 predictors of ED presentations identified, 27 common to both outcomes and 7 were unique to each. The hospitalisation and ED presentation models out-of-sample Harrell’s C-index was 0.664 (95% CI 0.657 to 0.672) and 0.655 (95% CI 0.648 to 0.662), respectively. Some common predictors of high risk of unplanned hospitalisation and ED presentations included: being a man, age, delirium history, higher activity of daily living, behavioural and complex care needs, as well as history, number and recency of healthcare use (including hospital, general practitioners attendances), experience of a high sedative load and several medications.ConclusionsWithin 90 days of RACF entry, 18.0% of individuals had unplanned hospitalisations and 22.6% had ED presentations. Several predictors, including modifiable factors, were identified at the time of care entry. This is an actionable period for targeting individuals at risk of hospitalisations.

Novel chest wall blocks for severe chest wall injuries in older persons: A case series

Patients over the age of 65 years admitted to hospital with more than six rib fractures have a mortality rate as high as 38%. Of the survivors, 34% are likely to be admitted to an aged care facility. High-quality analgesia is paramount to the mitigation of rib fracture–associated morbidity and mortality. We report a series of ten consecutive patients over the age of 65 years with more than eight fractured ribs. All patients were managed with a novel chest wall block. There were no deaths, and only one patient was discharged into an aged care facility.

Remodelling Aged Living to Reduce Stigma

<p><b>This thesis investigates whether community-based architectural strategies can be used in aged care facility design to reduce the stigma of social isolation. New Zealand has a growing population, with an increasing number of people needing assistance from aged care facilities. However, the elderly resist moving into aged care facilities because of fears of marginalisation, social isolation and associated stigma. Stigma creates outcomes of discrimination towards marginalised individuals, resulting in negative projections on these people and consequent social exclusion. </b></p> <p>There are two main aims of this research. The first aim was to understand the relationship between stigma and architecture and stigma and aged care facilities. To achieve this aim, stigma and various strategies for addressing that stigma in aged care facilities were defined based on contemporary literature on this subject and analyses of relevant built precedents. </p> <p>The second aim was to develop, a contemporary aged care facility that demonstrates potential strategies for reducing stigma. This aim was achieved by developing criteria that respond to iterative design exercises and contemporary research in the fields of aged care facilities, architecture and stigma. An iterative design process, continually tested these criteria against literature and precedent reviews, was carried out to arrive at a coherent design and more refined set of criteria. </p> <p>Research conclusions showed that community-based architectural strategies can be used to reduce the stigma of social isolation in aged care facility design. This resulted in the outcome of a community-based model and criteria that can be applied to the design of aged care facilities and will resultantly provide residents with a purposive role and inclusion within society.</p>

Remodelling Aged Living to Reduce Stigma

<p><b>This thesis investigates whether community-based architectural strategies can be used in aged care facility design to reduce the stigma of social isolation. New Zealand has a growing population, with an increasing number of people needing assistance from aged care facilities. However, the elderly resist moving into aged care facilities because of fears of marginalisation, social isolation and associated stigma. Stigma creates outcomes of discrimination towards marginalised individuals, resulting in negative projections on these people and consequent social exclusion. </b></p> <p>There are two main aims of this research. The first aim was to understand the relationship between stigma and architecture and stigma and aged care facilities. To achieve this aim, stigma and various strategies for addressing that stigma in aged care facilities were defined based on contemporary literature on this subject and analyses of relevant built precedents. </p> <p>The second aim was to develop, a contemporary aged care facility that demonstrates potential strategies for reducing stigma. This aim was achieved by developing criteria that respond to iterative design exercises and contemporary research in the fields of aged care facilities, architecture and stigma. An iterative design process, continually tested these criteria against literature and precedent reviews, was carried out to arrive at a coherent design and more refined set of criteria. </p> <p>Research conclusions showed that community-based architectural strategies can be used to reduce the stigma of social isolation in aged care facility design. This resulted in the outcome of a community-based model and criteria that can be applied to the design of aged care facilities and will resultantly provide residents with a purposive role and inclusion within society.</p>