BackgroundThe potential harms of some medications may outweigh their potential benefits (inappropriate medication use). Despite recommendations to avoid the use of potentially inappropriate medications (PIMs) in older adults, the prevalence of PIM use is high in different settings including residential aged care. However, it remains unclear what the costs of these medications are in this setting. The main objective of this study was to determine the costs of PIMs in older adults living in residential care. A secondary objective was to examine if there was a difference in costs of PIMs in a home-like model of residential care compared to an Australian standard model of care.MethodsParticipants included 541 participants from the Investigation Services Provided in the Residential Environment for Dementia (INSPIRED) Study. The INSPIRED study is a cross-sectional study of 17 residential aged care facilities in Australia. 12 month medication costs were determined for the participants and PIMs were identified using the 2015 updated Beers Criteria for older adults.ResultsOf all of the medications dispensed in 1 year, 15.9% were PIMs and 81.4% of the participants had been exposed to a PIM. Log-linear models showed exposure to a PIM was associated with higher total medication costs (Adjusted β = 0.307, 95% CI 0.235 to 0.379, p < 0.001). The mean proportion (±SD) of medication costs that were spent on PIMs in 1 year was 17.5% (±17.8) (AUD$410.89 ± 479.45 per participant exposed to a PIM). The largest PIM costs arose from proton-pump inhibitors (34.4%), antipsychotics (21.0%) and benzodiazepines (18.7%). The odds of incurring costs from PIMs were 52% lower for those residing in a home-like model of care compared to a standard model of care.ConclusionsThe use of PIMs for older adults in residential care facilities is high and these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes. Adopting a home-like model of residential care may be associated with reduced prevalence and costs of PIMs.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0704-8) contains supplementary material, which is available to authorized users.

Background: Inappropriate polypharmacy may negatively impact quality of life of residents in aged care facilities, but it remains unclear which medications may influence this reduced quality of life.Objective: The objective was to examine whether the Drug Burden Index (DBI) and potentially inappropriate medications (PIMs), were associated with quality of life in older adults living in residential care with a high prevalence of cognitive impairment and dementia.Methods: Cross-sectional analyses of 541individuals recruited from 17 residential aged care facilities in Australia in the Investigating Services Provided in the Residential Environment for Dementia (INSPIRED) study. Quality of life was measured using the EQ-5D-5L (a measure of generic quality of life) and the DEMQOL (a measure developed for use in dementia) completed by the participant or a proxy.Results: In the 100 days prior to recruitment, 83.1% of the participants received at least one anticholinergic or sedative medication included in the DBI and 82.7% received at least one PIM according to the Beers Criteria. Multi-level linear models showed there was a significant association between higher DBI and lower quality of life according to the EQ-5D-5L (β (SE): -0.034 (0.012), p=0.006) after adjustment for potential confounding factors. Increasing numbers of PIMs were also associated with lower EQ-5D-5L scores (-0.030 (0.010), p=0.003) and DEMQOL-Self-Report-Utility scores (-0.020 (0.009), p=0.029). Exposure to both DBI-associated medications and PIMs was associated with lower DEMQOL-SelfReport-Utility scores (-0.034 (0.017), p=0.049).Conclusion: Exposure to anticholinergic and sedative medications and PIMs occurred in over three-quarters of a population of older adults in residential care and was associated with a lower quality of life.  This study provides evidence to support that there is a need for greater adherence to recommendations for appropriate medication use in residential aged care.

Clustered domestic models of residential care are associated with better quality of life and fewer hospitalisations for residents, without increasing whole of system costs.

BACKGROUND: Child maltreatment (CM) is a global public health issue, with reported impacts on health and social outcomes. Evidence on mortality is lacking. In this study, we aimed to estimate the impact of CM on death rates in persons 16 to 33 years. METHODS: A retrospective cohort study of all persons born in South Australia 1986 to 2003 using linked administrative data. CM exposure was based on child protection service (CPS) contact: unexposed, no CPS contact before 16 years, and 7 exposed groups. Deaths were observed until May 31, 2019 and plotted from 16 years. Adjusted hazard ratios (aHRs) by CPS category were estimated using Cox proportional hazards models, adjusting for child and maternal characteristics. Incident rate ratios (IRRs) were derived for major causes of death, with and without CPS contact. RESULTS: The cohort included 331 254 persons, 20% with CPS contact. Persons with a child protection matter notification and nonsubstantiated or substantiated investigation had more than twice the death rate compared with persons with no CPS contact: aHR = 2.09 (95% confidence interval [CI] = 1.62–2.70) to aHR = 2.61 (95% CI = 1.99–3.43). Relative to no CPS contact, persons ever placed in out-of-home care had the highest mortality if first placed in care aged ≥3 years (aHR = 4.67 [95% CI = 3.52–6.20]); aHR was 1.75(95% CI = 0.98–3.14) if first placed in care aged &lt;3 years. The largest differential cause-specific mortality (any contact versus no CPS contact) was death from poisonings, alcohol, and/or other substances (IRR = 4.82 [95% CI = 3.31–7.01]) and from suicide (IRR = 2.82 [95% CI = 2.15–3.68]). CONCLUSIONS: CM is a major underlying cause of potentially avoidable deaths in early adulthood. Clinical and family-based support for children and families in which CM is occurring must be a priority to protect children from imminent risk of harm and early death as young adults.

Private health insurance plays a key role in financing dental care in Australia. Having private dental insurance has been associated with higher levels of access to dental care, visiting for a check-up and receiving a favourable pattern of services. Associations with better oral health have also been reported. In the absence of any existing review, this paper aims to systematically review the relationship between dental insurance and dental service use and/or oral health outcomes in Australia. A systematic search of online databases and subsequent sifting resulted in 36 publications, 33 of which were cross sectional and three cohort analyses. Dental service outcomes were more commonly reported than oral health outcomes. There was considerable heterogeneity in the outcome measures reported, for both service use and health outcomes. Overall, the majority of the evidence was from cross sectional studies and few studies reported analyses adjusted for confounding factors. The consolidated evidence points towards a positive association between dental insurance and dental visiting. Dentally insured adults are likely to have more regular access to dental care and have a more favourable pattern of service use than the uninsured. However, evidence of associations between dental insurance and oral health are mixed.

Background Current information on the patterns of medication use in nursing home residents living with dementia is conflicting. Aim The aim of this study was to investigate medication use and its associations with dementia diagnosis in Australian nursing home residents. Methods A cross‐sectional study of 541 residents from 17 Australian nursing homes was performed. Results Over 12 months, nursing home residents were prescribed a mean (±SD) of 14.5 ± 6.8 medications each. Approximately 95% of residents were prescribed medications for the nervous system, and 94% were prescribed medications for the alimentary tract and metabolism. After adjustment for potential confounders, those with dementia were less likely to be prescribed medications for the cardiovascular system (odds ratio (OR) 0.45, 95% confidence interval (CI) 0.27–0.77, p = 0.0032) and respiratory system (OR 0.38, 95% CI: 0.25–0.60, p < 0.0001). Further analysis of specific medications showed that residents with dementia were more likely to be prescribed risperidone (OR: 9.38, 95% CI: 4.01–21.94, p < 0.0001), buprenorphine (OR 3.37, 95% CI: 1.78–6.36, p = 0.0002) and trimethoprim (OR 1.78, 95% CI: 1.06–2.97, p = 0.0282), but less likely to be prescribed glyceryl trinitrate (OR 0.42, 95% CI: 0.19–0.94, p = 0.0340) and salbutamol (OR 0.34, 95% CI: 0.2–0.6, p = 0.0002) in addition to other specific medications. Conclusions Increased awareness of possible undertreatment of cardiovascular and respiratory conditions, and possible overtreatment of urinary tract infection, in those living with dementia in nursing home settings may improve management of this vulnerable population.

There may be a lack of formal diagnosis of dementia in Australian RACFs. Greater efforts from all health professionals to improve diagnosis in this setting are required. This is an opportunity for improved person-centred care and quality of care in this vulnerable population.

ObjectivesThis 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.MethodsData were collected from 541 individuals living permanently in 17 care facilities across Australia. The annual cost of health and residential care was determined by using individual resource use data and reported by the dementia status of the individuals.ResultsThe average annual whole‐of‐system cost for people living with dementia in residential care was approximately AU$88 000 (US$ 67 100) per person in 2016. The cost of residential care constituted 93% of the total costs. The direct health care costs were comprised mainly of hospital admissions (48%), pharmaceuticals (31%) and out‐of‐hospital attendances (15%). While total costs were not significantly different between those with and without dementia, the cost of residential care was significantly higher and the cost of health care was significantly lower for people living with dementia.ConclusionThis study provides the first estimate of the whole‐of‐system costs of providing health and residential care for people living with dementia in residential aged care in Australia using individual level health and social care data. This predominantly bottom‐up cost estimate indicates the high cost associated with caring for people with dementia living permanently in residential care, which is underestimated when limited cost perspectives or top‐down, population costing approaches are taken.