Diagnosis of dementia in residential aged care settings in Australia: An opportunity for improvements in quality of care?

Dyer, Suzanne M; Gnanamanickam, Emmanuel; Liu, Enwu; Whitehead, Craig; Crotty, Maria

doi:10.1111/ajag.12580

Cited by 33 publications

(21 citation statements)

References 11 publications

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“…Our results suggest that ACFI data alone may generally underestimate condition prevalence, but the magnitude of underestimation varies by condition. Consistent with prior research, dementia can be reasonably well identified from ACFI data(18), but we suspect that dementia may still be underdiagnosed and underreported in this setting as previous research has shown (19). This trend in underreporting of conditions is supported by condition prevalence reported in Aged Care Assessment Program (ACAP) data(16) (an assessment conducted before RACF admission -i.e.…”

Section: Discussionsupporting

confidence: 86%

Measuring the prevalence of 60 health conditions in older Australians in residential aged care with electronic health records: a retrospective dynamic cohort study

Lind

Raban

Brett

et al. 2020

Preprint

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Background : The number of older Australians using aged care services is increasing, yet there is an absence of reliable data on their health. Multimorbidity in this population has not been well described. A clear picture of the health status of people using aged care is essential for informing health practice and policy to support evidence-based, equitable, high-quality care. Our objective was to describe the health status of older Australians living in residential aged care facilities (RACFs) and develop a model for monitoring health conditions using data from electronic health record systems. Methods : Using a dynamic retrospective cohort of 9436 RACF residents living in 68 RACFs in New South Wales and the Australian Capital Territory from 2014-2017, we developed an algorithm to identify residents’ conditions using: aged care funding assessments; medications administered; and clinical notes from their facility electronic health record (EHR). We generated age and sex-specific prevalence estimates for 60 health conditions. Agreement between conditions recorded in aged care funding assessments and those documented in residents’ EHRs was evaluated using Cohen’s Kappa. Cluster analysis was used to describe combinations of health conditions (multimorbidity) occurring among residents. Results : Using all data sources, 93% of residents had some form of circulatory disease, with hypertension the most common (62%). Most residents (93%) had a mental or behavioural disorder, including dementia (58%) or depression (54%). For most conditions, EHR data identified approximately twice the number of people with the condition compared to aged care funding assessments. Agreement between data sources was highest for multiple sclerosis, Huntington’s disease and dementia. The cluster analysis identified seven groups with distinct combinations of health conditions and demographic characteristics and found that the most complex cluster represented a group of residents that had on average the longest lengths of stay in residential care. Conclusions : The prevalence of many health conditions among RACF residents in Australia is underestimated in previous reports. Aged care EHR data have the potential to be used to better understand the complex health needs of this vulnerable population and can help fill the information gaps needed for population health surveillance and quality monitoring.

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Section: Discussionsupporting

confidence: 86%

Measuring the prevalence of 60 health conditions in older Australians in residential aged care with electronic health records: a retrospective dynamic cohort study

Lind

Raban

Brett

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Our results suggest that ACFI data alone may generally underestimate condition prevalence, but the magnitude of underestimation varies by condition. Consistent with prior research, dementia can be reasonably well identi ed from ACFI data(22), but we suspect that dementia may still be underdiagnosed and underreported in this setting as previous research has shown (23). This trend in underreporting of conditions is supported by condition prevalence reported in Aged Care Assessment Program (ACAP) data(20) (an assessment conducted before RACF admission -i.e.…”

Section: Discussionsupporting

confidence: 86%

Measuring the prevalence of 60 health conditions in older Australians in residential aged care with electronic health records: a retrospective dynamic cohort study

Lind

Raban

Brett

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The number of older Australians using aged care services is increasing, yet there is an absence of reliable data on their health. Multimorbidity in this population has not been well described. A clear picture of the health status of people using aged care is essential for informing health practice and policy to support evidence-based, equitable, high-quality care. Our objective was to describe the health status of older Australians living in residential aged care facilities (RACFs) and develop a model for monitoring health conditions using data from electronic health record systems. Methods: Using a dynamic retrospective cohort of 9436 RACF residents living in 68 RACFs in New South Wales and the Australian Capital Territory from 2014-2017, we developed an algorithm to identify residents’ conditions using: aged care funding assessments; medications administered; and clinical notes from their facility electronic health record (EHR). We generated age and sex-specific prevalence estimates for 60 health conditions. Agreement between conditions recorded in aged care funding assessments and those documented in residents’ EHRs was evaluated using Cohen’s Kappa. Cluster analysis was used to describe combinations of health conditions (multimorbidity) occurring among residents.Results: Using all data sources, 93% of residents had some form of circulatory disease, with hypertension the most common (62%). Most residents (93%) had a mental or behavioural disorder, including dementia (58%) or depression (54%). For most conditions, EHR data identified approximately twice the number of people with the condition compared to aged care funding assessments. Agreement between data sources was highest for multiple sclerosis, Huntington’s disease and dementia. The cluster analysis identified seven groups with distinct combinations of health conditions and demographic characteristics and found that the most complex cluster represented a group of residents that had on average the longest lengths of stay in residential care.Conclusions: The prevalence of many health conditions among RACF residents in Australia is underestimated in previous reports. Aged care EHR data have the potential to be used to better understand the complex health needs of this vulnerable population and can help fill the information gaps needed for population health surveillance and quality monitoring.

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“…Providing high quality care for people living with dementia is complex (Dyer et al, 2018) and the poor quality of care currently being provided in care homes has been raised as a concern (e.g. Cadigan et al, 2012;Pot et al, 2013).…”

Section: Benefits Challenges and Best Practicesmentioning

confidence: 99%

Collecting self-report research data with people with dementia within care home clinical trials: Benefits, challenges and best practice

et al. 2019

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One-third of people with dementia live in care home settings and in order to deliver better evidence-based care, robust research including clinical trials is required. Concerns have been raised by researchers about the capacity of care home residents with dementia to participate in clinical trials. This includes self-report measures, completion of which researchers have suggested may be unreliable or impossible and may cause distress for residents. Many trials, therefore, utilise only proxy completed outcome measures. This is despite evidence that individuals with mild through to advanced dementia can reliably report on outcomes, if appropriate measures and approaches to data collection are used. However, little has been written about best practice in data collection with this group. This study aimed to explore the experiences of researchers working on dementia trials in care homes and identify best practices to assist design of future trials. Thirty-three researchers completed an online, qualitative questionnaire outlining their experiences and the perceived benefits and challenges of data collection with people with dementia. We identified five main benefits: (1) improving the delivery of person-centred care, (2) hearing the voice of people with dementia, (3) residents spending time with researchers, (4) improving researcher understanding, and (5) having an evidence base from multiple sources. We also identified five main challenges: (1) effective communication, (2) fluctuating capacity, (3) causing distress to residents, (4) time pressures, and (5) staff availability. Researchers also made suggestions about how these can be overcome. We recommend that the challenges identified could be overcome using appropriate methods for collecting data. Thorough training for researchers on data collection with people with dementia was identified as important for ensuring successful data collection.

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Diagnosis of dementia in residential aged care settings in Australia: An opportunity for improvements in quality of care?

Abstract: 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.

Cited by 33 publications

References 11 publications

Measuring the prevalence of 60 health conditions in older Australians in residential aged care with electronic health records: a retrospective dynamic cohort study

Measuring the prevalence of 60 health conditions in older Australians in residential aged care with electronic health records: a retrospective dynamic cohort study

Measuring the prevalence of 60 health conditions in older Australians in residential aged care with electronic health records: a retrospective dynamic cohort study

Collecting self-report research data with people with dementia within care home clinical trials: Benefits, challenges and best practice

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