Therapy-based allied health delivery in residential aged care, trends, factors, and outcomes: a systematic review

Abstract

Background Allied health professionals in residential aged care facilities (RACFs) make important contributions to the physical and mental wellbeing of residents. Yet to date, health services research in RACFs has focused almost exclusively on nursing disciplines. This review aims to synthesise the current evidence on allied health services in RACF; specifically, how therapy-based allied health is delivered, what factors impact the quantity delivered, and the impact of services on resident outcomes and care quality. Methods Empirical peer-reviewed and grey literature focusing on allied health service delivery in RACFs from the past decade was identified through systematic searches of four databases and over 200 targeted website searches. Information on how allied health delivered, factors impacting service delivery, and impact on resident outcomes were extracted. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT) and the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklist. Results Twenty-eight unique studies were included in this review; 26 peer-reviewed and two grey literature studies. Sixteen studies discussed occupational therapy and 15 discussed physiotherapy, less commonly studied professional groups included dieticians (n = 9), allied health assistants (n = 9), and social workers (n = 6). Thirteen studies were assigned a 100% quality rating. Levels of allied health service provision were generally low and varied. Five studies examined the association between system level factors and allied health service provision, and seven studies examined facility level factors and service provision. Higher levels of allied health provision or access to allied health services, specifically physiotherapy, occupational therapy, and nutrition, were associated with reduced falls with injury, improved care quality, activities of daily living scores, nutritional status, and meal satisfaction in five studies. Conclusion Evidence on how allied health is delivered in RACFs, and its impact on resident health outcomes, is lacking globally. While there are some indications of positive associations between allied health staffing and resident outcomes and experiences, health systems and researchers will need commitment to consistent allied health data collection and health services research funding in the future to accurately determine how allied health is delivered in RACFs and its impact on resident wellbeing.

Ocular injuries among patients with major trauma in England and Wales from 2004 to 2021

“…Other studies report that enforcement interventions, such as speed cameras and police patrols, are most effective at reducing the number of RTCs [55] and such prevention strategies may be adopted in settings where the burden of RTCs is higher. In the UK, eye injury prevention strategies should target falls prevention and common approaches in older adults include physical exercise and environmental modifications such as the installation of nonslip mats and grab rails in bathrooms where falls frequently occur [56]. Low vision is a risk factor for falls [57], ophthalmologists should play an active role in falls prevention by educating at-risk groups and by optimising services such that reversible causes of low vision, such as cataract, are treated in a timely manner.…”

Caregiver Involvement and Concerns with Care of Residents of Assisted Living before and during the COVID-19 Pandemic

“…We found high levels of caregiver concerns for residents’ physical and mental health conditions and for the lack of access to care services. Lack of access to supportive therapies (occupational therapy, physiotherapy, speech-language therapy) and mental health supports has been an ongoing challenge in LTC and AL [40], a problem that further increased during the COVID-19 pandemic. This is particularly concerning since resident physical and mental health was severely affected by the visitor restrictions [11, 18, 32], in keeping with increased caregiver concerns in our study.…”

Reforming allied health service provision in residential aged care to improve the rehabilitation reach: a feasibility study

“…Alongside nursing and medical care, allied health care is important in residential aged care to optimise nutrition, oral health and communication, and minimise adverse events such as falls [2][3][4] . In addition, allied health services can increase resident's physical activity and function through rehabilitation, resulting in short and long term positive impacts on resident's independence, health and wellbeing [3][4][5][6][7] .…”