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Adverse impacts in residential aged care facilities: The resident perspective 养老院中的不良影响:居民的观点
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-04-10 DOI: 10.1111/ajag.13306
Bella St Clair, Amy Nguyen, Mikaela Jorgensen, Andrew Georgiou

Objectives

Inclusion of consumer perspectives is a key component to person-centred health-care approaches. While current residential aged care systems focus on recording adverse events to meet the requirements of regulatory reporting, little is known about the views of residents. The aim of this research was to explore residents' responses on the types of incidents that have an adverse impact on them and how they are affected by these incidents.

Methods

The study used a qualitative, inductive approach to derive themes from interviews with 20 permanent residents of aged care facilities in New South Wales and the Australian Capital Territory.

Results

Four main themes surrounding adverse incidents emerged: (i) social relationships and the adverse impacts of lack of meaningful interactions, (ii) adjustment to life in the residential aged care facility and the loss of residents' former life and self-determination, (iii) the impact of COVID-19 lockdowns which meant that residents were not able to go out or interact with others and (iv) acceptance, resignation and resilience in coping with adverse incidents.

Conclusions

This research highlights the difference between health-care definition, used for incident management reporting and quality indicators, and the way residents respond when asked to describe an incident that has affected them. Resident responses discuss situations having an adverse effect on them in contrast to the way adverse events and incidents are reported and monitored. The findings suggest that within adverse event and incident management systems and resident governance systems, there is scope for incorporating periods of transitions and well-being measures that capture elements that matter to older people.

目标纳入消费者观点是以人为本的医疗保健方法的关键组成部分。虽然目前的安老院系统侧重于记录不良事件,以满足监管报告的要求,但对院友的看法却知之甚少。本研究旨在探讨住户对对其产生不良影响的事件类型的反应,以及他们如何受到这些事件的影响。研究方法本研究采用定性归纳法,从对新南威尔士州和澳大利亚首都领地 20 名养老机构长期住户的访谈中得出主题。结果围绕不良事件出现了四个主要的主题:(i) 社会关系以及缺乏有意义的互动所带来的不良影响;(ii) 适应老年护理机构的生活以及居民失去以往的生活和自决权;(iii) COVID-19 封锁的影响,这意味着居民无法外出或与他人交流;以及 (iv) 应对不良事件时的接受、顺从和适应能力。结论这项研究强调了用于事件管理报告和质量指标的医疗定义与居民在被要求描述对其产生影响的事件时的反应方式之间的差异。住院患者在回答中讨论了对他们产生不良影响的情况,这与不良事件和事故的报告和监控方式形成了鲜明对比。研究结果表明,在不良事件和事故管理系统以及居民管理系统中,可以纳入过渡时期和福利措施,以捕捉对老年人重要的因素。
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引用次数: 0
Comparison of polypharmacy and potentially inappropriate medication use in older adults with and without dementia receiving residential medication management reviews 有痴呆症和无痴呆症的老年人接受住院用药管理审查时的多药和潜在用药不当情况比较
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-04-06 DOI: 10.1111/ajag.13316
Mouna J. Sawan, Alexander Clough, Jodie Hillen, Natalie Soulsby, Danijela Gnjidic

Objectives

Among residents who had a residential medication management review (RMMR), there is a lack of studies assessing exposure to polypharmacy and potentially inappropriate medications (PIMs) in people with dementia. This study compared the exposure to polypharmacy and PIMs in residents with dementia and without dementia receiving RMMR.

Methods

A retrospective analysis was performed using data of 16,261 residents living in 343 Australian residential aged care facilities who had an RMMR in 2019. Medication use was assessed as polypharmacy (defined as ≥9 medications) and use of ≥1 PIMs using the 2019 updated Beers criteria. Dementia diagnosis was determined with ICD-10 coding from medical records. Descriptive analyses reported resident demographics and patterns of medication use. Pearson's χ2 tests and logistic regression analysis were conducted to compare medication exposure between residents with and without dementia.

Results

Among 16,261 residents, 6781 (42%) had dementia. Residents with dementia were significantly more likely to be exposed to polypharmacy and PIMs, compared to those without dementia (74% vs. 70% and 83% vs. 73%, p < .001 respectively). Residents with dementia had 1.31 times the odds of exposure to polypharmacy (adjusted OR: 1.31, 95% CI: 1.22–1.41, p < .001) and 1.88 times the odds of being prescribed ≥1 PIMs than people without dementia (adjusted OR: 1.88, 95% CI: 1.73–2.04, p < .001).

Conclusions

In a study of residents receiving RMMR, polypharmacy and PIMs were highly common, and those with dementia were more likely to be exposed to inappropriate polypharmacy. There is a need for targeted deprescribing strategies to immediately address inappropriate prescribing in residents, particularly those living with dementia.

目的在接受过住院用药管理审查(RMMR)的住院患者中,缺乏对痴呆症患者接触多种药物和潜在不适当药物(PIMs)情况的评估研究。本研究比较了痴呆症患者和非痴呆症患者在接受RMMR时的多药性和潜在不当用药暴露情况。方法利用2019年接受RMMR的343家澳大利亚养老院16261名住院患者的数据进行了回顾性分析。根据2019年更新的Beers标准,将药物使用情况评估为多药(定义为≥9种药物)和使用≥1种PIMs。痴呆诊断根据病历中的 ICD-10 编码确定。描述性分析报告了住院患者的人口统计学特征和用药模式。进行了皮尔逊χ2检验和逻辑回归分析,以比较有痴呆症和无痴呆症居民的用药情况。与非痴呆症患者相比,痴呆症患者接触多种药物和PIMs的几率明显更高(分别为74%对70%和83%对73%,P< .001)。与非痴呆症患者相比,痴呆症患者接触多种药物的几率是后者的 1.31 倍(调整后 OR:1.31,95% CI:1.22-1.41,p < .001),被开具≥1 种 PIMs 的几率是后者的 1.88 倍(调整后 OR:1.结论在一项对接受 RMMR 的住院患者进行的研究中,多药治疗和 PIMs 非常普遍,痴呆患者更有可能接触到不适当的多药治疗。有必要采取有针对性的去处方化策略,立即解决住院患者,尤其是痴呆症患者的不当处方问题。
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引用次数: 0
Co-production processes for translation and validation of psychosocial assessments for older adults in aged care 翻译和验证老年人社会心理评估的共同生产过程
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-04-04 DOI: 10.1111/ajag.13315
Joyce Siette, Amy D. Nguyen, Laura Dodds, Lindsey Brett, Andrew Georgiou

Objective

Given the diverse ethnic backgrounds of aged care clients, there is a critical requirement to translate psychosocial assessment tools into various languages to effectively evaluate social engagement and quality of life in older adults receiving aged care services. This study aimed to translate psychosocial tools into Turkish, Korean and Mandarin, the primary languages spoken by clients of an Australian community aged care provider.

Methods

A co-development approach encompassing forward and backward translations of the Australian Community Participation Questionnaire and ICEpop CAPability measure for Older people tools, along with focus group discussions involving bilingual staff (n = 7) and clients (n = 16), was employed to ensure precision and cultural relevance. Multiple iterations were undertaken until linguistic, conceptual and scaling equivalence was achieved, with recorded sessions transcribed and analysed thematically.

Results

Cultural appropriateness significantly impacted the delivery of questions within the tools, emphasising translation challenges tied to specific queries. These difficulties included the lack of terms for unique places of worship, the use of outdated language (e.g., references to reading newspapers), and varying priorities in social and well-being matters between Western and Eastern/Asian cultures. Staff feedback identified that formal translated tool versions eased administration for culturally and linguistically diverse (CALD) clients, enabling them to independently interpret questions, resulting in improved questionnaire completion rates.

Conclusions

Insights indicate the need for continued efforts in tailoring assessment tools to diverse cultural contexts to ensure accurate and meaningful data collection.

目的鉴于老年护理客户的种族背景各不相同,因此迫切需要将社会心理评估工具翻译成各种语言,以便有效评估接受老年护理服务的老年人的社会参与度和生活质量。本研究旨在将社会心理评估工具翻译成土耳其语、韩语和普通话,这三种语言是澳大利亚一家社区养老服务机构的服务对象所使用的主要语言。研究采用了共同开发的方法,包括澳大利亚社区参与问卷和 ICEpop CAPability measure for Older people 工具的正向和反向翻译,以及有双语工作人员(n = 7)和服务对象(n = 16)参与的焦点小组讨论,以确保准确性和文化相关性。在实现语言、概念和比例的等效性之前,进行了多次反复,并对记录的会议内容进行了转录和专题分析。这些困难包括缺乏独特礼拜场所的术语、使用过时的语言(例如,提及阅读报纸),以及西方文化和东方/亚洲文化在社会和福利问题上的优先次序不同。工作人员的反馈意见表明,正式翻译版本的工具简化了对不同文化和语言(CALD)客户的管理,使他们能够独立地解释问题,从而提高了问卷的完成率。
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引用次数: 0
Prevalence of frailty according to the Hospital Frailty Risk Score and related factors in older patients with acute coronary syndromes in Vietnam 越南急性冠状动脉综合征老年患者根据医院虚弱风险评分得出的虚弱患病率及相关因素
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-04-04 DOI: 10.1111/ajag.13307
Tan Van Nguyen, Huy Minh Tran, Ha Bich Thi Trinh, Vu Hoang Vu, Vien Ai Bang

Objectives

(1) To investigate the prevalence of frailty defined by the Hospital Frailty Risk Score (HFRS), a new scale for assessing frailty, in older patients with acute coronary syndrome (ACS); (2) To identify associations between frailty and the prescriptions of cardiovascular medications, percutaneous coronary intervention (PCI) and in-hospital adverse outcomes.

Methods

An observational study was conducted in patients aged older than 60 years with ACS at Thong Nhat Hospital from August to December 2022. The Hospital Frailty Risk Score is retrospectively calculated for all participants based on ICD-10 codes, and those with HFRS scores ≥5 were defined as frail. Logistic regression models were applied to examine the relationship between frailty and the study outcomes.

Results

There were 511 participants in the study. The median age was 72.7, 60% were male and 29% were frail. Frailty was associated with lower odds of beta-blocker use at admission (OR .49 95% CI .25–.94), treatment with PCI during hospitalisation (OR .48, 95% CI .30–.75), but did not show an association with prescriptions of cardiovascular drugs at discharge. Frailty was significantly associated with increased odds of adverse outcomes, including major bleeding (OR 4.07, 95% CI1.73–9.54), hospital-acquired pneumonia (OR 2.55, 95% CI 1.20–5.42), all-cause in-hospital mortality (OR 3.14, 95% CI 1.37–7.20) and non-cardiovascular in-hospital mortality (OR 10.73, 95% CI 1.93–59.55).

Conclusions

The HFRS was an effective tool for stratifying frailty and predicting adverse health outcomes in older patients with ACS. Further research is needed to compare the HFRS with other frailty assessment tools in this population.

目的(1)调查急性冠状动脉综合征(ACS)老年患者中由医院虚弱风险评分(HFRS)定义的虚弱发生率,HFRS是评估虚弱的一种新量表;(2)确定虚弱与心血管药物处方、经皮冠状动脉介入治疗(PCI)和院内不良结局之间的关联。方法2022年8月至12月,在Thong Nhat医院对60岁以上的ACS患者进行了一项观察性研究。根据ICD-10编码对所有参与者进行医院虚弱风险评分(Hospital Frailty Risk Score)的回顾性计算,HFRS评分≥5分者定义为虚弱。应用逻辑回归模型来检验虚弱与研究结果之间的关系。中位年龄为 72.7 岁,60% 为男性,29% 为体弱者。体弱与入院时使用β-受体阻滞剂(OR.49,95% CI.25-.94)和住院期间接受 PCI 治疗(OR.48,95% CI.30-.75)的几率较低有关,但与出院时的心血管药物处方没有关系。虚弱与不良结局几率的增加有明显关联,包括大出血(OR 4.07,95% CI 1.73-9.54)、医院获得性肺炎(OR 2.55,95% CI 1.20-5.42)、全因院内死亡率(OR 3.结论HFRS是对ACS老年患者进行体弱分层和预测不良健康结局的有效工具。在这一人群中,还需要进一步研究将 HFRS 与其他虚弱评估工具进行比较。
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引用次数: 0
Implementation and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT™) in acute care 支持性姑息关怀指标工具(SPICT™)在急症护理中的实施与评估。
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-04-01 DOI: 10.1111/ajag.13308
Olivia Paulik, Robyn Whitaker, Monita Mesuria, Debbie Wong, Katie Swanson, Heidi Green, Nqobile Sikhosana, Ritin Fernandez

Objectives

The Supportive and Palliative Care Indicators Tool (SPICT™) has been used to identify patients at risk of deteriorating and dying within 1 year. Early identification and integration of advance care planning (ACP) provides the opportunity for a better quality of life for patients. The aims of this study were to identify the number of patients who were SPICT™ positive; their mortality rates at 6 and 12 months of the SPICT™ assessment; and level of adherence to ACP documentation.

Methods

A retrospective audit of the Supportive and Palliative Care database was conducted at an acute aged care precinct in a major metropolitan tertiary referral hospital in New South Wales, Australia. Data comprising demographics, clinical conditions, SPICT™ positivity and compliance with ACP documentation were collected. SPICT™-positive patients and mortality were tracked at 6 and 12 months, respectively.

Results

Data from 153 patients were collected. The mean age of the patients was 84.1 (±7.8) years, and the length of hospital stay was 10 (±24.7) (range 1–269) days. Approximately 37% were from residential care, and 80% had family deciding on their care. About 15% died during hospitalisation, and 48% were discharged to a care facility. The ACP documentation showed various levels of completion. Mortality rates at 6 and 12 months were 36% and 39%, respectively. Most patients (99%) were SPICT™-positive, with indicators correlating with higher mortality rates at both follow-ups.

Conclusions

The study emphasises the critical need for addressing ACP and palliative care among older patients with life-limiting conditions. It underscores the importance of timely discussions, documentation, and cessation of futile interventions.

目的:支持性姑息治疗指标工具(SPICT™)已被用于识别有可能在一年内病情恶化和死亡的患者。早期识别和整合预先护理计划(ACP)为患者提供了提高生活质量的机会。本研究的目的是确定 SPICT™ 阳性患者的人数、SPICT™ 评估后 6 个月和 12 个月的死亡率以及 ACP 文件的遵守程度:方法:在澳大利亚新南威尔士州一家主要的大都市三级转诊医院的急性老年护理区对支持性和姑息治疗数据库进行了回顾性审计。收集的数据包括人口统计学、临床状况、SPICT™ 阳性率和 ACP 文件合规性。对 SPICT™ 阳性患者和死亡率分别进行了 6 个月和 12 个月的跟踪调查:结果:共收集了 153 名患者的数据。患者的平均年龄为 84.1 (±7.8) 岁,住院时间为 10 (±24.7) 天(范围为 1-269 天)。约 37% 的患者来自寄宿护理机构,80% 的患者由家人决定其护理事宜。约15%的患者在住院期间死亡,48%的患者出院后被送往护理机构。ACP文件显示了不同程度的完成情况。6个月和12个月的死亡率分别为36%和39%。大多数患者(99%)SPICT™呈阳性,在两次随访中,这些指标都与较高的死亡率相关:这项研究强调了在患有生命垂危疾病的老年患者中开展 ACP 和姑息治疗的迫切需要。研究强调了及时讨论、记录和停止无用干预的重要性。
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引用次数: 0
Help-seeking preference in obtaining social support for older adults in depopulated areas 人口稀少地区老年人在获得社会支持时的求助偏好。
IF 1.4 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-04-01 DOI: 10.1111/ajag.13303
Hanami Tone, Michiyo Hirano

Objective

To clarify the circumstances of help-seeking preference among older adults in depopulated areas and the relationship between help-seeking preference and social support.

Methods

This was a cross-sectional study that included a sample of 271 men and women aged 65–79 years living in Japan. A questionnaire survey was conducted to assess help-seeking preference, social cohesion (community trust, norms of reciprocity and community attachment), socialising (interaction with neighbors and social network) and social support. Multiple regression analysis was performed with items that were found to be significantly associated with social support in the univariate analysis. Then, we examined the significance of the change in the coefficient of determination between a model that included help-seeking preference as an independent variable and a model that did not.

Results

Social support was related to help-seeking preference, living arrangements, economic status, norms of reciprocity and social networks. There was a significant difference in the coefficient of determination between the models with and without help-seeking preference.

Conclusions

For older adults in depopulated areas to obtain social support, it is important to build trusting relationships with others and shows a willingness to seek and accept help.

目的阐明人口稀少地区老年人的求助偏好情况以及求助偏好与社会支持之间的关系:这是一项横断面研究,包括 271 名居住在日本的 65-79 岁男性和女性样本。通过问卷调查评估了求助偏好、社会凝聚力(社区信任、互惠规范和社区依恋)、社交(与邻居和社会网络的互动)和社会支持。我们对在单变量分析中发现与社会支持显著相关的项目进行了多元回归分析。然后,我们检验了将求助偏好作为自变量的模型与不将求助偏好作为自变量的模型之间决定系数变化的显著性:结果:社会支持与求助偏好、生活安排、经济状况、互惠规范和社会网络有关。有求助偏好和没有求助偏好的模型之间的决定系数存在明显差异:人口稀少地区的老年人要获得社会支持,必须与他人建立信任关系,并表现出寻求和接受帮助的意愿。
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引用次数: 0
Before Dementia: 20 Questions You Need to Ask about Preventing, Preparing, Coping By K. Gregorevic. HarperCollins Publishers, 2023. ISBN 978-0-7333-4222-6 (paperback). ISBN 978-1-4607-1454-6 (ebook). Paperback AUD 14.99 痴呆前:关于预防、准备和应对,您需要问的 20 个问题》,K. Gregorevic 著。哈珀柯林斯出版社,2023 年。ISBN 978-0-7333-4222-6(平装本)。ISBN 978-1-4607-1454-6(电子书)。平装本 14.99 澳元
IF 1.6 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-03-27 DOI: 10.1111/ajag.13289
Jane Fyfield
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引用次数: 0
List of Reviewers 审查员名单
IF 1.6 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-03-27 DOI: 10.1111/ajag.13298
{"title":"List of Reviewers","authors":"","doi":"10.1111/ajag.13298","DOIUrl":"https://doi.org/10.1111/ajag.13298","url":null,"abstract":"","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"43 1","pages":"225-226"},"PeriodicalIF":1.6,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140297291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Innovating for a rapidly changing publishing environment 针对瞬息万变的出版环境进行创新。
IF 1.6 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-03-27 DOI: 10.1111/ajag.13296
Mark Hughes
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引用次数: 0
Book Award, 2023 图书奖,2023 年。
IF 1.6 4区 医学 Q4 GERIATRICS & GERONTOLOGY Pub Date : 2024-03-27 DOI: 10.1111/ajag.13292
Yvonne Wells
{"title":"Book Award, 2023","authors":"Yvonne Wells","doi":"10.1111/ajag.13292","DOIUrl":"10.1111/ajag.13292","url":null,"abstract":"","PeriodicalId":55431,"journal":{"name":"Australasian Journal on Ageing","volume":"43 1","pages":"10"},"PeriodicalIF":1.6,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Australasian Journal on Ageing
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