The Aged Care Evaluation and Research (ACER) Team
Communities and health care providers are seeking effective ways to plan and manage the health and support services required to enable older adults to actively engage in society and maintain a high quality of life. Information and communication technologies (ICT) can help meet these challenges, from client-focused mobile health and programs that offer direct assistance to individuals, through to large-scale electronic health record systems that can coordinate care across health care sectors.
As residential and community aged care clients and providers embrace ICT, the Aged Care Evaluation and Research (ACER) team is focusing on:
- Unlocking valuable data and integrating health and aged care information in order to answer important questions about care trajectories and outcomes;
- Engaging residential and community aged care clients and the aged care workforce in research to provide valuable insight into the needs and preferences of older people;
- Using ICT to monitor social participation and quality of life as important outcome indicators of community and aged care services; and
- Monitoring major policy initiatives such as consumer-directed care.
Ms Bella St Clair
Follow us on @Acer_mq
- Ageing Well: social participation and wellbeing tools to enhance the delivery of quality, person-centred community aged care services
- Connections Matter: the role of social networks in community aged care
- Driving digital connectivity in residential aged care and the private system with My Health Record
- Evaluating the impact of aged care policy reforms
- iConnect: Improving the way social interactions are recorded in aged care facilities
- Improving the quality of aged care in Australia
- Leveraging information technology to monitor the health and outcomes of residential and community aged care clients
- Use it or lost it? Maximising your brain health
See ACER other projects and initiatives
Ageing Well Stakeholder Forum 2
The ACER team recently held a final stakeholder forum which marked the culmination of a successful Ageing Well project with the aged care provider, Uniting. Those in attendance included community aged care clients and staff, senior management from Uniting, health consumers, representatives from the Department of Health and the ACER researchers. The forum reflected on the findings of the Ageing Well project and focused on looking forward in improving social participation and wellbeing in the aged care sector. The forum welcomed diverse opinions and perspectives on integrated care and highlighted the reality and importance of consumer choice regarding aged care services. Amid the Royal Commission into Aged Care Quality and Safety, these meaningful insights and passionate stories from all aged care contributors at the forum offered a sense of hope, demonstrating the importance of evidence-based action in research and evaluation delivering a promising pathway to effective and quality care for elderly Australians.
Osteoporosis: Underreporting and undertreatment in residential aged care facilities puts people at risk
Osteoporosis causes a significant reduction in bone density and currently affects over 1 million Australians. Although preventable, if the condition is not treated with medication, exercise and dietary changes older people can be at increased risk of fractures which can lead to chronic pain, increased dependency, functional decline, and premature death. Untreated osteoporosis will lead to an estimated 866 out of 100,000 women suffering from a hip or femur fracture within the span of a year. For older individuals with osteoporosis, even minor bumps could result in fracture cascades.
The first large study of osteoporosis medication use among people in Australian residential aged care facilities showed that osteoporosis is likely underreported in electronic health records. Based on international studies, 85% of people in residential aged care are expected to have osteoporosis. However, according to research by Dr Kim Lind and the ACER team at the Australian Institute of Health Innovation published in the journal of Health Services Insights the recognition of osteoporosis is much lower – only 34%.
Results from the study suggest that many people may not be receiving the PBS subsidised medication that would reduce their risk of fracture. Researchers speculate that since multiple chronic health conditions are common for people living in residential aged care facilities, osteoporosis remains unrecognised and not prioritised, leading to undertreatment and underreporting.
The Royal Commission in Aged Care Quality and Safety has highlighted that medication management is a leading concern. Osteoporosis identification and management is a prime example of where systematic monitoring of adherence to medication guidelines could quickly improve the care of our most vulnerable people. As a result of these findings from over 10,000 residents in 68 residential aged care facilities in NSW and ACT, Macquarie University researchers are urging for better recognition and treatment of osteoporosis for people living in aged care facilities.
Antidementia medication use: Implications for medication management in RACFs
Dementia is the second leading cause of death in Australia. It causes cognitive, behavioural and psychological changes as well as a loss of physical functioning. Currently, there are no disease-modifying treatments for dementia, but there are medications (cholinesterase inhibitors and memantine) that can improve symptoms and quality of life, but little is known about the use of these medications in Australia, and specifically in the residential aged care setting.
Researchers at Macquarie University conducted the first study to examine antidementia medication use in residents with dementia in Australian aged care facilities.
The findings, published in the International Journal of Geriatric Psychiatry, indicate that antidementia medication use is strikingly low compared to other countries and use decreased over the 3 year period. Lower levels of antidementia medication use was found in residents living in rural or regional facilities, suffering from multiple chronic health conditions, with greater functional decline, and for foreign-born residents. Antidementia medications are rarely initiated after being admitted to a facility and majority of the sample were administered mild to moderate dementia medication rather than moderate to severe dementia medication, which is more common for people living in a high care setting.
Medication management is a priority for the Royal Commission in Aged Care Quality and Safety and the research by Dr Kim Lind and the ACER team demonstrates that medication monitoring in RACFs is possible with existing electronic health record data.
Researchers suspect that Australian subsidy restrictions may be a barrier to accessing these medications. Additionally, facilities in remote areas may have particularly limited access to specialist consultations to obtain or confirm a dementia diagnosis – a necessary step in order to qualify for PBS subsidisation. Macquarie University researchers call for an increased focus on antidementia medication assessment and review, and use of electronic health record data for improving the quality of aged care for people with dementia.
The co-branded Macquarie University and NSW Australian Association of Gerontology was held on Wednesday the 18th of September. Attendees enjoyed passionate presentations and a panel discussion from featured speakers across the sector including representatives from academia, policy makers and aged care providers. The event was a great opportunity to gain insights from a variety of stakeholders and set the scene for aged care in the future. It enabled us to continue the discussion about next steps and priorities in caring for older Australians, as well as identify common ground and forward-thinking strategies to achieve sustainable, quality, person-centred care.
Social preparedness in response to spatial distancing measures for aged care during COVID-19
Lead author Dr Joyce Siette discusses how to support wellbeing during spatial distancing in residential care in a Letter to the Editor in the Journal of the American Medical Directors Association.
We are looking for PhD Candidates
Passionate about aged care, digital health or health systems? Eager to improve service delivery and quality of life of older adults?
The Aged Care Evaluation and Research (ACER) team at the Australian Institute of Health Innovation (AIHI), Macquarie University has an opportunity for a PhD candidate to undertake research on an NHMRC funded partnership grant. The research involves developing and evaluating an electronic dashboard to improve the delivery of care to clients in residential and community aged care. The partners on this project, Sydney North Health Network (SNHN), Northern Sydney Local Health District, Anglicare, Aged Care Quality and Safety Commission and Australian Healthcare and Hospitals Association, will allow for strong potential for translation of the research and development of skills and connections within these industries. The successful candidate will have the opportunity to be co-located at the SNHN.
Interested? View the full scholarship details.
ACER researchers at the 52nd Australian Association of Gerontology Conference
Macquarie University researchers, including representatives from ACER, CACW and the Business School, recently attended the 52nd Australian Association of Gerontology Conference in Sydney.
This national conference is the largest gerontology conference in Australian connecting research, policy and practice to improve the experience of ageing.
Dr Mikaela Jorgensen awarded prize at the 11th International Association of Gerontology and Geriatrics (IAGG) Asia/Oceania Regional Congress
Dr Mikaela Jorgensen was awarded the Outstanding Oral Presentation prize at the 11th International Association of Gerontology and Geriatrics (IAGG) Asia/Oceania Regional Congress in Taipei in October 2019. She presented findings of research undertaken by the ACER team on establishing new models to monitor outcomes using electronic information systems in Australian home and community-based aged care.
Use it or Lose it? Maximising your brain health
Our very own Dr Joyce Siette has been awarded a NSW Government “My Community Project” grant for the Lane Cove electorate called “Use it or Lose it? Maximising your brain health”.
This full day free clinic will provide an opportunity for older individuals to receive memory screenings from qualified health professionals, form new connections with like-minded community members and participate in activities that improve memory functioning and delay dementia such as exercise classes and learning brain boosting strategies. Dr Siette’s research is evidence that age is not the only predictor of declining mental capacity, but in fact, targeting social isolation is likely to have a major positive impact on brain health and wellbeing.
This event will be the first of its kind to actively promote community engagement in activities that enhance brain capacity. The clinic will be held in February 2021 at a local community Centre. Watch this space!
ACER in the media
Time for a technological revolution in aged care
Aged Care Insite reported on a study co-authored by Dr Joyce Siette, that found the more social interactions aged care recipients have, the better their cognitive function.
Some timely suggestions for social care for older people
Dr Joyce Siette's recent article in Croakey outlined the potential effects of prolonged social distancing on disadvantaged populations such as older adults who are dealing with chronic illnesses or disabilities, and those who are particularly vulnerable to social isolation.
Increasing concerns about “bottom-feeders” as home care providers outnumber residential providers for first time.
“A greater number of providers has the potential to create more choice and tailored services, but only where there is clear and accessible information for older people and their families to compare services, prices and provider quality. Currently there isn’t.”- Dr Mikaela Jorgenson.
The 2018-19 report on the Operation of the Aged Care Act indicates that only 21% of aged care consumers receive residential aged care services whilst the remainder receive the Commonwealth Home Support Programme (CHSP) (66%), home care (10%) and restorative care (2%). Dr Jorgenson highlights increasing concerns of care quality and motivation with evidence demonstrating a rise in “bottom-feeders” entering the market in search for a get-rich quick opportunity.
Researchers developing data tool to identify at-risk residents
AIHI and the ACER team have recently been granted funding from the NHMRC and joint partner Anglicare to develop a digital dashboard to help aged care providers monitor quality indicators and improve the health and wellbeing of older Australians accessing residential and community care. Led by Professor Johanna Westbrook, the project aims to integrate aged care data silos to provide a comprehensive picture of changes to individuals health and wellbeing, and support staff to make evidence-based decisions about client care. The current state of the aged care sector is “data rich but information poor” states Westbrook, indicating that the project is a ground-breaking and innovative approach that will provide actionable and measurable outcomes for aged care clients and staff across Australia.
Gout under-recognised in residential aged care
Dr Amy Nguyen’s recent publication found that over 10% of residents are reported to be suffering with gout. In an interview with the Australian Ageing Agenda , she stated that this number is high but the actual prevalence is likely to be under-estimated and under-recognised due to inefficiencies in facility recording systems. Gout is a low priority health condition for many residents and they often only receive medication when experiencing an attack. To effectively manage gout, medication should be taken regularly as a preventative measure. In light of her research, Dr Nguyen has increasing concerns that if gout is left untreated, residents will face further debilitation and permanent joint damage.
Dementia: How big is the ageing tsunami? It’s a best guess scenario
To accurately determine dementia prevalence and incidence as well as the overall health status of older Australians, Dr Kim Lind expressed the need for a rigorous population-based Australian study in a recent article in the Sydney Morning Herald. She explained that the underreporting of dementia in hospital records is a likely reason for the drop in dementia hospitalisation rates published in a recent report by the AIHW. She also stated that “There’s a lack of reliable data on the health status of older Australians, particularly those in residential aged care” which makes it difficult to forecast the impact of health issues amongst Australia’s ageing population.
More ACER Media
- Nine News Sydney (2019) - Aged care residents on drug 'triple whammy' face risk of acute kidney injury
- Skatssoon J (2019). Home care reforms leaving most vulnerable behind. Community Care Review.
- Burke C (2019). Gout on the rise, underdiagnosed in aged care. Aged Care Insite. September 2019
- Burke C (2019). The cost of chronic disease in Australia: ABC’s 7.30 report. Aged Care Insite. July 2019
- Cheu S (2019). Researchers developing data tool to identify at-risk residents. Australian Ageing Agenda.
- Cheu S (2019). Gout under-recognised in residential aged care. Australian Ageing Agenda. August 2019
- Power J (2019). Dementia: How big is the ageing tsunami? It’s a best guess scenario. The Sydney Morning Herald
- Power J (2019). Aged care residents on drug ‘triple whammy’ face risk of acute kidney injury. The Sydney Morning Herald
- Power J (2019). Aged care residents turned into ‘zombies’ on antipsychotics for more than 200 days at a time. The Sydney Morning Herald
- Jorgensen M, Lind KE, Georgiou A, Westbrook J. (2018) Big data analytics meets aged care The Health Advocate 51: 44-45
- Jorgensen M. (2019) Aged care reforms stumble as older Australians struggle to stay at home. The Lighthouse January 2019
- Westbrook J. (2018) Aged care: no need to wait for Royal Commission. MJA InSight November 2018
- Siette J. (2019) Is memory decline an inevitable part of ageing? The Lighthouse March 2019
- Braithwaite J, Westbrook J, Coiera E. Evidence-based research is key to the Aged Care Royal Commission. Sydney: Macquarie University 2018
- Skatssoon, J. (2018) Talking about social engagement pays off. Australian Ageing Agenda August 2018
- Brett L, Georgiou A, Jorgensen M, Siette J, Scott G, Westbrook J. (2017) Where have all my friends gone? The Health Advocate 44: 34-35.
- Egan N. (2017) Link between home care hours, social support and entry to residential care. Australian Ageing Agenda September 2017
- Sax Institute. Researchers use data analytics to map aged care journey. Sydney: Sax Institute 2017
- ABC Radio Hobart – interview with Dr Mikaela Jorgensen on aged care.
Recent ACER publications
- Siette, J, Georgiou, A, Brayne, C, Westbrook, J. I (2020). Social networks and cognitive function in older adults receiving home- and community-based aged care. Archives of Gerontology and Geriatrics.
- Jorgensen M, Siette J, Georgiou A, Westbrook JI (2020).The effect of home care package allocation reforms on service uptake, use and cessation at a large Australian aged care provider. Australasian Journal on Ageing.
- Brett L, Siette J, Nguyen AD, Jorgensen M, Miao M, Westbrook JI, Lee W, Gow E, Hourihan F, Georgiou A (2019). At the grassroots of home and community-based aged care: strategies for successful consumer engagement. BMJ Open
- Brett L, Noblet T, Jorgensen M, Georgiou A (2019). The use of physiotherapy in nursing homes internationally: a systematic review. PLOS One; 14(7):e0219488.
- Lind (2020). Highlighting the Need for Action Regarding Persistent Sex Bias in Research. JAMA Internal Medicine.
- Nguyen A, Lind KE, Day R, Georgiou A, Westbrook J. A profile of health status and demographics of aged care facility residents with gout. Australasian Journal on Ageing.
- Brett L, Mguyen A, Siette J, Dove-Pizarro J, Hourihan F, Georgiou A (2019) The co-design of timely and meaningful information needed to enhance social participation in community aged care services: Think Tank proceedings. Australiasian Journal on Ageing.
- Siette J, Georgiou A, Westbrook J (2019). Observational cohort study investigating cognitive outcomes, social networks and well-being in older adults: a study protocol. BMJ Open.
- Lind KE, Raban MZ, Georgiou A, Westbrook J (2019). NSAID use among residents in 68 residential aged care facilities 2014 to 2017: An analysis of duration, concomitant medication use, and high-risk conditions. Pharmacoepidemiology & Drug Safety.
- Lind KE, Raban MZ, Georgiou A, Westbrook JI (2019). Duration of Antipsychotic Medication Use by Aged Care Facility Residents With Dementia. Alzheimer Disease & Associated Disorders.
- Lind KE, Jorgensen M (2019). Cleaning the air: why a link between Alzheimer’s disease and air quality cannot be validly determined using prescription data in Australia. Health & Place.
- Lind KE. (2019) Aged care residents miss out on anti-dementia meds. The Lighthouse June 2019
- Lind KE, Jorgensen ML, Gray LC, Georgiou A, Westbrook JI. (2019) Anti-osteoporosis Medication Use in a High Fracture-Risk Population: Contemporary Trends in Australian Residential Aged Care Facilities. Health Services Insights.
- Lind KE, Gray LC, Raban MZ, Georgiou A, Westbrook J (2019). Anti‐dementia medication use by aged care residents with dementia. International Journal of Geriatric Psychiatry.
- Brett L, Georgiou A, Jorgensen M, Siette J, Scott G, Gow E, Westbrook J (2019). Ageing well: evaluation of social participation and quality of life tools to enhance community aged care (study protocol). BMC Geriatrics, 19(1), 78.
- Siette J, Georgiou A, Jorgensen M, O'Donnell C, Westbrook J (2018). Integrating social engagement instruments into community aged care assessments to enhance service provision. Journal of Health & Social Care in the Community; 26(6):810-818.
- Jorgensen M, Siette J, Georgiou A, Westbrook J (2018). Longitudinal variation in pressure injury incidence among long-term aged care facilities. International Journal for Quality in Health Care; [Epub ahead of print].
- Pont L, Raban MZ, Jorgensen M, Georgiou A, Westbrook J (2018). Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use. International Journal for Quality in Health Care; [Epub ahead of print].
- Jorgensen M, Siette J, Georgiou A, Warland A, Westbrook J (2017). Modelling the association between home care service use and entry into residential aged care: a cohort study using routinely collected data. Journal of the American Medical Directors Association; 19(2):117-21.
- Douglas H, Georgiou A, Tariq A, Prgomet M, Warland A, Armour P, Westbrook J (2017). Implementing information and communication technology to support community aged care service integration: Lessons from an Australian aged care provider. International Journal of Integrated Care; 17(1):9-21.
- Prgomet M, Douglas H, Tariq A, Georgiou A, Armour P, Westbrook J (2017). The work of front line community aged care staff and the impact of a changing policy landscape and consumer-directed care. The British Journal of Social Work; 47(1):106–124.
- Borotkanics R, Rowe C, Georgiou A, Douglas H, Makeham M, Westbrook J (2017). Changes in the profile of Australians in 77 residential aged care facilities across New South Wales and the Australian Capital Territory. Australian Health Review; 41(6):613-620.
- Douglas H, Georgiou A, Westbrook J (2016). Social participation as an indicator of successful aging: an overview of concepts and their associations with health. Australian Health Review; 41(4):455-462.
- Tariq A, Georgiou A, Raban M, Baysari M, Westbrook J (2016). Underlying risk factors for prescribing errors in long term aged care: a qualitative study. BMJ Quality and Safety; 25(9):704-715.
- Tariq A, Douglas H, Smith C, Georgiou A, Osmond T, Armour P, Westbrook J (2015). A descriptive analysis of incidents reported by community aged care workers. Western Journal of Nursing Research;37(7):859-76.