Aged care residents receive best practice care for continence but not for all conditions

Quality of care revealed in world first research

Most residents of aged care homes in Australia receive best practice care for continence issues but not for six other common conditions including mental health, end-of-life care and urinary tract infections, according to new research from the Australian Institute of Health Innovation, Macquarie University.

This study is the first to evaluate adherence to evidence-based care for people in long term residential aged care across multiple common conditions.

With aged care nurses conducting specialised reviews, the researchers found that on average, residents received care in line with guidelines 53.2% of the time. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators for best care.

In the paper to be published in BMC Medicine on 23 January 2024, researchers evaluated the care received by 294 residents across 27,585 care encounters in 25 residential aged care facilities.

Lead author and internationally recognised patient safety expert, Professor Peter Hibbert (pictured), said the results pointed to the continued difficulties faced by the aged care sector including workforce shortages with medical, nursing and allied health staff.

The lowest rate of adherence was for the management of depression despite more than half of all permanent aged care residents experiencing depression symptoms. The research found that only 1% of residents who had been receiving antidepressants for four weeks were monitored on a monthly basis for side-effects as per the guidelines.

The research also found that urinary tract infections were not being managed according to guidelines designed to ensure frail older people received evidence-based treatment and antibiotics were not used unnecessarily.

“Being treated according to evidence-based care is a fundamental human right and essential for ensuring people in aged care are safe and experience the best possible quality of life,” Professor Hibbert said.

“Caring for older people in aged care is likely to become more and more challenging as demand increases and resources become more stretched,” he said.

“Understanding where and how evidence-based care is being delivered, or not, is very important to keeping people safe and allocating limited resources,” he said.

“Listening to the experiences of residents and their families is also essential,” he said.

The number of people aged 80 years and over in Australia is expected to quadruple to 1.8 million by 2050.

Clinical practice guidelines contain recommendations intended to ensure patients receive care that has proven benefit. National experts worked with the researchers to identify indicators of care drawn from the clinical practice guidelines for 16 conditions or care processes. Trained aged care nurses then reviewed records of care delivered in residential facilities between 1 March and 31 May 2021 to assess adherence with the indicators.

Professor Hibbert said "We are not judging individual aged care providers with these results."

This is a commentary on the overall aged care sector which is struggling to provide residents the right care at the right time.

“The data for this study was collected around the time that the Royal Commission into Aged Care reported its findings in 2021. The Royal Commission recommended that registered nurses should be onsite 24/7 and that other healthcare staff be more available. These changes are very welcome, however, broader workforce shortages have increased since 2021, which has continued to put pressure on the system.”

A lack of ongoing systematic monitoring of the performance of the sector also contributes to the lower rates of evidence-based care and the results provide valuable insights into specific conditions and clinical processes where improvements should be targeted, he said.

Table 1: Level of adherence to evidence-based care by condition

Table 2: Level of adherence to evidence-based care by phase of care

This research is funded by the NHMRC Partnership Project CareTrack Aged led by Professor Jeffrey Braithwaite, Australian Institute of Health Innovation, Macquarie University.

Professor Peter Hibbert is available for interview, please contact chrissy.clay@mq.edu.au

Read the research article here:

Hibbert PD, Molloy CJ, Wiles LK, Cameron ID, Gray LC, Reed RL, Wiles LK, Westbrook J, Arnolda G, Bilton R, Ash R, Georgiou A, Kitson A, Hughes CF, Gordon SJ, Mitchell RJ, Rapport F, Estabrooks C, Alexander GL, Vincent C, Edwards A, Carson-Stevens A, Wagner C, McCormack B, Braithwaite J. The quality of care delivered to residents in long-term care in Australia: an indicator-based review of resident records (CareTrack Aged)  BMC Med 22, 22 (2024). https://doi.org/10.1186/s12916-023-03224-8

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