Evidence-based research is key to the Aged Care Royal Commission

Professors Jeffrey Braithwaite, Johanna Westbrook and Enrico Coiera from the Australian Institute of Health Innovation welcome the call for a Royal Commission into Aged Care announced by the Prime Minister The Hon Scott Morrison MP. They counsel that evidence-based research is the key to achieving improved outcomes for the most vulnerable in our society.

Professor Braithwaite said the recent Four Corners program, showed nothing short of elder abuse. He said “The way we treat the most vulnerable in our society is a real reflection of our values. What we saw should make us think deeply about how we believe the elderly, frail or vulnerable in our community should be treated.”

Professor Braithwaite is the lead investigator on the National Health and Medical Research Council (NHMRC) funded CareTrack Aged project, which is an Australia-first study into the level of evidence-based care delivered to residents of Australian residential aged care facilities.

Professor Braithwaite said CareTrack Aged and other research being undertaken by AIHI, would be a unique source of evidence-based benchmarking for the Royal Commission.

Professor Braithwaite indicated that although anecdotal evidence of problems in aged care facilities is valuable and sometimes heart-wrenching, it was equally important to systematically monitor, measure and investigate the level of evidence-based care provided.

Further, Professor Braithwaite went on to say: “We know that care that follows best practice guidelines plays a critical role in people’s health and wellbeing and by investigating this for aged care, we are identifying opportunities for improvement."

We know most residents of aged care facilities are over 85 years of age, have multiple medical issues and rely largely or solely on staff for their needs. Yet very little research has been done before now to identify if the care being delivered is in line with best practice – put simply, what evidence has shown us works best - and if the social wellbeing needs of residents are being met.

CareTrack Aged is looking at fifteen conditions that are frequently managed in residential aged care facilities such as delirium, dementia, depression, pain management and medication management. The project will also assess the quality of life of residents.

Professor Braithwaite commented that healthy ageing is more than just the absence of disease or infirmity. “It is much more complex, taking into account the physical, mental and social engagement of our mothers, fathers, grandparents, and loves ones,” he said.

CareTrack Aged would also have important implications for the aged care workforce. “By identifying what works well in residential aged care facilities, we can develop strategies that will lead to a more sustainable workforce,” he said.

CareTrack Aged and other AIHI quality of life studies already underway, encompass concepts that relate to older peoples’ attachments such as love and friendship, security, enjoyment and control.

Professor Westbrook said: “Understanding how information technology can enhance aged care services and client outcomes is a major focus of our research in both residential and community aged care. By analysing data routinely collected by service providers, it is now possible to piece together a more complete picture of a person’s journey from when they first begin accessing services at home to what happens to them when in residential care.

Most Australians would like to stay in their homes for as long as possible. Recent research lead by AIHI researchers has shown that the provision of community care services significantly delays older people’s admissions to residential aged care.

Professor Westbrook said:

Importantly, we found that social support services were particularly important in reducing the chance of clients needing to go into residential care.  For every extra hour of community support services clients received there was a 6% lower risk of admission to a residential aged care facility.

Measuring client wellbeing and quality of life are important indicators.  A study underway in collaboration with aged care providers is monitoring these measures in more than 1,000 older people in the community receiving care.  “This study will assist in evaluating programs targeting improved social networks for older people, including those with chronic conditions such as dementia.”

Professor Westbrook reflected on further research being done at AIHI in health systems and safety for aged care. “We have been investigating the quality of care delivered in residential aged care facilities through leveraging new information technology to monitor medication use and pressure injury management.”

AIHI’s current research into aged care includes the following:

• NHMRC Care Track Aged: Appropriate care delivered to Australians living in residential aged care - Professor Jeffrey Braithwaite
• Ageing well – a social participation and engagement tool to enhance consumer choice and the delivery of quality, person-centred community aged care services - Professors Andrew Georgiou and Johanna Westbrook
• Understanding the impact of dementia on rehabilitation following hip fracture to improve health outcomes for older people – Associate Professor Rebecca Mitchell
• Creating safe, effective systems of care the translational challenge – Professors Braithwaite, Westbrook and Coiera
• Connections matter – the role of social networks in community aged care – Dr Joyce Siette
• Integrating aged care services in the community – Drs Mikaela Jorgensen, Joyce Siette and Lindsey Brett
• Improving the quality use of medicines in residential aged care – Drs Kim Lind and Magda Raban

Recent publications include:

• Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use
• Longitudinal variation in pressure injury incidence among long-term aged care facilities
• Integrating social engagement instruments into Australian community aged care assessments to enhance service provision
• Modeling the Association Between Home Care Service Use and Entry Into Residential Aged Care: A Cohort Study Using Routinely Collected Data

Professor Jeffrey Braithwaite

Founding Director, Australian Institute of Health Innovation, and Director, Centre of Healthcare Resilience and Implementation Science, AIHI

Professor Johanna Westbrook

Director, Centre for Health Systems and Safety Research, AIHI

Professor Enrico Coiera

Director, Centre of Health Informatics, AIHI

For more information, please contact chrissy.clay@mq.edu.au