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Article << Previous     |     Next >>   Contents Vol 38(3)

Public sector residential aged care: identifying novel associations between quality indicators and other demographic and health-related factors

Kirsten J. Moore A F G, Colleen J. Doyle A B, Trisha L. Dunning C D, Ann T. Hague D, Lucas A. Lloyd D, Jo Bourke D and Stephen D. Gill E

A National Ageing Research Institute, PO Box 2127, Royal Melbourne Hospital, Vic. 3050, Australia.
B Australian Catholic University, 115 Victoria Parade, Fitzroy, Vic. 3000, Australia. Email: c.doyle@nari.unimelb.edu.au
C Deakin University, Kitchener House, PO Box 281, Geelong, Vic. 3220, Australia. Email: Trisha.dunning@barwonhealth.org.au
D Barwon Health, Barwon Health, PO Box 281, Geelong, Vic. 3220, Australia. Email: annha@barwonhealth.org.au; llloyd@barwonhealth.org.au; jo.bourke@barwonhealth.org.au
E Safety and Quality Unit, Barwon Health, Barwon Health, PO Box 281, Geelong, Vic. 3220, Australia. Email: steveg@barwonhealth.org.au
F Present address: Marie Curie Palliative Care Research Unit, UCL Division of Psychiatry, Charles Bell House, 63-73 Riding House Street, London W1W 7EJ, UK.
G Corresponding author. Email: kirsten.moore@ucl.ac.uk

Australian Health Review 38(3) 325-331 http://dx.doi.org/10.1071/AH13184
Submitted: 13 February 2013  Accepted: 4 February 2014   Published: 8 May 2014

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Objective To explore associations among quality indicators (QI; e.g. pressure ulcers, falls and/or fractures, physical restraint, use of multiple medications, unplanned weight loss) of the Victorian Public Sector Residential Aged Care Services (VPSRACS) with other demographic and health-related factors.

Methods Data for 380 residents over a 3-month period were extracted retrospectively from client databases at four VPSRAC facilities.

Results Four significant logistic regression models were developed. The strongest models related to falls and polypharmacy. Significant associations for these models included the following: (1) residents with a higher body mass index were 6% less likely (95% confidence interval (CI) 1%–11%) to fall, whereas high levels of cognitive impairment increased the risk of falling by 8% (95% CI 2%–14%); (2) being ambulant with a gait aid more than doubled the risk of falling compared with non-ambulant residents (95% CI 19%–546%); and (3) higher cognitive impairment was associated with a 6% (95% CI 1%–11%) reduction in the likelihood of polypharmacy.

Conclusions Identification of significant relationships between the VPSRACS QI and other demographic and health-related factors is a preliminary step towards a more in-depth understanding of the factors that influence the QI and predict adverse events.

What is known about the topic? Currently, the VPSRACS report on five QI. Previous research has shown associations between several of these indicators, but not all.

What does this paper add? This paper examines associations between the five VPSRAC QI as well as other key demographic and health-related factors. Novel findings from regression analyses included an increased risk of falls associated with recommended body mass index and using gait aids, but no association between pressure ulcers and the Norton score. Regression models for other QI were limited by the small occurrences of the QI. However, significant associations were identified indicating that residents using a gait aid had a lower level of unplanned weight loss and residents with polypharmacy had higher unplanned weight loss.

What are the implications for practitioners? This paper reinforces the value of collecting VPSRAC QI data to enable facilities to consider how these variables could impact on care quality and to proactively plan to reduce the risk of adverse events. Although QI data can be used to benchmark with other settings, this paper shows how QI data can be used to inform practice within a facility and help identify patient-related factors that may warrant further investigation.


[1]  Courtney M, O’Reilly M, Edwards H, Hassall S. The relationship between clinical outcomes and quality of life for residents of aged care facilities. Aust J Adv Nurs 2009; 26: 49–57.

[2]  Hawes C, Vladeck BC, Morris JN, Phillips CD, Fredeking H. The RAI and the politics of long term care: the convergence of science and politics in US Nursing Home Policy. In: Bries BE, Fahey C, editors. Implementing the Resident Assessment Instrument: case studies of policy making for long-term care in eight countries. New York: Milbank Memorial Fund; 2003.

[3]  Rantz MJ, Petroski GF, Madsen RW, Mehr DR, Popejoy L, Hicks LL, et al Setting thresholds for quality indicators derived from MDS data for nursing home quality improvement reports: an update. Jt Comm J Qual Improv 2000; 26: 101–10.
| CAS | PubMed |

[4]  Courtney M, O’Reilly M, Edwards H, Hassall S. Content validity of the ResCareQA: an Australian residential care quality assessment based on resident outcomes. Aust J Adv Nurs 2011; 28: 37–46.

[5]  Courtney M, O’Reilly MT, Edwards H, Hassall S. Development of a systematic approach to assessing quality within Australian residential aged care facilities: the Clinical Care Indicators Tool. Aust Health Rev 2007; 31: 582–91.
CrossRef | PubMed |

[6]  Department of Human Services. Resource manual for quality indicators in Public Sector Residential Aged Care Services–Resource Manual 2007–2008 version 1. Melbourne: Rural and Regional Health and Aged Care Services Division, Victorian Government Department of Human Services; 2007.

[7]  Blaum CS, Fries BE, Fiatarone MA. Factors associated with low body mass index and weight loss in nursing home residents. J Gerontol A Biol Sci Med Sci 1995; 50: M162–8.
CrossRef | CAS | PubMed |

[8]  Capezuti E, Strumpf NE, Evans LK, Grisso JA, Maislin G. The relationship between physical restraint removal and falls and injuries among nursing home residents. J Gerontol A Biol Sci Med Sci 1998; 53: M47–52.
CrossRef | CAS | PubMed |

[9]  Castle NG, Engberg J. The health consequences of using physical restraints in nursing homes. Med Care 2009; 47: 1164–73.
CrossRef | PubMed |

[10]  Cooper JW, Freeman MH, Cook CL, Burfield AH. Assessment of psychotropic and psychoactive drug loads and falls in nursing facility residents. Consult Pharm 2007; 22: 483–9.
CrossRef | PubMed |

[11]  Demir A. Nurses’ use of physical restraints in four Turkish hospitals. J Nurs Scholarsh 2007; 39: 38–45.
CrossRef | PubMed |

[12]  Evans D, Wood J, Lambert L. Patient injury and physical restraint devices: a systematic review. J Adv Nurs 2003; 41: 274–82.
CrossRef | PubMed |

[13]  Lipsitz LA, Jonsson PV, Kelley MM, Koestner JS. Causes and correlates of recurrent falls in ambulatory frail elderly. J Gerontol 1991; 46: M114–22.
CrossRef | CAS | PubMed |

[14]  Lofgren RP, MacPherson DS, Granieri R, Myllenbeck S, Sprafka M. Mechanical restraints on the medical wards: are protective devices safe? Am J Public Health 1989; 79: 735–8.
| CAS | PubMed |

[15]  Moore K, Haralambous B. Barriers to reducing the use of restraints in residential elder care facilities. J Adv Nurs 2007; 58: 532–40.
CrossRef | PubMed |

[16]  Neufeld RR, Libow LS, Foley WJ, Dunbar JM, Cohen C, Breuer B. Restraint reduction reduces serious injuries among nursing home residents. J Am Geriatr Soc 1999; 47: 1202–7.
| CAS | PubMed |

[17]  Shahin E, Meijers J, Schols J, Tannen A, Halfens R, Dassen T. The relationship between malnutrition parameters and pressure ulcers in hospitals and nursing homes. Nutrition 2010; 26: 886–9.
CrossRef | PubMed |

[18]  Sterke CS, Verhagen AP, van Beeck EF, van der Cammen TJM. The influence of drug use on fall incidents among nursing home residents: a systematic review. Int Psychogeriatr 2008; 20: 890–910.
CrossRef | PubMed |

[19]  Tinetti ME, Wen-Liang L, Ginter SF. Mechanical restraint use and fall-related injuries among residents of skilled nursing facilities. Ann Intern Med 1992; 116: 369–74.
CrossRef | CAS | PubMed |

[20]  Garcia AD, Thomas DR. Assessment and management of chronic pressure ulcers in the elderly. Med Clin North Am 2006; 90: 925–44.
CrossRef | PubMed |

[21]  Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell scale for depression in dementia. Biol Psychiatry 1988; 23: 271–84.
CrossRef | CAS | PubMed |

[22]  Jorm A, Mackinnon A. Psychogeriatric assessment scales: user’s guide. Canberra: Commonwealth Department of Human Services and Health; 1997.

[23]  Australian Government Department of Health and Ageing. Aged Care Funding Instrument (ACFI) user guide. Canberra: Australian Government Department of Health and Ageing; 2013.

[24]  Hill K, Vrantsidis F, Haralambous B, Fearn M, Smith R, Murray K. et al. An analysis of research on preventing falls and fall injury in older people: community, residential care and hospital settings. Report to the Australian Government, Department of Health and Ageing, Injury Prevention Section by the National Ageing Research Institute. Canberra: Australian Department of Health and Ageing; 2004.

[25]  Courtney M, O’Reilly MT, Edwards H, Hassall S. Benchmarking clinical indicators of quality for Australian residential aged care facilities. Aust Health Rev 2010; 34: 93–100.
CrossRef | PubMed |

[26]  Kojima T, Akishita M, Nakamura T, Nomura K, Ogawa S, Iijima K, et al Polypharmacy as a risk for fall occurrence in geriatric outpatients. Geriatr Gerontol Int 2012; 12: 425–30.
CrossRef | PubMed |

[27]  Australian Government Department of Health and Ageing. Guiding principles for medication management in residential aged care facilities. Canberra: Australian Department of Health and Ageing; 2012.

[28]  Australian Commission on Safety and Quality in Healthcare. Preventing falls and harm from falls in older people: best practice guidelines for Australian residential aged care facilities. Canberra: Commonwealth of Australia; 2009. Available at http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Guidelines-RACF.pdf [verified 28 March ,2014].

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