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Abstract Background Hospitalized older patients with cognitive impairment (CI) experience poor outcomes and high rates of hospital acquired complications (HACs). This study investigated the effectiveness of a multimodal hospital CI identification and education program. Method A prospective stepped-wedge, cross-sectional, continuous-recruitment, hybrid effectiveness-Implementation study was conducted in acute hospitals in four Australian states/territories. The intervention, the Dementia Care in Hospitals Program (DHCP) provided: clinical/ non-clinical hospital staff CI awareness support and education; CI screening for older patients and a bedside alert—the Cognitive Impairment Identifier (CII). The primary outcome was change in the rate of the combined risk of four HACs (urinary tract infection, pneumonia, new onset delirium, pressure injury). Results Participants were patients aged 65 years and over admitted for 24 h or more over a 12-month period between 2015–2017 (n = 16,789). Of the 11,309 (67.4%) screened, 4,277 (37.8%) had CI. HACs occurred in 27.4% of all screened patients and were three times more likely in patients with CI after controlling for age and sex (RR = 3.03; 95%CI:2.74–3.27). There was no significant change in HAC rate for patients with CI (RR = 1.084; 95%CI: 0.93; 1.26). In the intervention period the raw HAC rate for all screened patients was 27.0%, which when adjusted for age and sex suggested a small reduction overall. However, when adjusted for hospital site, this reduction in HAC risk not statistically significant (RR = 0.968; 95%CI:0.865–1.083). There was considerable interhospital variation in intervention implementation and outcomes which explains the final non-significant effect. Conclusion For patient with CI the implementation of the DCHP did not result in a reduction in HAC rates. Education for hospital staff regarding cognitive impairment screening, care support, carer engagement and bedside alerts, using the DCHP, can be feasibly implemented in acute hospitals. Reducing high frequency HACs in older hospital patients with CI, warrants further research. Trial Registration. The trial was registered retrospectively with the Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12615000905561 on 01/09/2015 with 92 patients (0.8% of total sample) recruited in the baseline and none in the intervention before registration submission.

Background: Symptoms of emotional and physical stress near death may be related to previous experiences of trauma. Objective: To investigate current evidence regarding the following: (1) Is previous trauma identified in people who are dying, and if so, how? (2) How is previous trauma associated with the experience of death/dying in people with or without cognitive impairment? and (3) What palliative care interventions are available to people with previous trauma at the end of life? Design: This integrative review was conducted per Whittemore and Knafl’s guidelines, which involves a stepped approach, specifically (1) problem identification, (2) literature search, (3) data evaluation, (4) data analysis and (5) presentation. Methods: This integrative review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Electronic databases were searched in August 2021 and updated in August 2023. The articles were quality appraised, and narrative data were analysed using Grounded Theory (GT). Results: Of 1310 studies screened, 11 met the inclusion criteria (four qualitative and seven quantitative) conducted in Australia, Canada, Japan and the United States; and American studies accounted for 7/11 studies. Eight were focused on war veterans. Descriptive studies accounted for the majority, with only two publications testing interventions. Re-living trauma near death has additional features to a diagnosis of post-traumatic stress disorder alone, such as physical symptoms of uncontrolled, unexplained acute pain and this distress was reported in the last weeks of life. Conclusion: This study proposes that re-living trauma near death is a recognisable phenomenon with physical and psychological impacts that can be ameliorated with improved clinical knowledge and appropriate management as a new GT. Further research is needed to enable past trauma identification at the end of life, and trauma-informed safe interventions at the end of life are an urgent need.

Abstract Background There are huge demands for aged-care workers, and undergraduate gerontological nursing education plays a critical role in providing academic and professional training. Purpose To examine relationships of characteristics, aged-care education, and gerontological nursing competencies with the intention to work in aged care. Methods An online survey was distributed to undergraduate nursing students between April and June 2022 to gather characteristics, relevant aged-care education, gerontological nursing competencies, and intentions to work in aged care data. Multivariate regression analyses were conducted to identify determinants of the intention to work in aged care. Results Students (n = 358) who were older (p

Background: This study evaluates the dementia care system in a local area and aimed to include all specialised services designed to provide health and social services to people with dementia or age-related cognitive impairment, as well as general services with a high or very high proportion of clients with dementia. Methods: The study used an internationally standardised service classification instrument called Description and Evaluation of Services and DirectoriEs for Long Term Care (DESDE-LTC) to identify and describe all services providing care to people with dementia in the Australian Capital Territory (ACT). Results: A total of 47 service providers were eligible for inclusion. Basic information about the services was collected from their websites, and further information was obtained through interviews with the service providers. Of the 107 services offered by the 47 eligible providers, 27% (n = 29) were specialised services and 73% (n = 78) were general services. Most of the services were residential or outpatient, with a target population mostly of people aged 65 or older, and 50 years or older in the case of Aboriginal and Torres Strait Islander Australians. There were government supports available for most types of care through various programmes. Conclusions: Dementia care in the ACT relies heavily on general services. More widespread use of standardised methods of service classification in dementia will facilitate comparison with other local areas, allow for monitoring of changes over time, permit comparison with services provided for other health conditions and support evidence-informed local planning.

Background: This pilot study aimed to assess whether an on-site pharmacist could influence indicators of quality use of medicines in residential aged care. Methods: A pharmacist was embedded in a residential aged care home for six months. A similar control site received usual care. Polypharmacy, drug burden index, antipsychotic and benzodiazepine use, hospital admission rates and length of stay, and emergency department presentation rates were outcomes used to indicate medication use quality. Data were extracted from participating resident health records. Results: Fifty-eight residents at the study site and 39 residents at the control site were included in the analysis. There was a reduction in the proportion of residents at the study site who had at least one hospital admission at follow-up (28% to 12%, p < 0.01), but no significant difference in other outcomes. Conclusions: This pilot study suggests that a residential care pharmacist may positively influence indicators of medication use quality in aged care; however, further research is needed to expand on these findings.

Hospital-acquired complications increase length of stay and contribute to poorer patient outcomes. Older adults are known to be at risk for four key hospital-acquired complications (pressure injuries, pneumonia, urinary tract infections and delirium). These complications have been identified as sensitive to nursing characteristics such as staffing levels and level of education. The cost of these complications compared to the cost of admission severity, dementia, other comorbidities or age has not been established.To investigate costs associated with nurse-sensitive hospital-acquired complications in an older patient population 157,178 overnight public hospital episodes for all patients over age 50 from one Australian state, 2006/07 were examined. A retrospective cohort study design with linear regression analysis provided modelling of length-of-stay costs. Explanatory variables included patient age, sex, comorbidities, admission severity, dementia status, surgical status and four complications. Extra costs were based on above-average length-of-stay for each patient's Diagnosis Related Group from hospital discharge data.For adults over 50 who have length of stay longer than average for their diagnostic condition, comorbid dementia predicts an extra cost of A$874, (US$1,247); any one of four key complications predicts A$812 (US$1,159); each increase in admission severity score predicts A$295 ($US421); each additional comorbidity predicts A$259 (US$370), and for each year of age above 50 predicts A$20 (US$29) (all estimates significant at p