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The article presents a study which examined diabetes prevalence in Australian long-term care (LTC) facilities using a linked national health and aged care data platform and the level of agreement of prevalence estimates between datasets that capture diabetes cases. Topics include diabetes case ascertainment using linked aged care and health administrative data sets, prevalence of diabetes in National Death Index (NDI) data, and the high burden of diabetes in Australian LTC facilities.

• Little is known regarding changes in primary health care utilisation following LTC entry. • After hours and urgent after hours GP attendances increased almost 2-fold after LTC entry. • Only a third of residents received a GP health assessments or care planning after LTC entry. • Utilisation of pain, palliative and geriatric specialist medicine attendances were low (<3%). • There is an opportunity to improve the utilisation of primary health care services to ensure that residents' complex care needs are adequately met. To examine utilisation of primary health care services (subsidised by the Australian Government, Medicare Benefits Schedule, MBS) before and after entry into long-term care (LTC) in Australia. A retrospective cohort study of older people (aged ≥65 years) who entered LTC in Australia between 2012 and 2016 using the Historical Cohort of the Registry of Senior Australians. MBS-subsidised general attendances (general practitioner (GP), medical and nurse practitioners), health assessment and management plans, allied health, mental health services and selected specialist attendances accessed in 91-day periods 12 months before and after LTC entry were examined. Adjusted relative changes in utilisation 0–3 months before and after LTC entry were estimated using risk ratios (RR) calculated using Generalised Estimating Equation Poisson models. 235,217 residents were included in the study with a median age of 84 years (interquartile range 79–89) and 61.1% female. In the first 3 months following LTC entry, GP / medical practitioner attendances increased from 86.6% to 95.6% (aRR 1.10 95%CI 1.10–1.11), GP / medical practitioner urgent after hours (from 12.3% to 21.1%; aRR 1.72, 95%CI 1.70–1.74) and after-hours attendances (from 18.5% to 33.8%; aRR 1.83, 95%CI 1.81–1.84) increased almost two-fold. Pain, palliative and geriatric specialist medicine attendances were low in the 3 months prior (<3%) and decreased further following LTC admission. There is an opportunity to improve the utilisation of primary health care services following LTC entry to ensure that residents' increasingly complex care needs are adequately met. [ABSTRACT FROM AUTHOR]

Objective: To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods: A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results: The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions: Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access. What is known about the topic? People living in residential aged care facilities report very high rates of mental health conditions, including depression and anxiety. What does this paper add? We demonstrate very low use (<3%) of Government-funded mental health services among people living in residential aged care facilities in Australia, with only small increases in use over time. What are the implications for practitioners? Practitioners should routinely assess the mental health needs of people living in residential aged care and refer for in-reach mental health services where needed, noting that facility staff are usually not trained for this role. [ABSTRACT FROM AUTHOR]

Objective: The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods: A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results: The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8–43.3], vs 37.8% [37.6–38.0]), unplanned hospitalisation (39.8% [39.6–40.1] vs 33.4% [33.2–33.6]) and potentially preventable hospitalisation (11.8% [11.6–12.0] vs 8.2% [8.1–8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions: While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency. What is known about the topic? Unplanned hospitalisations and emergency department presentations are frequent and burdensome for older people receiving long-term aged care. What does this paper add? While unplanned hospitalisations and emergency department presentations were high in all people receiving long-term care, these events were higher in people receiving home care packages than those in residential aged care. What are the implications for practitioners? Further efforts to address the high unplanned hospitalisations and emergency department presentations experienced by the increasing number of older adults accessing home care packages are required to allow this population to remain at home successfully. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Although largely preventable, pressure injury is a major concern in individuals in permanent residential aged care (PRAC). Our study aimed to identify predictors and develop a prognostic model for risk of hospitalization with pressure injury (PI) using integrated Australian aged and health care data. National retrospective cohort study. Individuals ≥65 years old (N = 206,540) who entered 1797 PRAC facilities between January 1, 2009, and December 31, 2016. PI, ascertained from hospitalization records, within 365 days of PRAC entry was the outcome of interest. Individual, medication, facility, system, and health care–related factors were examined as predictors. Prognostic models were developed using elastic nets penalized regression and Fine and Gray models. Area under the receiver operating characteristics curve (AUC) assessed model discrimination out-of-sample. Within 365 days of PRAC entry, 4.3% (n = 8802) of individuals had a hospitalization with PI. The strongest predictors for PI risk include history of PIs [sub-distribution hazard ratio (sHR) 2.41; 95% CI 1.77–3.29]; numbers of prior hospitalizations (having ≥5 hospitalizations, sHR 1.95; 95% CI 1.74–2.19); history of traumatic amputation of toe, ankle, foot and leg (sHR 1.72; 95% CI 1.44–2.05); and history of skin disease (sHR 1.54; 95% CI 1.45–1.65). Lower care needs at PRAC entry with respect to mobility, complex health care, and medication assistance were associated with lower risk of PI. The risk prediction model had an AUC of 0.74 (95% CI 0.72–0.75). Our prognostic model for risk of hospitalization with PI performed moderately well and can be used by health and aged care providers to implement risk-based prevention plans at PRAC entry. [ABSTRACT FROM AUTHOR]

To date, access to appropriate and timely GP services for those in aged care has been described as limited, in part due to inadequate models of care and remuneration. As the Australian population ages and more Australians become dependent on aged-care services, the need for good quality medical care that meets the needs of residents will continue to grow. The purpose of this study was to provide a current analysis of trends in GP services in residents in Australian aged-care facilities. Longitudinal population data (2005-2014) was used to describe the changing population demographics and calculate annual rates for GP services specific to this population. Total population and age-group strata (<85 years and 85+ years) rates were calculated for standard consultations, after-hours consultations, contribution to a care plan and collaborative medication review. For the period 2005-2014 there was an increase of 1.5 million GP services to this population, which had simultaneously grown by 19 800 residents, aged (6% increase in residents aged 85+ years) and become more dependent (14% increase is high-care residents). Significant increases in allGPservice rates were observed, with a shift towards after-hours consultations. Residents aged <85 years received significantly more services than residents aged 85+ years. GP service delivery to the whole aged-care population continues to be heavily weighted towards standard and after-hours consultations, while collaborative GP services remain a very small proportion of services accessed by this population. There is scope to increase collaborative GP services, which have been linked to improved outcomes for this population. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy has been associated with increased mortality but the contribution of different medication-related factors to this is unknown. Aims: The aim of this study was to identify demographic and medication-related predictors of mortality in the older population. Given the intrinsic link between polypharmacy and multimorbidity, the secondary aim was to examine if the medicines or underlying diseases predicted mortality. Methods: Patients aged ≥ 65 years from an outpatient multimorbidity clinic were included. Medication-related factors included the medicines count, high-risk medicines, inappropriate medicines duplication, and potential drug–drug and drug–disease interactions. Logistic regression was used to identify mortality predictors within a year of clinic discharge from the outpatient clinic. Patients attend the clinic until medications and comorbidity management have been optimised, at which point they are discharged from the clinic, and their General Practitioner provides ongoing care. Results: A total of 584 patients were included (median age 80.0 years) and 9.9% (n = 58) died within a year of discharge. Demographics, namely age (adjusted odds ratio [aOR] 1.05; 95% CI 1.01–1.09; p = 0.018) and being male (aOR 5.10; 95% CI 2.63–9.88; p < 0.001); chronic disease, namely heart failure (aOR 3.36; 95% CI 1.78–6.35; p < 0.001); and medication-related factors, namely the number of sedative and anticholinergic medicines (aOR 1.66; 95% CI 1.19–2.33; p = 0.003) predicted mortality in the study population. Conclusion: Whilst polypharmacy has been defined using the number of medicines in the literature, a combination of demographics, chronic disease and medications predicted mortality in our study. This provides guidance for the development of future tools and guidelines regarding the inclusion of key factors for identifying high-risk patients at risk of adverse health outcomes such as mortality. [ABSTRACT FROM AUTHOR]

Background: In the literature, polypharmacy is commonly defined as using five or more medicines. Little is known about how physicians and pharmacists define and assess polypharmacy in practice. Aim: This study determined how expert physicians and pharmacists define and assess polypharmacy in practice. Methods: An online survey was sent to 25 expert physicians and pharmacists who were chosen if they had done significant work in the area of polypharmacy through major research, clinical practice or both, to identify how experts define and assess polypharmacy in practice. Results: Twenty‐two participants completed the survey (88% response rate). There was strong agreement between experts, including which factors are important when assessing polypharmacy (intraclass correlation coefficient = 0.94). Respondents used the number of medicines (n = 18 respondents; 56.3% of all definitions), such as five or more medicines, and brief descriptions (n = 4 respondents; 43.7% of all definitions), such as assessing appropriateness given comorbidities, to define polypharmacy. Respondents commonly indicated patient factors such as functional status (n = 11 respondents; 50%) and medicine‐related factors such as drug–drug interactions (n = 11; 50%) as important when assessing polypharmacy. Experts reported low use of externally validated polypharmacy tools during polypharmacy assessment, with 36.4% (n = 8) being unfamiliar with or never or rarely using these tools. Conclusion: Medication‐ and patient‐related factors beyond a medicines count were deemed important in assessing polypharmacy. Given the low use of externally validated polypharmacy tools, strategies that include important medication‐ and patient‐related factors are required to facilitate polypharmacy rationalisation. [ABSTRACT FROM AUTHOR]

Background: There are tools and criteria in the literature aimed at distinguishing between appropriate and inappropriate medicines use. However, many have not been externally validated with regard to patient-related outcomes, potentially limiting their use in clinical practice.Objectives: The aim of the study was to conduct a systematic review to summarise (1) available prescribing appropriateness assessment tools and criteria, and (2) their associations with patient-related outcomes (external validity).Methods: A systematic review was conducted using MEDLINE, EMBASE and Informit (Health Collection) databases to screen for articles in English that examined (1) tools to assess the appropriateness of prescribing and (2) associations of tools with patient-related outcomes, published between 2000 and 2016, without any limits placed on the study design, participant age or setting.Results: After screening 1710 articles, removing duplicates and shortlisting relevant articles, 42 prescribing assessment tools were identified. Out of the 42 tools, 78.6% (n = 33) provided guidance around stopping inappropriate medications, 28.6% (n = 12) around starting appropriate medications, 61.9% (n = 26) were explicit (criteria based) and 31.0% (n = 13) had been externally validated, with hospitalisation being the most commonly used patient-related outcome (n = 9, 21.4%).Conclusion: The results of this systematic review highlight the need for evidence-based and externally validated tools, which combine the different aspects of medication management to optimise patient-related outcomes. PROSPERO registration number: CRD42017067233. [ABSTRACT FROM AUTHOR]

To examine the (1) cohort of individuals living at home with Home Care Packages (HCPs) in 2016, (2) their access to other aged care services after HCP commencement, and (3) their hospital and ambulance service utilization. A cross-sectional study was conducted using integrated aged care and health care data contained within the National Historical Cohort of the Registry of Senior Australians. This study included people who accessed HCP between January 1, 2016 and December 31, 2016. The access to permanent residential aged care, transition care, respite care, hospital and ambulance services among Australian HCP recipients ≥65 years old in 2016 was evaluated. Descriptive statistics were employed. In 2016, 84,681 individuals received HCPs, of which 68.4% (n = 57,942) accessed HCP levels 1‒2, 26.0% (n = 22,057) accessed HCP levels 3‒4, and 5.5% (n = 4682) accessed both care levels within the year. Of the individuals receiving HCP, 34.0% (n = 27,787) started services that year and 16.7% (n = 14,117) moved to permanent residential aged care, 18.4% (n = 15,592) used respite care and 5.8% (n = 4937) used transition care that year. Emergency department (ED) presentations [43.6%, 95% confidence interval (CI) 43.3‒44.0] were the most common hospital encounters, followed by inpatient hospitalizations for any reason (43.3%, 95% CI 42.9‒43.7), and unplanned hospitalizations (38%, 95% CI 37.6‒38.3). Forty-four percent (44.5%, 95% CI 43.9‒45.0) of individuals utilized ambulance services. ED presentations, hospitalization for any reason, and unplanned hospitalizations were more common in individuals receiving HCP levels 3‒4 compared with those accessing HCP levels 1‒2. HCP recipients in Australia have frequent hospitalizations, including ED presentations. In addition, almost 1 in 5 access respite care and 16.7% transition to permanent residential care each year. As the population accessing HCP is increasing, adequate support for these individuals to live well at home and avoid health events that lead to hospitalizations are necessary. [ABSTRACT FROM AUTHOR]

An abstract of the article "Drug Allergy Reports on Medicalalert ® Devices," by Caroline Foreman and colleagues is presented.