The reliability and validity of the Care Planning Assessment Tool

Objective: The development of a simple, comprehensive, valid and reliable tool to assist aged care services staff develops and monitors care plans. Method: An assessment with proven utility in a psychogeriatric setting was modified to improve its relevance to aged care services. Reliability was assessed from the scores obtained from two independent raters assessing 48 randomly selected residents in a large aged care facility. Validity was assessed by comparison with well‐validated measures of cognition and function. Results: The Care Planning Assessment Tool has very high interrater reliability and good internal consistency. The validity of the subscales compared with well‐validated assessments was very high. Conclusion: The psychometric properties of the Care Planning Assessment Tool are sufficiently good to allow it to be used with confidence in the care planning process. This is supported by a similar evaluation carried out on the Japanese version.     

Our dementia challenge: arise palliative care

While many of the maladies of the 20th century are steadily coming under control, the march of neurodegenerative disorders continues largely unchecked. Dementias are an exemplar of such disorders; their incidence and prevalence continue to rise, in large part due to a steadily ageing population worldwide. They represent a group of chronic, progressive and, ultimately, fatal neurodegenerative diseases. Dementia has remained therapeutically recalcitrant. It is not a single disease, and because of that, we cannot expect a single panacea. While primary prevention rightly gains prominence, those with established disease currently require a shift in focus from curative intent towards improved quality of life. Enter palliative care. The sheer number and complexity of needs of patients with dementia, from the physical to the psychosocial and spiritual, necessitates the engagement of a wide range of medical disciplines, nursing and allied health professionals. One of those disciplines, as highlighted in the recent Australian Royal Commission into Aged Care Quality and Safety, is palliative care. This paper shall expand upon that role in the overall context of care for those with dementia.     

Applying workability in the Australian residential aged care context

The study is based on an innovative demonstration project which trialled the implementation of the Finnish ‘workability’ framework and research measures. It aimed, firstly, to test the applicability of the Workability Index (WAI) to the Australian residential aged care workforce, focusing on personal care assistants (PCAs), and secondly, to assess the effectiveness of actions aimed at improving workability. The facility manager implemented multidimensional ‘actions’ according to the workability framework. The Workability Survey (WAS) and WAI and intervention instruments were administered (n = 64). Completed responses to ‘pre’ and ‘post’ instruments formed matched pairs (n = 15). WAI scores increased significantly, by 3 points on average, after all ‘actions’ were implemented. The only significant ‘action’ was increasing the number of PCAs in high care. Workability provides a useful research workforce development instrument measuring interactions between aged care workers and organisational demands and the outcomes of ‘actions’.     

An update on the pilot trial of consumer‐directed care for older persons in Australia

The Australian Government has commenced a two‐year pilot of consumer‐directed care (CDC) across 500 home and community aged care packages. This policy paper discusses the model being trialled in Australia in light of the UK's Individual Budgets' Pilot Programme and the USA's Cash and Counselling Demonstration. The results of these randomised controlled studies suggest that older people vary in their preferences for consumer direction and that many find the administrative tasks of implementing CDC programs difficult. The relatively restricted model of CDC that the Australian Government is trialling may minimise the problems encountered in the overseas programs, but does not allow consumers to hire family or friends which they preferred to do overseas.     

Health care for older persons: a country profile-Korea

The Korean healthcare system is faced with a crisis caused by rapidly changing social values tending toward westernization, increasing insurance benefit requests for elder health care, financial instability of the National Health Insurance (NHI) program, and a lack of social infrastructure for the elderly. The demand for health care for the elderly has increased markedly, because of a rapidly aging population, growing female participation in the labor market, elevated expectations for health care, and a change in the pattern of medical conditions in the elderly from acute illness to chronic disability. NHI lacks the finances to meet the benefit request for long-term care (LTC). Only 0.39% of the elderly can be accommodated in LTC beds. Consequently, the chronically disabled elderly overflow to acute care beds in general hospitals, which places an undue burden on the already strained NHI system in terms of longer stays and higher cost of treatment in hospitals compared with care specific to the elderly in LTC facilities. It is clear that the Korean healthcare system does not have the facilities to meet such challenges and is in a state of disorder. Korea has failed to predict and prepare for population needs before they arise, including financing and the development of appropriate care models, particularly concerning the adequate provision of LTC. This paper advocates the necessity of international discussion of the prospects for developing health care for aging populations and encourages the sharing of differing national experiences concerning care for the elderly.     

Development of a Japanese Version of the Care Planning Assessment Tool

Aim: To develop a Japanese version of the Care Planning Assessment Tool (J‐CPAT), originally developed in Australia as a comprehensive assessment of people with dementia. Methods: The process of adapting the CPAT into Japanese included translation into Japanese, assessment of item comprehension, and a validity and reliability study. The J‐CPAT is composed of eight domains: Communication, physical problems, self‐help skills, confusion, behaviour, social interaction, psychiatric observations and carer dependency. The participants were 199 aged care clients. Measures were the J‐CPAT, Mini‐Mental State Examination (MMSE) and Care Levels used in the Long‐term Care Insurance scheme. Results: Cronbach's alpha values in each J‐CPAT domain were 0.74–0.95. The correlation coefficient between the score of Confusion and MMSE was ?0.90, and those between physical problems, self‐help skills, carer dependency in the J‐CPAT, and care level were 0.70, 0.75 and 0.67. Conclusions: The J‐CPAT appears to be a reliable and valid tool for care planning in Japan.     

What defines quality of care for older people in aged care? A comprehensive literature review

The quality of the care provided to frail older people in aged care is a concern for all Australians and for the citizens of many other countries internationally. This paper summarizes the methods and findings from an Australian study commissioned by the Royal Commission into Aged Care Quality and Safety to identify and synthesize international literature relating to the quality of care in aged care. A comprehensive literature review was undertaken to search and identify the literature (grey and peer reviewed) relating to quality of care and/or person-centered care in aged care. The review identified nine key themes as salient to the quality of care experience, which include treating the older person with respect and dignity; acknowledging and supporting their spiritual, cultural, religious and sexual identity; the skills and training of the aged care staff providing care; relationships between the older person and the aged care staff; social relationships and the community; supporting the older person to make informed choices; supporting the older person's health and well-being; ensuring the delivery of safe care in a comfortable service environment; and the ability to make complaints and provide feedback to the aged care organization. In practice, particularly in the context of residential care, quality of care has traditionally been measured using clinical indicators of care quality. These findings highlight the central importance of person-centered care and care experience as fundamental tenets of the quality of aged care service delivery in Australia and internationally. Geriatr Gerontol Int 2021; 21: 765–778 .     

Prescribing for older people discharged from the acute sector to residential aged‐care facilities

For frail older people, admission to hospital is an opportunity to review the indications for specific medications. This research investigates prescribing for 206 older people discharged into residential aged care facilities from 11 acute care hospitals in Australia. Patients had multiple comorbidities (mean 6), high levels of dependency, and were prescribed a mean of 7.2 regular medications at admission to hospital and 8.1 medications on discharge, with hyper‐polypharmacy (≥10 drugs) increasing from 24.3% to 32.5%. Many drugs were preventive medications whose time until benefit was likely to exceed the expected lifespan. In summary, frail patients continue to be exposed to extensive polypharmacy and medications with uncertain risk–benefit ratio.     

The association between specific nurse case management interventions and elder health

OBJECTIVES: To describe the association between specific nursing interventions performed in the context of nurse case management and older people's quality of life and functional ability. DESIGN: Longitudinal. SETTING: Nurse case management through a university hospital and two community health centers. PARTICIPANTS: One hundred seventy-five community-dwelling frail older persons (> or =70 and at risk for repeated hospitalizations). MEASUREMENTS: Specific groups of nursing interventions provided in the context of nurse case management over a 10-month period--coping assistance, lifespan care, risk management, and physical comfort promotion--were focused on. These interventions were recorded using a standardized nursing language. Outcomes were measured using telephone and home interview and medical record review using the 36-item Short Form and the Older American Resources and Services Multidimensional Functional Assessment Questionnaire. RESULTS: Older people receiving coping assistance interventions demonstrated an increase in instrumental activity of daily living functioning although they had lower general health, role-emotional, and mental health scores. CONCLUSION: Coping assistance is one nursing intervention of several provided in the context of nurse case management that is independently associated with improving the functional status of frail older persons even in the presence of declining health normally associated with aging over several months. Examining the relationships between specific nursing activities and health outcomes of frail older persons may be useful in furthering understanding of the results of randomized trials of nurse case management in this population.