The acute–aged care interface: Exploring the dynamics of ‘bed blocking’

Objective: To understand the dynamics underlying ‘bed‐blocking’ in Australian public hospitals that is frequently blamed on older patients. Methods: Analysis of primary and secondary data of utilisation patterns of hospital and aged care services by older Australians. Results: A model of the dynamics at the acute–aged care interface was developed, in which the pathway into permanent high‐care Residential Aged Care (RAC) is conceptualised as competing queues for available places by applicants from the hospital, the community and from within RAC facilities. The hospital effectively becomes a safety net to accommodate people with high‐care needs who cannot be admitted into RAC in a timely manner. Conclusion: The model provides a useful tool to explore some of the issues that give rise to access‐block within the public hospital system. Access‐block cannot be understood by viewing the hospital system in isolation from other sectors that support the health and well‐being of older Australians.     

Allied health in residential aged care: Using routinely collected data to improve funding opportunities

Consumers and providers have long been advocating for increased access to and delivery of allied health services in Australian residential aged care (RAC). There is significant evidence that allied health interventions are effective; however, there is limited evidence on the benefit of routine day-to-day allied health service delivery in RAC. This information is critical to effectively inform funders and policy advisors of the necessity of allied health in RAC. To improve arguments for future funding opportunities, providers, facilities and consumers need to partner together to use routinely collected, yet disparate, data, in electronic health and billing records, to improve data collection practices and evidence generation on allied health in aged care.     

Development and Testing of the Person-Centered Environment and Care Assessment Tool (PCECAT)

ABSTRACT

Objective: While person-centered principles provide an ideal foundation for developing service standards in residential aged and dementia care, there has been limited attention to developing tools which can measure service structures, processes and outcomes according to these principles. The Person-Centered Environment and Care Assessment Tool (PCECAT) was developed to assess and improve residential aged-care standards using person-centered principles, while also adhering to the Australian residential aged-care standards.

Methods: A mixed-methods approach was used to develop and validate the PCECAT in five sequential stages.

Results: Content, face, concurrent, and convergent validity were established and test-retest reliability was confirmed in 334 aged/dementia care units belonging to 131 Australian and New Zealand aged-care homes.

Conclusions: The PCECAT and its Guidelines have helped providers to improve service quality. While Australian residential aged-care standards were used as guidelines in developing the scale, there is potential for PCECAT adaptation in other countries and cultures.     

The probability of using an aged care home over a lifetime (1999–00)

Objective: This paper aims to project the probability of using an aged care home over a lifetime for Australian men and women at various ages. Method: This paper applies life table models [1] to 1999–00 residential aged care data to estimate the probability of using an aged care home over a lifetime. Results: Women are more likely than men to enter an aged care home for permanent care over their lifetime. Based on current patterns of use of aged care homes, a woman at age 65 faces a probability as high as 0.46 of using an aged care home for permanent care before her death compared with 0.28 for a man at the same age. Conclusion: A much larger proportion of older people than has often been recognised are likely to be admitted to an aged care home at some point in their lives.     

Use of Sleeping Medication and Quality of Life among Older Women who Report Sleeping Difficulty

Objective : To estimate the proportion of older women who report sleeping difficulties and/or use sleeping medication; and to identify associated factors. Method: Cross sectional survey of Australian women aged 70–75 years. These women were participants in the Australian Longitudinal Study on Women's Health (ALSWH) randomly selected from the Australian Medicare database. Results : Of the 12,624 women aged 70–75 years who provided data for this analysis (36% response rate), 50%{n‐6,042) reported sleeping difficulty “never/rarely”, 33% (n=3,979) “sometimes”, and 17% (n=2,011) “often”. Approximately 18% (n=2,287) of women reported using sleeping medication within the previous four weeks. Women reporting sleeping difficulty “sometimes ” were over five times more likely to be taking sleeping medications than women who reported “never/rarely” experiencing difficulties (p≤0.0001); while women reporting difficulty sleeping “often” were over 15 times more likely to be using sleeping medications (p≤0.0001). Mean scores for sub‐scales of the SF‐36 health‐related quality of life measure were significantly lower for women reporting sleeping difficulty and women using sleeping medication (p≤0.001). Similarly, there was an inverse relationship between the SF‐36 physical and mental health summary scores and difficulty sleeping or sleeping medication use. Conclusion : Self‐reported sleeping difficulty is significantly related to reduced quality of life, suggesting sleeping difficulty is not a benign complaint. After adjustment for other explanatory variables there were strong, clinically significant differences between the SF‐36 scores of women reporting sleeping difficulty. However, while this association is statistically and clinically significant, it is not clear whether sleeping difficulty reduces quality of life, or whether quality of life interferes with sleep, or whether both problems are a result of other associated conditions. Further longitudinal exploration of this relationship is necessary. Further, issues need to be explored with older women, with a view to identifying acceptable and effective alternatives to sleeping medication use.     

Longitudinal predictors of changes to illicit drug use among young Australian women

AIM: Much information regarding predictors of illicit drug initiation and cessation is drawn from cross-sectional data. This paper aims to determine the longitudinal changes in factors associated with initiation and cessation of illicit drugs by young Australian women over a 3-year period. PARTICIPANTS: The sample was the cohort of young women moving from their mid- to late 20s, completing the Australian Longitudinal Study on Women's Health (ALSWH) survey in 2000 and 2003, who were either 'new' users or 'quitters' at the 2003 survey. MEASUREMENTS: Crude and multivariate associations between changes in predictor variables and the probability of illicit drug initiation or cessation were evaluated. Variables significant in univariate analyses were used to create multivariable logistic regression models which predicted initiation and cessation of illicit drugs. FINDINGS: All categories of smokers, except ex-smokers and those who adopted and quit smoking between surveys, were less likely to cease the use of illicit drugs. Women who became pregnant were more likely to cease illicit drug use. Women who continued to drink at levels described as long-/short-term risk and women who suffered continuing emotional abuse were less likely to cease use of illicit drugs. CONCLUSIONS: Longitudinal studies that examine factors associated with illicit drug initiation are best conducted in a cohort aged in their late teens to early 20s. Following the current cohort into their late 30s may further explain predictors of illicit drug cessation.     

Improving diet quality over nine-years is associated with less weight gain in mid-age Australian women: A cohort study

Background and aimsMost studies measure baseline diet quality exclusively and hence the impact of longitudinal changes in dietary intake in relation to weight change is not considered. Therefore, this study aimed to examine whether change in diet quality over nine-years was associated with weight change over the same period in mid-age Australian women.Methods and resultsHealthy mid-age (45–49 years) women from the Australian Longitudinal study on Women's Health (ALSWH) were eligible a valid total energy intake (TEI) was reported at baseline (n = 2381), determined using Goldberg cut-offs. Diet quality was measured by the Australian Recommended Food Score (ARFS) using data derived from a validated food frequency questionnaire. Multiple linear regressions were used to evaluate relationships between change in diet quality and weight in mid-age women (n = 1999). Women in the highest tertile of ARFS change improved diet quality [mean ± SD] [7 ± 4 points], while those in the lowest [-9 ±5 points] and middle [-1±2 points] tertiles had worse diet quality at follow-up. Overall, mean weight gain was 2.3 ± 7.2 kg over nine years. Those in the highest tertile of ARFS change gained significantly less weight, compared to the lowest tertile; β = −1.2 kg [95% CI: −2.31, −0.11; p = 0.03] after adjustment for changes in confounders and baseline weight, baseline ARFS, and total energy intake.ConclusionsImproving diet quality could be an important strategy for promoting modest weight loss and potentially contribute to preventing weight gain in mid-age women, which is important for metabolic health.     

Significant inter-observer variation in the diagnosis of extrapancreatic necrosis and type of pancreatic collections in acute pancreatitis – An international multicenter evaluation of the revised Atlanta classification

BackgroundFor consistent reporting and better comparison of data in research the revised Atlanta classification (RAC) proposes new computed tomography (CT) criteria to describe the morphology of acute pancreatitis (AP). The aim of this study was to analyse the interobserver agreement among radiologists in evaluating CT morphology by using the new RAC criteria in patients with AP.MethodsPatients with a first episode of AP who obtained a CT were identified and consecutively enrolled at six European centres backwards from January 2013 to January 2012. A local radiologist at each center and a central expert radiologist scored the CTs separately using the RAC criteria. Center dependent and independent interobserver agreement was determined using Kappa statistics.ResultsIn total, 285 patients with 388 CTs were included. For most CT criteria, interobserver agreement was moderate to substantial. In four categories, the center independent kappa values were fair: extrapancreatic necrosis (EXPN) (0.326), type of pancreatitis (0.370), characteristics of collections (0.408), and appropriate term of collections (0.356). The fair kappa values relate to discrepancies in the identification of extrapancreatic necrotic material. The local radiologists diagnosed EXPN (33% versus 59%, P < 0.0001) and non-homogeneous collections (35% versus 66%, P < 0.0001) significantly less frequent than the central expert. Cases read by the central expert showed superior correlation with clinical outcome.ConclusionDiagnosis of EXPN and recognition of non-homogeneous collections show only fair agreement potentially resulting in inconsistent reporting of morphologic findings.     

Validation of hospital frailty risk score to predict hospital use in older people: Evidence from the Australian Longitudinal Study on Women’s Health

BackgroundFrailty is among the most serious global public health challenges due to the rapid increase in the ageing population and age-associated declines in health. We aimed to validate hospital frailty risk score (HFRS) for its ability to predict prolonged hospital length of stay, 28-day unplanned readmission, repeated admission, and mortality in older people over a 15-year follow-up period.MethodsWe linked data from the Australian Longitudinal Study on Women’s Health (ALSWH) with hospital admission and National Death Index datasets to identify admitted patients and death dates. This study included patients with an index unplanned admission resulting in an overnight hospital stay in 2001–2016 and aged 75–95 years at the time of admission. HFRS and Charlson comorbidity index (CCI) were calculated from the hospital data using the International Statistical Classification of Diseases, Australia Modification (ICD-10-AM) diagnostic codes.ResultsOf 2740 older women aged 75 years and over with unplanned admission, the proportions of patients with low, intermediate, and high frailty risks were 77.15 % (n = 2114), 20.95 % (n = 574), and 1.90 % (n = 52), respectively. The 15-year follow-up revealed that high frailty risk patients increased 5-fold in 2015 (15.67 % patients, mean age = 92.26 years) compared to 2001 (2.56 % patients, mean age = 77.96 years). Prolonged hospital length of stay was higher in the intermediate (AOR = 2.86, 95 %CI: 2.26, 3.62) and high frailty risk group (AOR = 4.26, 95 %CI: 2.32, 7.63) compared to the low frailty risk group. Frailty risk was not associated with unplanned or repeated hospital admission. However, the intermediate frailty risk group (AHR = 1.78, 95 %CI: 1.47, 2.17) and the high frailty risk group (AHR = 4.17, 95 %CI: 2.00, 8.66) had a significant risk of mortality compared to the low frailty risk group.ConclusionsThis study confirms the ability of HFRS to identify older, frail people at higher risk of prolonged hospital length of stay and increased mortality risk. However, we did not observe a significant association between HFRS and 28-day unplanned readmission or repeated hospital admission.     

Identifying patterns of retention in care and viral suppression using latent class analysis among women living with HIV in Florida 2015–2017

ABSTRACT

The study objective was to classify women with newly diagnosed HIV into patterns of retention in care (≥2 HIV care visits ≥3 months apart) and viral suppression over time and identify factors associated with class membership. Florida HIV/AIDS surveillance data were used to conduct Latent Class Analysis to classify women into patterns, and multinomial regression was used to compare the prevalence of class membership by demographic and clinical factors. Four classes were selected based on model fit parameters: (Class 1) consistently retained and suppressed (>90% probability of being retained and suppressed), (Class 2) not consistently retained or suppressed (≤10% probability of being retained and suppressed), (Class 3) increasingly retained and suppressed, and (Class 4) decreasingly retained and suppressed. The proportion of women in each class was 48.6%, 24.9%, 14.3%, and 12.2%, respectively. Women aged 25–34 compared to 35–49 years old, injection drug use mode of exposure, US born, and not linked to care three months post-diagnosis had a lower prevalence of belonging to the consistently retained and suppressed class. Findings may be useful in tailoring and targeting interventions to increase the prevalence of women who are consistently retained in care and virally suppressed.     

Gender differences regarding opinions on long-term care arrangements: A study of community-dwelling older adults

BackgroundNumerous studies have attempted to identify predictors of institutionalization in the general population. Gender studies have led to inconsistent results. Some authors argued that older women were more likely than older men to use long-term care services, while others failed to highlight a specific gender effect on the use of long-term care services. The aim of this study was to assess the effects of gender on the preferences of older citizens for long-term care using a panel of disability situations.MethodsWe used a set of ten vignettes displaying disability situations with or without an able-bodied spouse present and used a population-based survey to inquire about appropriate long-term care. Participants were 3102 community-dwelling persons aged 68–83 years included in the representative Lausanne cohort 65+ study in January 2017. Multinomial logistic regression analyses were used to explore the effect of gender on long-term care choices by older men and women, controlling for the respondent's age and living arrangement.ResultsThe respondents’ choices shifted toward institutionalization when the disorder severity increased in vignettes and when there was no spouse able to help. Men were more likely to choose a home setting with caregiving only by spouse even when the level of disability increased. Women chose help from professionals, sheltered homes, or institutionalization more quickly than men.ConclusionsExploring gender preferences for long-term care arrangements is critical for improving and planning long-term care services.     

Do health assessments affect time to permanent residential aged care admission for older women with and without dementia?

Aim

To investigate the effect of health assessments on permanent residential aged care admission for older Australian women with and without dementia.

Methods

A total of 1427 older Australian women who had a health assessment between March 2002 and December 2013 were matched with 1427 women who did not have a health assessment in the same period. Linked administrative datasets were used to identify health assessment use, admission to permanent residential aged care, and dementia status. Outcome was time to residential aged care admission from the matched date of health assessment.

Results

Women who had health assessments were less likely to be admitted to residential aged care in the short term (100 days), irrespective of dementia status (subdistribution hazard ratio [SDHR] = 0.35, 95% CI = [0.21, 0.59] for women with dementia; SDHR = 0.39, 95% CI = [0.25, 0.61] for women without dementia). However, there were no significant differences at 500- and 1000-days follow-up. At 2000-days follow-up, women who had a health assessment were more likely to be admitted to residential aged care, regardless of dementia status (SDHR = 1.41, 95% CI = [1.12, 1.79] for women with dementia; SDHR = 1.55, 95% CI = [1.32, 1.82] for women without dementia).

Conclusions

Benefits from health assessments may depend on the recency of the assessment, with women less likely to be admitted to residential aged care in the short term after a health assessment. Our results add to a growing body of literature suggesting that health assessments may provide benefits to older people, including those with dementia. Geriatr Gerontol Int 2023; 23: 595–602 .     

Utilization of services by abused, low-income African-American women

BACKGROUND: Little is known about health care and service utilization patterns among low-income African-American women, particularly those who report intimate partner violence (IPV). OBJECTIVES: (1) Identify utilization patterns among low-income African-American women. (2) Demonstrate utilization differences by IPV status. PARTICIPANTS: One hundred and fifty-three African-American women from medical care clinics at a large inner-city public hospital. DESIGN: Case-control study. Predictor variable IPV assessed by the Index of Spouse Abuse. Outcome variables, health care, and service utilization, determined using the Adult Service Utilization Form. RESULTS: Of the 153 participants, 68 reported high IPV levels. The mean age was 32 years, majority were poor and unemployed, and 15.7% were homeless. The overall utilization rates were low. When controlled for homelessness and relationship status, high IPV levels were associated with greater psychiatric outpatient utilization. We found differences in the use of other medical or community services by IPV group. CONCLUSIONS: Women reporting high IPV levels are more likely to receive mental health services than women reporting low IPV levels, but may not have access to other needed services. Primary care providers should assess the mental health, legal, and social service needs of abused women, which will facilitate receipt of services. The authors have no conflicts of interest to report. Dr. Paranjape is supported by the Emory Mentored Clinical Research Scholars Program (K12 NIH/NCRR RR017643). The SAFETY study is funded by a grant from the Centers for Disease Control and Prevention (grant number #R49/CCR419767-0).     

Consultations with complementary and alternative medicine practitioners amongst wider care options for back pain: a study of a nationally representative sample of 1,310 Australian women aged 60–65 years

Back pain is a significant health service issue in Australia and internationally. Back pain sufferers can draw upon a range of health care providers including complementary and alternative medicine (CAM) practitioners. Women are higher users of health services than men and tend to use CAM frequently for musculoskeletal conditions. However, there remain important gaps in our understanding of women’s consultation patterns with CAM practitioners for back pain. The objective of this study is to examine the prevalence of use and characteristics of women who use CAM practitioners for back pain. The method used was a survey of a nationally representative sample of women aged 60–65 years from the Australian Longitudinal Study on Women’s Health. Women consulted a massage therapist (44.1 %, n?=?578) and a chiropractor (37.3 %, n?=?488) more than other CAM practitioners for their back pain. Consultations with a chiropractor for back pain were lower for women who consulted a General Practitioner (GP) (OR, 0.56; 95 % CI 0.41, 0.76) or a physiotherapist (OR, 0.53; 95 % CI 0.39, 0.72) than for those who did not consult a GP or a physiotherapist. CAM practitioner consultations for back pain were greater for women who visited a pharmacist (OR, 1.99; 95 % CI 1.23, 3.32) than for women who did not visit a pharmacist. There is substantial use of CAM practitioners alongside conventional practitioners amongst women for back pain, and there is a need to provide detailed examination of the communication between patients and their providers as well as across the diverse range of health professionals involved in back pain care.     

Health service use by community-dwelling patients with heart failure in northwest London, 2015–18: a retrospective cohort analysis

BackgroundHeart failure management is complex and requires multidimensional care. Clinical guidelines advocate for the use of integrated care, but few studies have described overall health service use by patients with heart failure. We describe overall care usage by community-dwelling patients with heart failure in northwest London using a dataset linked across multiple health-care settings.MethodsIn this retrospective cohort analysis, we used Whole Systems Integrated Care (WSIC) data, a dataset of individual clinical events from primary care, secondary care, and other (defined as community, mental health, and social care) services in northwest London to analyse a retrospective cohort of patients with heart failure. Patients who remain in the WSIC dataset, were aged at least 18 years on Jan 1, 2015, with known age and gender, and whose diagnosis was not made after their date of death. The primary outcome was health-care usage of each of the three service categories overall as well as individual components of secondary care (eg, outpatient appointments) and other services (eg, nursing contacts). Usage patterns were identified using k-means cluster analysis using all distinct contacts for the whole study period and visualised by a heatmap. Nine health-care use variables were used to identify clusters, and differences between clusters in both clustering and non-clustering variables were analysed using Kruskal-Wallis and Pearson χ² tests. This study was approved by the Discover Research Advisory Group.FindingsData from 39 301 patients with heart failure across 359 general practices between Jan 1, 2015, and Dec 31, 2018, were analysed. Almost all patients had some health service contact during the study period (21 226 [89·1%] of 23 828 in 2015; 24 876 [90·6%] of 27 443 in 2016; 28 663 [90·8%] of 31 554 in 2017; and 31 584 [91·1%] of 34 651 in 2018). Most commonly used services in 2018 were outpatient appointments (24 283 [70·1%] of 34 651 patients), general practitioner (GP) consultations (20 741 [59·9%] patients), unplanned accident and emergency visits (14 145 [40·8%] patients) and community services (13 762 [39·7%] patients), often for nursing. Use of cardiology-specific services ranged from 1005 (2·9%) patients for community visits to 8231 (23·8%) for outpatient visits. Five clusters of patients were identified, each with significantly different care usage patterns and distinct patient characteristics. Patterns included underuse of GP consultations, relative to the average use by the whole cohort, in patients living in more deprived areas; and increased use of other services in patients older than 75 years and those with three or more comorbidities.InterpretationHealth and social care service use was widespread but varied. Patterns of care usage suggest differences across patient groups. This might be due to variation in patients’ access to care and insufficiently integrated care at earlier stages of heart failure. The limitations of our study are that electronic health records like WSIC are not coded for research and subject to some biases; k-means testing is sensitive to the input variables and selection of k; and our findings require further validation and might not be generalisable to regions beyond the northwest London area. Further research is needed to characterise the patterns we have identified.FundingDr Foster (a Telstra Health company), the National Institute for Health Research (NIHR) Health Services Research, and the Imperial NIHR Biomedical Research Centre and the NIHR Collaboration for Leadership in Applied Health Research and Care for northwest London. The views expressed are those of the authors and not those of the NIHR.     

The use of care robots in aged care: A systematic review of argument-based ethics literature

BackgroundAs care robots become more commonplace in aged-care settings, the ethical debate on their use becomes increasingly important. Our objective was to examine the ethical arguments and underlying concepts used in the ethical debate on care robot use in aged care.MethodsWe conducted a systematic literature search for argument-based ethics publications focusing on care robot use in aged-care practices. We used an innovative methodology that consisted of three steps: (a) identifying conceptual-ethical questions, (b) conducting a literature search, and (c) identifying, describing and analyzing the ethical arguments in connection with the conceptual-ethical questions.ResultsTwenty-eight appropriate publications were identified. All were published between 2002 and 2016. Four primary ethical approaches were distinguished: (a) a deontological, (b) a principlist, (c) an objective-list, and (d) a care-ethical. All approaches were equally represented across the articles, and all used similar concepts that grounded their diverse ethical arguments. A small group of publications could not be linked to an ethical approach.ConclusionsAll included publications presented a strong ethical rationale based on fully elaborated normative arguments. Although the reviewed studies used similar grounding concepts, the studies’ arguments were very diverse and sometimes diametrically opposed. Our analysis shows how one envisions care robot use in aged-care settings is influenced by how one views the traditional boundaries of the ethical landscape in aged care. We suggest that an ethical analysis of care robot use employs “democratic spaces,” in which all stakeholders in aged care, especially care recipients, have a voice in the ethical debate.     

HIV-1 associated cognitive/motor complex in an injecting drug user.

The clinical and social consequences of AIDS dementia complex/HIV-1 associated cognitive/motor complex (ADC/HACC) in drug users have not been well documented. The value of prospective serial neuropsychological, neuroradiological and neurophysiological measurements to assist diagnosis of ADC/HACC in patients with premorbid personality disorder and intercurrent drug use is demonstrated. The psychosocial problems resulting from ADC/HACC with respect to community care and the location of hospitalization is considered. The relevance of the 1984 Mental Health Act (Scotland) with regard to drug users with ADC/HACC is discussed.     

Assessment of clinical pharmacist interventions in drug therapy in patients with diabetes mellitus in a tertiary care teaching hospital

AimTo assess the impact of clinical pharmacist interventions in drug therapy in hospitalized patients with diabetes mellitus.MethodsA Prospective interventional study was carried out in the medicine wards of a tertiary care teaching hospital over a period of 10 months from September 2013 to June 2014. The drug therapy details of the patients were collected from inpatient case records in the respective clinical wards. Clinical pharmacist reviewed the drug therapy, identified the drug related problems during ward rounds and discussed with the physicians and suitable suggestions was provided which had been documented.ResultsA total of 189 drug therapy problems were identified from 151 patient case records. The number of drug related problems was found to more in males than females. Drug related problems were commonly seen in patients aged between 61 and 70 years of age. The most common drug related problems was found to be drug use without indication (17.98%) followed by improper drug selection (16.40%). The most frequent suggestions by the clinical pharmacist were on cessation of drug (30.68%). The acceptance rate of suggestions and the changes in drug therapy was found to be high (58.20%). The majority of the level of significance of drug related problems was seen to have moderate significance in grade.ConclusionInvolvement of clinical pharmacist as a member of healthcare team during ward rounds in hospitalized patients with diabetes mellitus helps in identification and prevention of drug related problems which will helps to rationalize drug therapy, achieve better therapeutic outcomes and improved patient care.     

An Evidence‐Based Program to Improve Analgesic Practice and Pain Outcomes in Residential Aged Care Facilities

Pain is common in individuals living in residential aged care facilities (RACFs), and a number of obstacles have been identified as recurring barriers to adequate pain management. To address this, the Australian Pain Society developed 27 recommendations for comprehensive good practice in the identification, assessment, and management of pain. This study reviewed preexisting pain management practice at five Australian RACFs and identified changes needed to implement the recommendations and then implemented an evidence‐based program that aimed to facilitate better pain management. The program involved staff training and education and revised in‐house pain‐management procedures. Reviews occurred before and after the program and included the assessment of 282 residents for analgesic use and pain status. Analgesic use improved after the program (P < .001), with a decrease in residents receiving no analgesics (from 15% to 6%) and an increase in residents receiving around‐the‐clock plus as‐needed analgesics (from 24% to 43%). There were improvements in pain relief for residents with scores indicative of pain, with Abbey pain scale (P = .005), Pain Assessment in Advanced Dementia Scale (P = .001), and Non‐communicative Patient's Pain Assessment Instrument scale (P < .001) scores all improving. Although physical function declined as expected, Medical Outcomes Study 36‐item Short‐Form Survey bodily pain scores also showed improvement (P = .001). Better evidence‐based practice and outcomes in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce using this program improved analgesic practice and pain relief in participating sites. Further attention to the continued targeted pain management training of aged care staff is likely to improve pain‐focused care for residents.