Health status and healthcare trends of individuals accessing Australian aged care programmes over a decade: the Registry of Senior Australians historical cohort

Abstract

Background: Understanding the health profile, service and medicine use of Australians in the aged care sector will help inform appropriate service provision for our ageing population.Aims: To examine the 2006-2015 trends in (i) comorbidities and frailty of individuals accessing aged care, and (ii) health services, medicine use and mortality after entry into long-term care.Methods: Cross-sectional and population-based trend analyses were conducted using the Registry of Senior Australians. Results: From 2006 to 2015, 509 944 individuals accessed permanent residential care, 206 394 home care, 283 014 respite and 124 943 transition care. Over this time, the proportion of individuals accessing permanent residential care with high frailty scores (≥0.3) increased (19.7-49.7%), as did the proportion with 5-9 comorbidities (46.4-54.5%), with similar trends observed for those accessing other services. The median number of medicines dispensed in the year after entering permanent residential care increased from 9 (interquartile range (IQR) 6-12) to 10 (IQR 7-14), while remaining stable in home care (2006: 9, IQR 5-12, 2015). Short-term (within 100 days) mortality in those accessing permanent care was higher in 2006 (15.6%, 95% CI 15.2-16.0) than 2015 (14.6%, 95% CI 14.3-14.9). Longer term (101-1095 days, 2006: 44.3%, 95% CI 43.7-45.0, 2015) mortality was higher in 2015 compared to 2006. Mortality in individuals accessing home care did not change. Conclusion:The health of older Australians accessing aged care programmes has declined while frailty increased, with an increasing use of medicine and worse long-term mortality in some. Funding and care models need to adapt to this changing profile.

National Trends and Policy Impacts on Provision of Home Medicines Reviews and Residential Medication Management Reviews in Older Australians, 2009–2019

“…Variation in HMR and RMMR provision by age and sex was observed. Our results are consistent with recent analyses showing significant national variation and overall low uptake of HMRs and RMMRs [ 14 , 15 , 16 , 17 , 18 , 19 ]. Du et al examined GP MBS claims for HMRs among individuals participating in the 45 and Up study between 2009 and 2014 and found that 4.7% of the cohort received at least one HMR during this period, with higher rates of service provision noted with increasing age [ 17 ].…”

“…Recent analyses of national claims data found that at least one HMR or RMMR was provided to 3.9% of individuals aged 75–84 years and 10.2% of those aged ≥85 years in 2018–19 [ 15 ]. National studies examining RMMR provision have identified that only one in five individuals entering RACFs between 2012 and 2015 received an RMMR within 3 months of entry [ 14 , 16 ], while annual age- and sex-adjusted rates of HMR/RMMR provision among permanent residents of RACFs increased from 18.3% in 2006 to 45.5% in 2015 [ 19 ]. Findings of the present study, together with existing HMR and RMMR research, show many older people continue to miss out on these valuable services.…”

“…RMMR provision slowly recovered between April 2014 and December 2019 but did not reach pre-2014 rates of provision. These findings are concerning, given increases in resident age, care needs, multimorbidity, and high-risk medicines utilization in RACFs during this period [ 19 ] and recent national recommendations to address medicines safety through broad and consistent access to these programs for older people [ 5 , 9 ].…”

Variation in Provision of Collaborative Medication Reviews on Entry to Long-Term Care Facilities

“…A retrospective cohort study was conducted using the National Historical cohort of the Registry of Senior Australians (ROSA), which includes records for all older people who access Australian government-subsidized aged care services. 5,21 Briefly, ROSA links deidentified data collected during aged care eligibility and entry into residential care assessments to information about the aged care, medical and pharmaceutical services accessed by that person. The aged care eligibility assessment collects demographic, health, functional limitations and carer information to determine services that may be appropriate.…”

Temporal and regional trends of antibiotic use in long-term aged care facilities across 39 countries, 1985-2019: Systematic review and meta-analysis

“…However, this result is heavily based on estimates from Australia (six of eight studies) which show a decreasing trend in appropriateness between 2010–2018. Between 2006 and 2015 in Australia, the people entering LTCFs were older and more frail, a trend which likely contributes to increases in antibiotic use overall, as well as inappropriate use [ 30 , 118 ]. However, the changes in the health and demographics of the LTCFs population would not account entirely for the decrease in antibiotic appropriateness, which requires further investigation.…”