Complex and Continuing Aged Care

The Tri-focal Model of Care: teaching and research aged care services

image of the tri-focal model

The Tri-focal Model of Care - Teaching and Research in Aged Care Services project, funded by the Department of Health and Aging, commenced in 2012. This project is led by Professor Alison Hutchinson, Chair in Nursing, Centre for Nursing Research-Deakin University and Monash Health Partnership, and Professor Bev O'Connell, Dean of the Faculty of Nursing, University of Manitoba, Canada.

The Tri-focal Model of Care promotes partnership-centred care, evidence based practice and positive and healthy work environments in Residential Aged Care (RAC). The Model takes account of Australian regulatory requirements in relation to the Accreditation Standards and brings together research, education, and practice to help transform residential aged care. The Tri-focal Model of Care education program consists of three professional modules and six clinical modules.

This project has evolved to involve the implementation of the Tri-focal Model of Care in seven RAC facilities within four healthcare organisations located in metropolitan and regional Victoria. Deakin University researchers are working in collaboration with facility staff to promote the principles of the Model and implement the Tri-focal Model of Care curriculum.

For further information about the project, the Model, and the education modules please visit the Centre for Innovation and Education in Aged Care or contact Professor Alison Hutchinson.

Quality use of medicines and glucose lowering medicines in aged care

an image of a patient and nurse

The problem of uncontrolled postoperative pain is well documented. Worldwide prevalence studies have shown up to 80% of patients experience significant pain after surgery and they receive less than 50% of the analgesics they are prescribed. Similar Australian studies have shown that over 40% of patients experience unnecessary pain after surgery.Diabetes is the leading chronic disease in Australia, especially in older people and the prevalence is increasing. Medicines play a key role in diabetes management and enhance physical functioning and quality of life (benefits) but are associated with significant adverse events (risks) that compromise safety and quality of life. In June 2013 Professor Trisha Dunning and her team received funding from the Australian Government Department of Health and Ageing Aged Care Service Improvement and Healthy Ageing Grants Fund to investigate the Quality Use of Medicines (QUM) and Glucose Lowering Medicines (GLM) in Aged Care. The aim of the project is to develop and evaluate QUM GLM resources and an education program for older people with diabetes and aged care staff. The focus of the program will be on how to apply the QUM framework to everyday clinical decision-making and when educating older people about their GLMs.

Previous research conducted by Professor Dunning and colleagues indicated that aged care staff have a limited understanding about the pharmacokinetics and pharmacodynamics of GLMs, key aspects of managing insulin, and how to interpret blood glucose patterns and HbA1c levels in relation to medicines. The QUM framework (published by the Commonwealth of Australia, 2002) has an integral place in health care generally and diabetes management in particular. However, there is a demonstrable need to enable aged care staff to develop the knowledge and competence to apply QUM principles when making clinical decisions when administering GLMs and when monitoring the effects of GLM. In addition, community dwelling older people with diabetes who self-manage their medicines or manage their medicines with some support from others require specific personalised information about how to use their GLMs to maximise benefit and reduce the risks.

In light of this observation, a compelling feature of the project is its objective to operationalise QUM principles for use at the 'bedside'. The new resources will improve the health, quality of life and safety of older people with diabetes. The study is highly significant given the high rates of medicine use by older people with diabetes (an average of 8 medicines in multiple doses per day) and the medicine-related adverse events that lead to hospital admissions and significant morbidity and mortality in older people. The other chief investigators are Dr Sally Savage, Research Fellow with Deakin University and Barwon Health and Ms Ann Hague, Executive Director of Aged Care at Barwon Health.

For more information, please contact: Professor Trisha Dunning

CHOICES in Consumer-Directed aged care

an image of four older gentleman playing cards

The CHOICES project, funded by the Department of Health and Ageing, commenced in 2012. The Project is led by Dr Goetz Ottmann, the inaugural Senior Research Fellow of the Uniting Care Community Options/Deakin University research partnership.

The CHOICES model addresses the support needs of older people with complex care needs living in rural/regional, culturally and linguistically diverse, and Aboriginal and Torres Strait Islander communities. It has been specifically designed for community aged care recipients who would like to have more input into and control over their own care arrangements. The model is based on the evidence gathered by a previous ARC Linkage-supported research project that developed and evaluated a self-directed community aged care model in partnership with older people, carers, and service provider staff. The evaluation of that model demonstrated that a capacity building- focused, self-directed care approach gives rise to important synergies that not only increase older people's satisfaction with their care arrangements and standard of living, it also gives older people the sense that they are having greater control over their care arrangements and are treated with dignity and respect.

Moreover, the research also suggests that psycho-social support provided in conjunction with more flexible support options improves their outlook on what they can achieve in life. These outcomes stand in stark contrast to the results associated with consumer-directed care models implemented in the US and UK. The CHOICES project produced four animation-supported training modules aimed at communicating the key elements of the model (restorative health maintenance, motivational goal setting, and assisted self-direction) to case managers. The CHOICES project will be evaluated during 2014 employing a stepped wedge trial design.

The research team includes: Dr Goetz Ottmann, Ms Anna Millicer, Ms Barbara Blakey, Ms Margarita Maragoudaki, Ms Claire Preistly

For more information about the project please visit CHOICES or contact Associate Professor Goetz Ottmann.

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