High rate of premature deaths in Australian nursing homes a 'systems' problem: study

May 27, 2017

A foundation study of nursing home care in Australia has revealed unacceptably high rates of premature death from potentially preventable causes such as falls, choking, suicide and homicide.

It found almost 3300 nursing home residents died from these causes between 2000 and 2013.

"We have uncovered a 'systems' problem, rather than a problem with a few bad nursing homes or individuals," says study leader Professor Joseph Ibrahim from the Department of Forensic Medicine at Monash University.

The study found a four-and-a-half-fold increase in premature death across nursing homes in the 13 years but there were caveats.

While part of the rise was due to better reporting of falls, he cautioned that the overall number of premature deaths was probably under estimated as deaths were often misclassified as "natural".

This occurred because of a tendency to downplay the significance of injury-related factors in old age and assume that an underlying illness caused the death.

"It's time to take a good hard look at what we deliver in aged care in the same way did in the 1990s with health care. Back then, multiple studies found one in 10 patients in hospital came to harm because of the care they were receiving," Professor Ibrahim says.

"That was a 'systems' problem and its recognition led to patient safety and quality measures that led to changes in practice that are still occurring today.

"It's time for the same thing to happen in nursing home care," he said.

This first comprehensive study of deaths in Australian nursing homes is published in the Medical Journal of Australia today.

As the population ages, the residential care sector is expanding. Just last week the federal government announced another 10,000 older Australians will get access to residential care services in the latest 2016-2017 Aged Care Approvals Round, requiring an additional investment of $649 million a year.

While individual stories of preventable death in nursing homes are intermittently reported in the media, this study describes the problem at a population level and illustrates it's not just due to a few bad apples.

Based on coronial data it found that of the 21,672 deaths of nursing home residents reported to the Coroners Court during the study period, 15.2 per cent were from external (non-disease) or preventable causes and that most were unintentional.

Of the 3289 who died from external causes, in 81 per cent of cases it was from falls and in 9 per cent from choking. Just over 1 per cent died from complications of clinical care.

Among the intentional deaths just over 4 per cent suicided and while 1 per cent died as a result of a resident-to resident assault.

Australia has about 2800 accredited nursing homes and while they are monitored by a range of mechanisms, no single entity is responsible for reducing harm by improving practice within them,

Professor Ibrahim says a national strategy is required to achieve this. He recommends professionals from governments and the nursing home sector establishing a lead authority to guide the process.

His national study is the first in the world to look at potentially preventable deaths in nursing homes using information from medico-legal investigations. It was made possible because of Australia's unique data collection facilities.

Where there was a paucity of information about the cause and manner of premature deaths, this study provides the first real assessment of the issue. It provides a foundation for review, better understanding and change.

While Professor Ibrahim acknowledges the increase in preventable deaths may, in part, be due to increased scrutiny of aged care facilities by the community and government, he says if we value older people we can work harder for them.

"And its' worth remembering that everyone who is in power now is going to get old and when they do, they will reap the benefits of whatever it is that they have set up."

In a linked editorial in the MJA, President of the Australian College of Physicians, Dr Catherine Yelland, says "we can do better'.



Read more: http://www.afr.com/lifestyle/health/mens-health/high-rate-of-premature-deaths-in-australian-nursing-homes-a-systems-problem-study-20170526-gwdwna#ixzz4iPWss79b 
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