Volume 208 - Issue 3
Premature deaths of nursing home residents: an epidemiological analysis
Authors: Judy A Lowthian, Claudia Meyer, Dianne Goeman and Colette Browning
Med J Aust 2018; 208 (3): 143. || doi: 10.5694/mja17.00642
Published online: 19 February 2018
Published online: 19 February 2018
To the Editor:
The study published by Ibrahim and colleagues1 raises questions about the quality of care delivered in residential aged care facilities. This analysis of routinely recorded coronial data identified that 15% of premature and preventable residents’ deaths resulted from external causes, with falls being the most frequent culprit.
Falls in residential aged care facilities are well recognised, with about half of all residents falling within a given year.2 Residents tend to be older and frailer, have higher rates of dementia and higher rates of psychotropic medication use compared with community-dwelling older people, which contributes to higher rates of falls. A falls risk assessment, using validated tools and appropriately qualified personnel, has the potential to reduce the rate of falls and related injuries by addressing individual and environmental risk factors.3 While the residential aged care sector is subject to variation in staffing numbers and skill mix, mandatory education related to falls prevention is also needed. The Australian Commission on Safety and Quality in Health Care’s Preventing falls and harm from falls in older people — best practice guidelines for residential aged care facilities4 provide a helpful framework.
In a separate study, Ibrahim, the lead author of the MJA article, and Davis5 state that residents in aged care facilities are entitled to the “dignity of risk” principles that allow them autonomy to accept risks that may be associated with short term increases in their quality of life. However, the reality is that a person’s quality of life is often determined by risk management rather than autonomy,6 which reflects a form of age discrimination whereby the risk of injury of falls and its consequences outweighs the older person’s quality of life, by making assumptions about their ability to make choices about their everyday activities. Promoting dignity and autonomy for older residents in aged care may see greater falls rates but it will allow residents to enact their choices. The work by Ibrahim and colleagues1 needs to be understood within this context.
Competing interests
No relevant disclosures.
References
- Ibrahim JE, Bugeja L, Willoughby M, et al. Premature deaths of nursing home residents: an epidemiological analysis. Med J Aust 2017; 206: 442-447.
- Kosse NM, de Groot MH, Vuillerme N, et al. Factors related to the high fall rate in long-term care residents with dementia. Int Psychogeriatr 2015; 27: 803-814.
- Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 2011; 59: 148-157.
- Australian Commission on Safety and Quality in Health Care. Preventing falls and harm from falls in older people — best practice guidelines for residential aged care facilities [website]. Sydney: ACSQHC; 2009. https://www.safetyandquality.gov.au/our-work/falls-prevention/falls-prevention-resources/#Preventing-Falls-and-Harm-from-Falls-in-Older-People:-Best-Practice-Guidelines-2009 (viewed Nov 2017).
- Ibrahim JE, Davis MC. Impediments to applying the “dignity of risk” principle in residential aged care services. Australas J Ageing 2013; 32: 188-193.
- Egan N. Better balance of rights and risk in dementia care needed: expert. Australian Ageing Agenda (Canberra) 2015; 10 Apr. https://www.australianageingagenda.com.au/2015/04/10/better-balance-dementia-rights-risk-needed (viewed Nov 2017).
Linked content
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MJA Letter: Premature deaths of nursing home residents: an epidemiological analysis
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MJA Letter: Premature deaths of nursing home residents: an epidemiological analysis
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MJA Letter: Premature deaths of nursing home residents: an epidemiological analysis