Research Contributions to Understanding Older People and Care Journeys

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Research Contributions to Understanding Older
People and Care Journeys

• Hal Kendig
• Matthew Carroll,
• Faculty of Health Sciences
  ARC/NHMRC Research Network in Ageing Well
  www.ageingwell.edu.au

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Acknowledgements

• MELSHA key collaborators
• Prof Colette Browning Co-Director with Hal
  Kendig
• Prof Shane Thomas collaborator in data
  collection strategies and health services
  analyses
• A/Prof Dave Grayson statistical consultant
• Note Results will be forthcoming in articles
  written with the collaborators

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Overview

• Policy ideas and information sources
• Findings
• Research directions
• Funding opportunities
• Policy directions

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1.a The Pathways Approach

• What it is
• Key questions
• How do peoples community care services change
  over 11 years
• What predicts entry to residential care?

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1.b Why take the Pathways Approach?

• Better understand
• Multiple use of services
• Duration of services use
• Predictors of key turns on paths
• and how it helps improve understanding of the
  aged care systems

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1.c Current efforts in services pathways

• Gibson and Duckett
• Pathways in Aged Care (dementia study)
• NSW Health Department
• Care Journeys

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1.d. The MELSHA Program(Browning and Kendig)

• Data Base 1994 Baseline Interviews with 1000
  persons aged 65 years and over living in the
  community.
• Biannual telephone and tracing efforts to 2002
  and 2006 with face to face in 2004.
• Funding - National Health and Medical Research
  Council Funding and Victorian Health Promotion
  Foundation

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2. Findings
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2.a Baseline Characteristics

• Capacities - Full instrumental independence
  (81)
• at baseline - Good or better self rated health
  (81)
• - Can walk two plus kilometres (70)
• Well-being - Frequently happy etc (80 plus)
• - High life satisfaction (80 plus)
• Risks - Most no energetic exercise - Less than
  half daily fruit, vegies, milk
• - A third of women fell in last year
• - 15 five plus prescribed medications
• - A third have some incontinence

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2.b Baseline characteristics cont.
MELSHA Baseline 1994 n 1000
Yes 175
No 825
IADL Dependent
With spouse 75
Living arrangement
Alone 75
With spouse 496
With others 69
Alone 260
With others 25
F 42
M 335
F 46
M 23
F 19
M 6
M 10
F 65
F 161
F 200
M 60
M 33
Gender
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2.c Outcomes after 11 years of the study
preliminary analyses

• 42 in the community
• 7 in residential care
• 50 known to have died
• (of whom 33 known to have entered residential
  care)
• Excludes the 18 of the sample that was lost
  to follow up and hence outcomes were not known

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2.d Service Use () at baseline groups
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2.e HACC Service use () by year of data
collection
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2.f Outcomes by year of data collection
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2.g Identified service use () prior to
residential care admission or death
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2.h Question 2 most important predictors of
entry to residential care

• From a total of 30 variables covering
  socioeconomic, health and lifestyle domains

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3a Future research directions

• Further analysis of MELSHA data
• New study linking HACC, hospitals, and 45 and Up
  survey data
• Jorm, Kendig, Byles et al.

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3a Research directions cont.

• Review of the community care research and policy
  agenda
• Ageing Well Network in collaboration with
• ACSA (Pat Sparrow)
• Australian Association of Gerontology (Gill
  Lewin)

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3b Research funding opportunities

• ARC Linkages scheme
• see materials from the Ageing Well Network
  workshop with ACSA(NSW ACT) in June 2007
  available at www.ageingwell.edu.au/links_resources
  _2.htm
• NHMRC Partnership grants

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3c Big picture policy reform?

• HACC split of younger and older people with
  disabilities
• Full Commonwealth consolidation of aged care and
  health funding
• Note Health and Hospital Reform Commission
  recommendations due before end of year