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Objective To assess effect of a complex, multidisciplinary intervention aimed at reducing avoidable acute hospitalization of residents of residential aged care (RAC) facilities. Design Cluster randomized controlled trial. Setting RAC facilities with higher than expected hospitalizations in Auckland, New Zealand, were recruited and randomized to intervention or control. Participants A total of 1998 residents of 18 intervention facilities and 18 control facilities. Intervention A facility-based complex intervention of 9 months' duration. The intervention comprised gerontology nurse specialist (GNS)-led staff education, facility bench-marking, GNS resident review, and multidisciplinary (geriatrician, primary-care physician, pharmacist, GNS, and facility nurse) discussion of residents selected using standard criteria. Main outcome measures Primary end point was avoidable hospitalizations. Secondary end points were all acute admissions, mortality, and acute bed-days. Follow-up was for a total of 14 months. Results The intervention did not affect main study end points: number of acute avoidable hospital admissions (RR 1.07; 95% CI 0.85–1.36; P = .59) or mortality (RR 1.11; 95% CI 0.76–1.61; P = .62). Conclusions This multidisciplinary intervention, packaging selected case review, and staff education had no overall impact on acute hospital admissions or mortality. This may have considerable implications for resourcing in the acute and RAC sectors in the face of population aging. [ABSTRACT FROM AUTHOR]

Objective: To describe changes in aged care residents’ dependency over a 20-year period. Design: All residents in 1988, 1993, 1998, and 2008 were assessed using the same 23-item functional ability survey. Setting: Residential aged care facilities in Auckland, New Zealand. Participants: In 1988 there were 7516 participants (99% response rate), 6972 in 1993 (85% response rate), 5056 in 1998 (65% response rate), and 6828 in 2008 (89% response rate). Data were weighted to accommodate variation in response. Measurements: A composite dependency score with 5 ordinal levels was derived from a census-type survey reporting mobility, activities of daily living ability, continence, and cognitive function. Results: The proportion of “apparently independent” residents decreased from 18% in 1988 to 9% in 1993, 5% in 1998, and 4% in 2008, whereas those “highly dependent” increased from 16% in 1988, to 18% in 1993, 19% in 1998, to 21% in 2008. All functional indicators demonstrated increased dependency over the 20-year period (P < .0001). However, between 1998 and 2008 there were significant increases in dependency for continence, mobility, self-care, and orientation, but no significant changes in memory and behavior. Conclusion: The increased dependency over 20 years directly affects care requirements for this population. [Copyright &y& Elsevier]