Ageing and geriatric medicine - Research
As one of Australia's most successful geriatric medicine research organisations, our centre has a strong multi-disciplinary focus and conducts research across multiple program areas.
Appropriate prescribing
Ageing is associated with the development of chronic illness and the implementation of guidelines for the management of these conditions has resulted in an increase in the cost and number of prescribed medications. Older people are the major recipients of medications with those aged over 65 contributing to over half of all Pharmaceutical Benefits Scheme expenditure. There is increasing concern that the prescription of multiple drugs for older people can cause significant harm. Pharmacokinetic and pharmacodynamics changes with chronological age increase the risk of adverse drug events. In community-dwellers, polypharmacy (defined as the use of 5 or more medications per day) is associated with falls, functional decline and mortality. On the other hand, medication can be of considerable value to older people, improving quality of life through symptom control, preventing cerebrovascular morbidity and reducing cardiovascular mortality.
At CRGM, we are investigating the effect of multiple medications on outcomes in older people. Our understanding of frailty provides a unique and innovative perspective to these studies. We hypothesise that frail older people may be more vulnerable to the adverse effects of drugs whereas those who are fitter may gain more benefit. The large and comprehensive datasets available for interrogation include older inpatients across multiple hospitals assessed using the interRAI Acute Care tool and very dependent older people in Residential Aged Care Facilities.
This work is led by Associate Professor Ruth Hubbard.
Assessment systems
Assessment Systems for Older People
The interRAI Research Collaborative
CeGA Online
RAIsoft
Assessment systems provide structure to clinical care, ensuring consistent appraisal, guides to assessors and care-givers, and accurate information to support care planning, funding, quality improvement and service planning. Our Program works closely with the interRAI international research collaborative in developing and promoting assessments produced by interRAI.
Within interRAI, we lead development of assessment systems for the hospital setting, including the interRAI Acute Care, the interRAI Acute Care for Comprehensive Geriatric Assessment, the interRAI Post-Acute Care and Rehabilitation and the interRAI Emergency Department.
Building on this work, in partnership with UniQuest, our group has developed clinical decision support software to facilitate assessment of older people in acute care, in long term care and in ambulatory care. These systems help clinicians to interpret their assessments, and also enables them to engage geriatricians to supply specialist advice "online". These systems are branded "CeGA Online".
More recently, the Program has formed a collaboration with Finnish interRAI specialist software company “RAIsoft” to develop nursing and geriatric consultation systems for acute hospital care.
This work is led by Professor Len Gray, Dr Melinda Martin-Khan and Dr Nancye Peel.
Dementia
The World Health Organisation (WHO) recognises Dementia as a public health priority. Worldwide, 47.5 million people have dementia, with just over half living in low- and middle-income countries. People with dementia are frequently denied the basic rights and freedoms available to others. The Centre has worked to support improvements in access to diagnostic services, care in hospital, understanding different health outcomes, health policy issues and general practice issues for people with dementia. The Centre is involved in a body of work which aims to increase our understanding of issues surrounding the timing of the diagnosis of dementia for individuals and their caregivers, and to use this to help frame health policy into the next decade. It is also developing specific quality indicators to assist in monitoring and improving care of people with dementia.
This work is led by Dr Melinda Martin-Khan.
Frailty
Older people in hospital are at high risk of adverse outcomes, a vulnerability commonly referred to as frailty.
In community-dwelling older people, frailty status can be measured precisely with an index of deficits. As people age, they accumulate problems across multiple systems (e.g. medical comorbidities, functional impairments, cognitive decline and loss of vision and hearing). By applying a well-defined methodology, these problems can be coded as deficits, summed and divided by the total number of potential problems to derive a frailty index (FI) score. As a continuous variable (rather than dichotomous frail vs not frail), the FI provides a precise, individualised summary of risk status. Though it has been validated in tens of thousands of community-dwellers, the FI has been criticised as too unwieldy for the busy inpatient setting. One of our current projects is to derive an FI from information that is already routinely collected for the interRAI Acute Care instrument. Integration of frailty quantification into an existing assessment system, which serves other clinical and administrative purposes, could optimise clinical utility and minimise costs, without losing fidelity. This would assist clinicians to identify vulnerable older inpatients, improving their care in the acute setting.
Other ongoing projects include the measurement of frailty in patients with chronic kidney disease, the stratification of risk for older people needing elective or emergency surgery, investigation of sex differences in frailty and the role of assets in mitigation of risk. Students undertaking research higher degrees are affiliated to each of these sub-themes.
This work is led by Associate Professor Ruth Hubbard.
Quality indicators
The Centre collaborates with experts, clinicians and institutions locally and internationally to develop practice-level quality indicators using a robust methodology which incorporates knowledge of the current scientific literature, expert panel review and comprehensive field work. Across a broad range of clinical setting (Acute care, Emergency Care, Transition Care) suites of indicators have been, or are currently being, developed. They incorporate Structural, Process and Outcome indicators.
The focus is on identifying current variation across sites in a common clinical setting where there is evidence that stakeholders can influence the outcome and impact quality. This results in meaningful quality indicators, amenable to change, with the potential to impact the health outcomes or experience of the patient. Where robust international quality indicators already exist (such as residential care), we incorporate indicators as measure of quality when testing an intervention implementation.
This work is led by Dr Melinda Martin-Khan and Professor Len Gray
The Centre has established a special program to promote quality indicator development and implementation: The Research Collaboration for Quality Care
Telegeriatrics
As demand for specialist advice grows, for a patient group that has difficulty with travel, new solutions are required to provide access in a timely, reliable and affordable manner. Our telegeriatrics program exploits new technologies and the internet to link older people with health professionals. Strategies include video-consultation, online systems and remote monitoring. Our work embraces home care, primary care practice, small rural hospitals and residential aged care facilities. The Centre works in partnership with the CHSR Telehealth Program to advance this work.
Models of remote consultation developed by CRGM have been widely implemented across Queensland, within Queensland Health, and in the private sector. CHSR has established a service entitled "Res-e-Care" to support private sector consultations into Residential Aged Care Facilities and primary care practices.
This work is led by Professor Len Gray and Dr Melinda Martin-Khan.