Aged care residents receive top care for continence but not for mental health, end-of-life or infection, world-first study finds

Aged care residents receive best practice care for continence issues but substandard attention when it comes to other common conditions including mental health, end-of-life care and urinary tract infections, according to world-first Australian research.


Led by the Australian Institute of Health Innovation at Macquarie University, the study, published today in the international journal BMC Medicine, is the first to evaluate adherence to evidence-based care for people in long term residential aged care across multiple common conditions.

Tapping into specialised reviews conducted by aged care nurses, researchers found that on average, residents received care in line with guidelines 53.2% of the time. Six conditions (skin integrity, end-of-life care, infection, sleep, medication, and depression) had less than 50% adherence with indicators for best care.

Level of adherence to evidence-based care by condition

Condition% adherence
Bladder and Bowel (continence)81
Cognitive Impairment74
Oral Health65
Dysphagia57
Admission54
Pain54
Mobility and Falls54
Nutrition and Hydration51
Skin Integrity50
End-of-Life Care44
Infection35
Sleep33
Medication27
Depression12

The study evaluated the care received by 294 residents across 27,585 care encounters in 25 residential aged care facilities.

Lead author and internationally recognised patient safety expert, Professor Peter Hibbert, said the results pointed to the continued difficulties faced by the aged care sector, including workforce shortages with medical, nursing and allied health staff.

Professor Peter Hibbert. Photo: Supplied

Findings show the lowest rate of adherence was for the management of depression, despite more than half of all permanent aged care residents experiencing symptoms. The research found only 1% of residents who had been receiving antidepressants for four weeks were monitored on a monthly-basis for side-effects, as per the guidelines.

The research also found that urinary tract infections were not being managed according to guidelines designed to ensure frail older people received evidence-based treatment and that antibiotics were not used unnecessarily.

“Being treated according to evidence-based care is a fundamental human right and essential for ensuring people in aged care are safe and experience the best possible quality of life,” Professor Hibbert said.

“Caring for older people in aged care is likely to become more and more challenging as demand increases and resources become more stretched.

“Understanding where and how evidence-based care is being delivered, or not, is very important to keeping people safe and allocating limited resources. Listening to the experiences of residents and their families is also essential.”

Clinical practice guidelines contain recommendations intended to ensure patients receive care that has proven benefit. National experts worked with the researchers to identify indicators of care drawn from the clinical practice guidelines for 16 conditions or care processes. Trained aged care nurses then reviewed records of care delivered in residential facilities between 1 March and 31 May 2021 to assess adherence with the indicators.

“We are not judging individual aged care providers with these results. This is a commentary on the overall aged care sector which is struggling to provide residents the right care at the right time,” Professor Hibbert said.

“The data for this study was collected around the time that the Royal Commission into Aged Care reported its findings in 2021. The Royal Commission recommended that registered nurses should be onsite 24/7 and that other healthcare staff be more available. These changes are very welcome, however, broader workforce shortages have increased since 2021, which has continued to put pressure on the system.”

A lack of ongoing systematic monitoring of the performance of the sector also contributes to the lower rates of evidence-based care and the results provide valuable insights into specific conditions and clinical processes where improvements should be targeted, Professor Hibbert added.

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