Prolonged wait time prior to entry to home care packages increases the risk of mortality and transition to permanent residential aged care services: findings from the Registry of Older South Australians (ROSA)

BACKGROUND:Older Australians prefer to live in their own homes for longer and reforms have attempted to increase the volume of home care packages (HCPs) accordingly but there remains a queue with the longer-term consequences unclear. OBJECTIVES:This study aims to characterise older Australians according to their wait times for a home care package (HCP), evaluate the association between wait time and mortality and evaluate the association between wait time and transition to permanent residential aged care services after HCP. DESIGN:A retrospective cohort study using data from the National Historical cohort (2003-2014) of the Registry of Older South Australians (ROSA) was conducted. SETTING:Home based aged care services, national cohort. METHODS:Wait time was estimated from approval date to date of receiving a HCP. Descriptive, survival estimates (95% confidence intervals (CIs)), and multivariable survival analyses (Cox-regression) were conducted to evaluate the risk of mortality and transition to permanent residential aged care services by quartiles of wait time for HCP. RESULTS:The cohort was followed for 4.0 years (interquartile range IQR (1.8-7.2)) and 38% were alive at the end of the study period with a median wait time for HCP of 62 (21-187) days. From 178,924 older people who received a HCP during the study period (2003-2013), 33.2% people received HCP within 30 days, 74.3% within 6 months and 25.7% after 6 months. The effect of wait time on risk of mortality was time-dependent, with longer wait times associated with higher mortality in the longer term. Compared to people who waited ≤30 days for a HCP, individuals who waited more than 6 months had an almost 20% excess risk of death (adjusted hazard ratio (aHR), 95%CI = (1.18, 1.16-1.21)) 2 years after entry into a HCP. Those who waited more than 6 months also had a 10% (1.10, 1.06-1.13) higher risk of transition to permanent residential aged care services after two years. CONCLUSION:Prolonged wait times for HCP is associated with a higher risk of long-term mortality as well as transition to permanent residential aged care. It remains to be seen if a shortening of this wait time translates into better health outcomes.Renuka Visvanathan, A. T. Amare, S. Wesselingh, R. Hearn, S. McKechnie, J. Mussared, M. C. Inaci

Evaluation of minimum ignition energy measurement techniques used at P.E.R.M.E

SIGLEAvailable from British Library Lending Division - LD:2265.63F(BR--92038) / BLDSC - British Library Document Supply CentreGBUnited Kingdo

The role of scientists and clinicians in raising public support for animal research in reproductive biology and medicine

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Fertility and social change: the neglected contribution of men's approaches to becoming partners and parents

Attitude survey and interview data are mobilised to address neglect of men's contribution to low fertility and wider social change in families and relationships. Men's attitudes are as relevant as women's to understanding fertility behaviour. However, fertility behaviour can only be understood in the context of a package of changes in gender relations and family life. Data from a random sample of men aged 18–49 surveyed in the Scottish Social Attitudes (SSA) survey 2005/06 are combined with in-depth interviews conducted in 2007 with 75 men aged 25–44 identified through the Scottish Household Survey as not living in co-resident partnership arrangements. Both datasets encompass the age span conventionally associated with having children and men who were the potential partners of women delaying a first child until their 30s. They allow consideration of the impact of social contact with parents and children on men's fertility intentions and how the role of provider features in men's views about parenting. The interviews focus on men who have fallen out of, or have not entered, co-resident partnerships and examine the relationship between partnering and parenting. In combination the data suggest how men act as a complementary or contradictory downward drag on women's fertility and that their role has been underestimated in understanding the package of family change of which low fertility is a part