Generating evidence to improve aged care in Australia

The cost of health care for older Australians is rapidly rising, but Flinders University senior research fellow Dr Jyoti Khadka – who also works with the Registry of Senior Australians (ROSA) – believes that introducing evidence-based interventions will greatly improve the care quality given to older Australians at a more modest cost. 

ROSA, based at the South Australian Health and Medical Research Institute (SAHMRI), monitors the health, service utilisation, medication use, mortality and other important outcomes of people receiving aged care services in Australia. 

“My work at ROSA has a common theme – generating economic evidence of health care use to influence better practice and policy decisions in aged care,” says Dr Khadka. 

Dr Jyoti Khadka

“We have limited resources, coupled with exponential demands upon those resources. Therefore, evaluating the costs and benefits of healthcare services and technologies will help drive efficiency and improvements in care quality that reduce negative outcomes and improve quality of life for all older Australian who use aged care services. 

“My work also assesses cost-effectiveness of specific health and aged care services that provide positive health outcomes.” 

In work funded by the Hospital Research Foundation, Dr Khadka is studying the cost implications of assessing care quality in aged care, focusing specifically on pressure injuries, falls and unwanted weight loss.  

“These are negative health outcomes that can be avoidable with improved care quality in aged care – and yet they result in significantly higher costs being inflicted on aged care services,” he says. 

“My work in this space will unravel the key questions about healthcare costs associated with these key negative health outcomes.” 

Through providing research that highlights the key cost indicators of primary care levels, Dr Khadka is confident this will influence policy and practice outcomes that will help avoid huge flow-on costs of health care provision for older Australians. 

“If we place more attention on interventions that can be introduced to aged care and prevent such unnecessary traumas as falls and drastic weight loss, we can offset downstream health costs,” he says.  

The depth of Dr Khadka’s analysis will reveal how older Australians access different parts of the primary health care system, their frequently, and what cost this has to the Australian health system. He will present these outcomes at a conference in the Gold Coast during November. 

At ROSA, Dr Khadka also developed a new assessment tool that measures a frailty index. Introduced in 2020, it was developed using historical data involving more than 900,000 older Australians to improve aged care and health outcomes for vulnerable older people.  

The frailty index is now being used by researchers and is proving versatile enough to be used across many types of assessments – from demonstrating how frailty changes the risk of death, functional limitation and higher level of aged care following a hip fracture, to accurately predicting an individual’s risk of death and the likelihood that they might need long-term residential aged care.  

It builds on other significant work that Dr Khadka has been doing with Flinders Caring Institute under the mentorship of Professor Julie Ratcliffe, including the development and validation of two aged care specific tools – the Quality of Life-Aged Care Consumers (QOL-ACC) and Quality of Care Experience-Aged Care Consumers (QCE-ACC).  

“These two tools were created from the perspectives of older Australians accessing aged care services in both home and residential care settings and are designed as a preference-based instrument for quality assessment and economic evaluations in aged care settings,” says Dr Khadka. From April 2023, the federal Department of Health and Aged Care has nationally rolled out both the tools in Australia as a mandatory quality indicator to assess, monitor and benchmark quality of life and quality of care experience of aged care recipients.  

In current work funded by a 2022 Flinders Foundation Health Seed Grant, Dr Khadka is studying the burden of hearing, vision and dental conditions among culturally and linguistically diverse populations who use aged care services in Australia.  

“The findings from this study will inform a bigger project that aims to develop an innovative care model for prevention of hearing, vision and dental conditions in these populations,” he says.   

All of these outcomes are consistent with recommendations of the Royal Commission into Aged Care Quality and Safety, to provide improved health care for all older Australians, and especially those in residential aged care. 

“The assessment of a person’s frailty at this important time in their aged care journey can be used to flag those who needs interventions, to lower their risk of adverse and very costly events like hospitalisation,” he says. 

“More effort needs to be put in to avoid these conditions as much as possible, to intervene before they become a major health care and cost problem.” 

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Quality Aged Care