Australia’s ageing population is placing increasing pressures on our health care system, with people aged 65 years being the nation’s fastest growing age group.
While older people currently represent 16% of Australia’s population, they account for 42% of all hospitalisations and 49% of the total days spent in hospital – yet the Royal Commission into Aged Care Quality and Safety identified that the health care system is failing to understand their specific needs to ensure their best possible quality of life.
To help improve this, Professor Julie Ratcliffe has led a team at Flinders University’s Caring Futures Institute to develop two crucial monitoring and reporting tools: QOL-ACC (Quality of Life – Aged Care Consumers) and QCE-ACC (Quality of Care Experience – Aged Care Consumers), to assess quality of life and quality of care experience across Australia’s aged care system.
These tools are the first measures co-designed with older people accessing aged care (both home care and residential care), and were introduced nationally by the Australian Government in April 2023 as key components of the Mandatory Quality Indicators Program for residential care.
Professor Ratcliffe has now obtained an NHMRC Leadership Fellowship, involving a five-year research program to investigate what impact these new assessment tools are having.
“It’s breakthrough research that can help steer the future of aged care in Australia and reveals a decisive change in thinking to include the input of older Australians,” says Professor Ratcliffe.
“By working with older people to develop new economic measurement tools, we can define a higher quality, fairer health care system for older people.”
The new research will further validate the QOL-ACC and QCE-ACC tools – which are proving to be very effective because they have been co-developed with older people from the start.
Professor Ratcliffe’s previous work identified three significant gaps compromising the quality and efficiency of care for older patients in the health care system. Firstly, the voices of older people were not being heard to outline quality of life preferences – yet this is the largest group of health care consumers requiring routine quality assessment.
Secondly, the quality of life measures implemented as part of an economic evaluation alongside a clinical trial have an over-reliance on proxy assessors, particularly for older patients with mild to moderate cognitive impairment and dementia.
Thirdly, quality of life measures typically applied in economic evaluations of interventions targeting older people were developed principally with and for younger adults – and fail to address wellbeing and Quality of life aspects that are most important to people as they age.
“We cannot continue using those older assessment tools,” says Professor Ratcliffe. “They take away older people’s influence on future health policy and health care system decision-making, and they result in system inefficiencies through the misalignment of scarce health care resources with interventions that are not highly valued by older people.
“My vision is to directly address these challenges by developing, validating and implementing new economic evaluation methods and evidence-based guidance to improve quality of life and quality of care outcomes for older people in our health care system.”
The next step of Professor Ratcliffe’s research will be to apply the newly developed economic evaluation methods to a series of clinical interventions and new models of care that specifically target older people.
“Generating new evidence-based guidance will ensure that older people with cognitive impairment and dementia are empowered to self-assess their own quality of life and quality of care experience,” says Professor Ratcliffe.
“The voices of this highly prevalent and increasing patient group are largely excluded from research and from our health care system. Enabling their inclusion will empower older patients to drive quality improvements, influence health policy and decision-making to positively impact their health and wellbeing.
This team’s published research and further information about measuring quality of life and quality of care experience for older adults is featured on the project website – www.qol-acc.org
The new measures will be made available for immediate application by researchers, practitioners and policymakers in Australia and internationally, to ensure that resources are targeted to models of care and service innovations which drive efficient improvements while maximising quality of life benefits for older people.
For more information about the Caring Futures Institute Health and Social Care Economics, read more.