The impact of adverse events on older Australians living in residential aged care: balancing safety and dignity

Background: There is a growing awareness of the need to create residential aged care systems that encompass safe environments and effective clinical care processes alongside attention to residents’ dignity and quality of life. Within Australia, reports of inadequate care, abuse, and poor clinical outcomes in aged care have been growing. Yet adverse event reporting systems and the development of quality indicators for aged care are in their infancy. 

Rationale: Previous research has focused on a narrow range of adverse events borrowed from the acute care sector such as falls and pressure injuries. However, there has been no quantification of the overall burden of adverse events, nor has there been much consideration of how residents conceive of and experience adverse events. 

Objective: The aim of this research is to: (i) understand the nature and type of adverse events researched, recorded, and experienced by those living in residential aged care; and (ii) use this information to create a conceptual framework of adverse impacts on older people in residential aged care. 

Research Studies: This thesis contains three interconnected studies. The first is a scoping review of 46 published articles on adverse events in residential aged care. The second study used 67,000 residential aged care incident reports to examine the types and incidence rates of recorded adverse events. The third study involved interviews with 20 aged care residents exploring their concept and experiences of adverse events. 

Methods and Participants: A multi-method concurrent design was used to triangulate the findings of the three studies. The second study utilised incident reports and other data collected in the information systems of a large Australian provider of aged care services. Interview participants for the third study were permanent residents drawn from four residential aged care facilities across NSW and the ACT. 

Research Findings: The scoping review and incident report analysis demonstrated that residential aged care research and reporting systems primarily have a quantitative focus on physical injuries such as falls and the impact of behavioural-driven incidents. In contrast, the qualitative interviews highlighted that the residents’ perspective on what constitutes an adverse event is broader than the current definitions used for incident management reporting. Together these studies provide the basis for a conceptual framework which embraces the diversity of both the quantitative and qualitative perspectives to enhance our understanding of adverse impacts on older people in residential aged care. 

What this thesis contributes: The thesis contributes to the knowledge base of adverse events in aged care by i) quantifying current incidence rates of adverse events recorded in residential aged care; ii) generating empirical evidence on the experience and definition of adverse events from the resident perspective; and iii) developing a framework that reconceptualises adverse events in the aged care sector to encompass the impact rather than just the event. Through the conceptual framework, this thesis demonstrates that future development of residential aged care systems will need to consider multi-faceted and often differing views to achieve better care and meaningful outcomes for older people living in residential aged care.