Medicolegal pitfalls when assessing decision-making capacity in people with cognitive impairment.

Background: The global population of older adults will double over the next three decades, and one in 10 will have dementia.

Objective: This article examines medicolegal pitfalls when assessing the decision-making capacity of cognitively impaired patients.

Discussion: Be aware of the pitfalls while completing the five steps of the assessment.

Search and rescue incidents among persons 65 years and older in the USA: Examination of factors associated with death.

Objectives: Older people are vulnerable to becoming lost from home, especially if alone and in unfamiliar environments. Incidents of older persons becoming lost are frequently reported and often requiring a search and rescue (SAR) response. Becoming lost is distressing to the person concerned, their carer, and family and may result in physical injury and/or death.

Integrity in Guardianship Decision Making: Applying the Will and Preferences Paradigm.

Guardianship laws have changed significantly over the 20th and 21st centuries to shift from the "best interests" model to the "supported decision-making" model. Such changes reflect the importance of supporting the dignity of risk of persons who lack decision-making capacity for some decisions. Recent changes to the Victorian Guardianship and Administration Act 2019 (Vic) in Australia require guardians to give effect to the "will and preferences" of the represented person, as far as practicable.

Aged care nurses' perception of unwanted sexual behaviour in Australian residential aged care services.

Objectives: To explore aged care nurses' awareness and experience of unwanted sexual behaviour (USB) in residential aged care services (RACS).

Methods: An anonymous online questionnaire was administered to an opportunistic sample of RACS nurses enrolled to complete an e-learning course in Australia. From the 167 participants who expressed interest to enrol, 129 were eligible and 53 returned completed consent forms.

Evaluation of an online course for prevention of unwanted sexual behaviour in residential aged care services-A pilot study.

Background: Residential aged care services (RACS) staff have substantial gaps in knowledge to prevent and manage unwanted sexual behaviour (USB) in RACS.

Objectives: This study aimed to explore the feasibility of a pilot online course (intervention) addressing USB in RACS.

Method: Development of a self-guided e-learning educational course was based on existing research, national and international approaches to human rights approaches to sexual assault and underwent internal and external peer review.

A Proactive Nursing Home Risk Stratification Model for Disaster Response: Lessons Learned from COVID-19 to Optimize Resource Allocation.

A coordinated emergency management response to disaster management in nursing homes is desperately needed globally. During the most recent COVID-19 pandemic, aside from a few exemplary countries, most countries have struggled to protect their nursing home populations. Timely and appropriate allocation of resources to nursing homes during disaster response is a challenging yet crucial task to prevent morbidity and mortality of residents.

Characteristics of nursing homes associated with COVID-19 outbreaks and mortality among residents in Victoria, Australia.

Objective: To determine nursing home characteristics associated with COVID-19 outbreak, outbreak size and mortality, during the second wave in Victoria, Australia.

Method: Population-based cross-sectional study of all nursing homes in Victoria between 7 July and 13 November 2020.

Results: There were one or more resident cases of COVID-19 in 9.

Epidemiology of Homicide in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.

Background: Empirical research investigating older adult homicide is sparse and rarely accumulated for greater insights. This systematic review and meta-analysis quantifies the prevalence and characteristics of homicide victimization among older adults (65 years and older) compared with younger adults (18-64 years).

Method: We searched Cumulative Index to Nursing and Allied Health Literature, Cochrane, Criminal Justice Abstracts, EMBASE, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science for studies published before December 31, 2018 (International Prospective Register of Systematic Reviews registration: CRD42017054536).

An Ageing Population Creates New Challenges Around Consent to Medical Treatment.

Obtaining consent for medical treatment in older adults raises a number of complex challenges. Despite being required by ethics and the law, consent for medical treatment is not always validly sought in this population. The dynamic nature of capacity, particularly in individuals who have dementia or other cognitive impairments, adds complexity to obtaining consent.

Risk Stratification of Nursing Homes to Plan COVID-19 Responses: A Case Study of Victoria, Australia.

Objective: Emergency management responses to coronavirus disease 2019 (COVID-19) in nursing homes lacked preparation and nuance; moving forward, responses must recognize nursing homes are not generic organizations or services, and individually appreciate each's unique nature, strengths, and limitations. The objective of this study was to describe an approach to stratifying nursing homes according to risk for COVID-19 outbreak.

Methods: Population-based cross-sectional study of all accredited nursing homes in Victoria (n = 766), accommodating 48,824 permanent residents.

Attitudes towards dignity of risk in older people: A survey following a short narrative film.

Objective: To evaluate aged care staff's 'willingness to help an older person with risk-taking activities' that improve quality of life ('dignity of risk').

Methods: Opportunity-based cross-sectional anonymous electronic survey in four Australian jurisdictions, conducted immediately after screening a short animated narrative film describing 'dignity of risk'. Survey comprised nine questions including respondent demographics, professional role, risk-taking and outcome.

Injury prevention among young people in nursing homes: Recommendations following expert consultation forums.

Background: Approximately 6,000 people under the age of 65 years reside in nursing homes each year in Australia. These young people in nursing homes are at risk of premature death and preventable morbidity from injuries. Choking and falls are the leading causes of premature deaths in this cohort with reported rates of 44% and 33%, respectively.

Systematic Review of Randomized Controlled Trials in Australian Nursing Homes from 2000 to 2018.

Background/objectives: High-quality research provides an evidence base for optimal practice care in clinical settings, yet, little is known about the nature and extent of randomized control trials (RCTs) conducted in Australian nursing homes (NHs). Research from other settings and other countries is not necessarily transferable to the Australian NH sector. We sought to identify and describe RCTs conducted in Australia which investigated interventions targeted at improving care for NH residents.

Developing a clinical screening tool for identifying COVID-19 infection in older people dwelling in residential aged care services.

Objective: To develop and conduct preliminary feasibility testing of a clinical screening instrument for early identification of COVID-19 infection in older people residing in residential aged care services (RACS).

Methods: A qualitative study was conducted using a multi-modal approach involving examination of existing literature and national guidelines for COVID-19 clinical screening, formulation of a discussion document with peer review and feasibility testing of a prototype screening tool.

Results: Existing COVID-19 clinical screening tools do not consider age-related impacts on clinical presentation.

Use of Alcohol in Long Term Care Settings: A Comparative Analysis of Personal Choice, Public Health Advice and the Law.

Alcohol is one of the most widely available psychoactive substances globally. Many accept the risks associated with alcohol consumption for reasons such as social engagement and feelings of pleasure. Alcohol consumption in a nursing home (NH) setting highlights the moral and logistical challenges of balancing the need for a safe living and working environment with the dignity of risk (DoR) and personal autonomy of residents.

Role of a Clinical Ethics Committee in Residential Aged Long-Term Care Settings: A Systematic Review.

Objectives: To conduct a systematic review of literature examining the establishment and operation of clinical ethical committees (CECs) in long-term care (LTC).

Design: Systematic review.

Setting And Participants: LTC recipients/family or staff.

Meeting the needs of older people living in Australian residential aged care: A new conceptual model.

Objective: To report on the conceptualisation of a model for residential aged care in Australia.

Methods: Three-stage approach involving initial model conceptualisation; extensive consultation with stakeholders to test and develop the model for feasibility and acceptability; and examination of whether the model addresses circumstances that arise in scenarios of organisational failure.

Results: A model consisting of five domains relevant to the experience of older adults living in residential aged care-health care; social inclusion; rights; personal care and re-ablement; and dementia management.

Geo-mapping of young people in residential aged care.

Objective: Reducing the need for permanent accommodation in nursing homes (residential aged care services) for young people is a major challenge in Australia and internationally. This study investigated the use of innovative geo-mapping strategies to describe the geographical distribution of young people living in residential aged care services (RACS).

Methods: Geographic Information System software was used to generate 13 choropleth maps using data from the Australian Institute of Health and Welfare.

Deaths of young people living in residential aged care: a national population-based descriptive epidemiological analysis of cases notified to Australian coroners.

Aim: This study provides a descriptive epidemiological analysis stratified by age of deaths reported to Australian Coroners of residential aged care facility residents aged under 65 years.

Method: A national population-based retrospective analysis was conducted of deaths of Australian residential aged care facility residents reported to Australian Coroners between 2000 and 2013. Descriptive statistics compared adult residents categorised using age by factors relating to the individual, incident and death investigation.