By Karly Bartrim

Aged care dietitian, academic (Griffith University), and PhD Candidate (University of Queensland)

Australia’s ageing population continues to place high strain on aged care services, urging the government to improve the system that supports older Australians to live and age well. [1] Strengthening the workforce that cares for older adults and increasing employment of allied health professionals are core recommendations continuing to be advocated for in media and by government today. [2] In addition, providing quality food that meets the nutrition needs of older adults and reducing malnutrition in these settings continues to be front of mind.

Dietitians are the only health professionals trained in providing nutrition care to prevent or reduce malnutrition and chronic diseases across all population groups. [3] Through the delivery of nutrition interventions, dietitians improve the health and wellbeing of older adults. This makes them an essential workforce for providing nutrition care in residential aged care facilities (RACF) and in-home services.

Dietitians’ roles and working hours vary worldwide. For example, in Ontario, Canada, dietitians have an allocated 30 minutes per resident per month to ensure Long Term Care Homes provide optimal nutrition care and ensure policies and procedures support older adults. [4] As such, Dietitians Australia have provided recommendations to introduce mandated dietitian hours in aged care to align with provinces in Canada and certain jurisdictions within the United States. To achieve this, the Australian dietetic workforce in aged care needs to increase substantially in size and capacity.

A greater understanding of dietitians’ attitudes when working with older adults in RACF or their homes can inform workforce strategies to support capacity-building initiatives that produce quality care. A recent integrative review was conducted, exploring dietitians’ attitudes working with older adults in these settings. [5] The review included studies from seven countries (the US, Canada, Australia, UK, Israel, Japan, and the Netherlands) conducted between 1986 and 2021. Twelve studies included dietitians working in RACFs, and five explored dietitians working within home care services.

Data from the studies were analysed and synthesised into five themes:

1. Recognising their contribution as dietitians
2. Lacking clarity about the boundaries of their role
3. All team members have a role to play in nutrition care
4. Assumptions and biases about working with older people
5. Needing to build capacity in the workforce.

Dietitians recognised the important contribution of their role in caring for older adults; however, they experienced low clarity about the boundaries of their role. Dietitians appeared to have positive and negative assumptions and biases about older people. Moreover, dietitians have recognised issues in the workforce, with not all team members prioritising nutrition care despite dietitians recognising all members have a role. Dietitians acknowledged that the dietetic workforce needs to build capacity through more time, funding, and professional development opportunities.

Future research is needed to understand dietitians’ confidence in their knowledge and skills regarding working in RACF and home care services to provide insight into future initiatives to support the growing workforce. Future directions need to include improving understanding of the dietitians’ role in aged care, incorporating practical opportunities for student dietitians in aged care, and considering the implementation of mandated dietitian hours. Integrating dietitian services and ensuring dietitians are well supported, will help improve the quality of Australia’s aged care system and improve the nutrition of older Australians.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

By Dr Priyanka Vandersman, Research Fellow

End of Life Directions for Aged Care (ELDAC), Flinders University

The aged care sector provides care and services to over 80% of Australians who are in the last year of their life, with statistics indicating that the residential aged care sector cares for over a third of all deaths. Following the Royal Commission into aged care 2018-2021, added demands have been placed on the already busy and fast-paced aged care sector. The need for greater reporting and transparency, high standards of care, and effective organisational processes has been placed on the sector forcing it to think of innovative approaches of care planning and delivery, including the care provided to those who are at the end of life.

One of the ways of ushering innovation into aged care is via use of advanced digital technologies to improve care outcomes. Indeed, prioritisation of technology integration into aged care, including the use of digital care management systems, is one of the recommendations of the Royal Commission, and in line with the  Department of Health and Aged Care’s Digital Transformation Agenda. As work continues at the systems level to address structural barriers to change, opportunities currently exist across the aged care sector to embrace strong leadership and foresight around digital technology to ensure that organisations are prepared to meet requirements in the future.

The Technology and Innovations stream of the End of Life Directions for Aged Care (ELDAC) project aims to support the aged care sector in utilising technology to improve their end of life and palliative care practices. Housed within the Research Centre for Palliative Care Death and Dying (RePaDD) at Flinders University, this stream of ELDAC has developed a number of digital health tools to support aged care services’ palliative care planning and provisioning processes, one of which is the ELDAC digital dashboard.

The ELDAC digital dashboard is a system application that aged care providers can embed as part of their IT systems. It is designed to track and visually represent key end-of-life care processes and indicators – supporting a consistent and comprehensive approach to end of life. One of the unique abilities of the dashboard is that it uses existing data that is captured within the service’s clinical data management system, processes it, and provides a one-stop shop for clinicians to graphically view and track all relevant care activities relating to their residents/clients. There is no need to feed data to the dashboard, which makes it ideal for integration into existing systems.

Since its development in late 2019, the dashboard has not only been integrated into the systems of four aged care IT providers/teams but has also been road tested in the real world with a rigorous implementation trial being conducted at 14 residential aged care sites across Australia. The results indicate a reassuring openness among the aged care workforce to engage with technology and a notable ability of the dashboard to help nurses organise end-of-life care, and support audit and compliance activities while promoting accountability in the EOL processes at the service level.

So, what does the dashboard experience tell us about technology for palliative care in the aged care sector? Firstly, it shows us that well-designed and carefully implemented digital tools can appropriately support staff and services in identifying and responding to an older person’s needs as they move into the last months, or year, of life. Secondly, the dashboard offers an interesting example of how new technologies can enhance the capacity of existing systems. Finally, the dashboard experience demonstrates that the aged care workforce is open to engaging with novel technologies, if these technologies have the potential to help them provide better end-of-life and palliative care to their older residents/clients.

The need for and rate of integration to IT within aged care is going to move rapidly in the next few years. Services will need to build workforce capability and look at how core work can be supported by digital innovations that have meaning for the workforce and the residents or clients. Technology providers and project leaders will need to ensure that technology products represent good value not only financially, but in terms of their value to aged care and their responsibilities.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

Dr Simone Marino, Postdoctoral Research Fellow

Social Care and Ageing (SAGE) Futures Lab, Edith Cowan University (ECU)

Dementia has become an epidemic with numbers projected to rise exponentially.

In Australia, this number includes people from culturally and linguistically diverse backgrounds (CaLD); and such diversity presents challenges to service delivery.

The existing literature reports that many existing aged care services in Australia do not adequately address the needs of Australia’s culturally diverse ageing population, particularly around ‘cultural safety’. Similarly, the Final Report of the Royal Commission into Aged Care Quality and Safety reported a lack of community support and social stimulation for individuals living with dementia, especially those from diverse backgrounds.

The Co-musichiamo project was inspired by the scarcity of studies involving people living with dementia from migrant backgrounds and their families, as well as the lack of appropriate services and resources to support their cultural wellbeing. Developed in collaboration with Professor Loretta Baldassar (Director of the ECU SAGE Lab), this project is located at the intersection of anthropology, ethnomusicology, ageing and dementia studies.

Co-musichiamo is a neologism evoking both the Italian term comunichiamo – ‘let’s communicate’, and musichiamo – ‘let’s make music together’.  Co-musichiamo explores the relevance of music, migration life-storytelling, and first language to support the wellbeing of people from culturally and linguistically diverse backgrounds living with dementia in Australia. This innovative idea uses reminiscence and autobiographic memory through the collection of oral histories with Italian migrants living with dementia and their families, both at home and in residential care, to co-create culturally tailored songs that support cultural identity and wellbeing.

Through a series of sessions involving participants and their family members, migrant stories and oral histories are collected, together with the soundscapes and individual soundtracks of participants’ lives, to co-create a song together. The songs feature the ipsissima verba – the very words that we all use in our narrative – which define the identity of a person, playing a pivotal role for their cultural memory and wellbeing to leverage identity. Music is known to release stress and nostalgia, reconnect socially, and facilitate retrieval of cultural memory. It is also a cultural strategy for the ‘loss of presence in the world’, as it is via the senses, that people can access ‘the original opening’, situated in one’s world.

The preliminary results of Co-musichiamo show that the co-creation of culturally tailored songs, composed and sung with the participants in their first/home language, can enhance physical and social engagement, and contribute to the general well-being of people from migrant backgrounds living with dementia. Participants demonstrated improvement in mood and increased communication.

Dementia Australia is very supportive and interested in the innovative idea of Co-musichiamo and the development and implementation of a music engagement intervention research project in residential and home care aged care settings.

*The views and opinions expressed in Knowledge Blogs are those of the authors and do not necessarily reflect those of ARIIA, Flinders University and/or the Australian Government Department of Health and Aged Care.

About the author

Simone is based in Adelaide and has been a lecturer for more than 10 years at the University of South Australia, teaching sociology, migration and identity studies, and Italian studies. He is currently a Postdoctoral Research Fellow at the Social Care and Ageing (SAGE) Futures Lab at Edith Cowan University (ECU). His work in this role focuses on implementing social science approaches to support the development of social and community care interventions for the ageing and aged care sectors, with a particular focus on dementia.