The burden of infectious diseases in Western Australian residential aged care facilities: a population-based record linkage study

Abstract

Despite infections being a major cause of morbidity and mortality in residential aged care facilities (RACFs), population-based epidemiological literature is currently lacking. The aims of this study were therefore to provide a baseline for infection surveillance in Australian RACFs, to examine the association between resident characteristics and infections and to calculate the inpatient cost implications of infections. A retrospective, population-based cohort was identified from Western Australian (WA) residential aged care claims data in 2001 (14,075 permanent care residents) linked with resident appraisals, hospital discharge and mortality records for 2 years. Almost one quarter (23.3%) of residents hospitalised in the 2 years of follow-up were hospitalised due to infection. The overall rate of infection was 0.29 per 1,000 resident days. Compared with residents assessed as low-care, high-care residents were at reduced risk of respiratory tract (RTIs) (OR = 0.86, 95% CI 0.75-0.99), urinary tract (UTIs) (OR = 0.65, 95% CI 0.56-0.76) or skin infections (OR = 0.59, 95% CI 0.46-0.76), but at increased risk of septicaemia (OR = 1.56, 95% CI 1.13-2.14). Residents hospitalised for infection used 18,731 bed days and had inpatient costs of A$12.1m. Infection is a common reason for patient transfers from RACFs to hospital. Workforce profile is the most likely explanation for the increased risk of infections (excluding septicaemia) in residents assessed as low-care. Efforts to reduce hospital transfers from Australian RACFs should focus on developing Australian practice guidelines and improving the availability of skilled clinical staff to support practice in low-care facilities.