The Czech-Austrian Long Term Care Research Project

Background: The Worlds population is rapidly aging. Age associated illnesses are also increasing the demand of care and institutional Long term Care (iLTC). Therefore, the organization of iLTC is one of the major challenges of our times in all countries around the world. There is a serious paucity of basic research data available in Austria and the Czech Republic making informed decision making difficult. It is estimated that for example only about 30% of persons affected by dementia do receive a medical diagnosis and appropriate treatment. Research question: This project aims at addressing 4 domains of interest with quantitative and qualitative research methods. (1)Resident related parameters such as dementia and other health conditions, and social parameters like loneliness; (2) Care team parameters such as burden; (3) Parameters related to the relatives of the resident and (4) Environmental Factors of the LTC institutions (size of institution, size of care team). Methods: 6 nursing homes will be randomly selected from the different iLTC categories in Austria and the Czech Republic. About 500 persons living in iLTC will be assessed in each country (Total N about 1000 study subjects). There will be an agreed upon common study protocol containing medical and social study parameters. The data will be entered into a common data base and commonly analysed. Innovation: The two research groups join in their expertise of medical and psychological knowledge, develop a common study protocol and join a common data base.

The fraction of elderly persons within most societies around the world is rapidly growing. Unfortunately connected to this chance of growing older then never before in human history is the chance of becoming care dependent in old age due to the development of cognitive deficits and dementia. In Austria, the access to nursing home care has been restricted in recent years which has led to a change in populations being cared for. In the Czech Republic a mix of care concepts is currently explored. New concepts of care and team work are necessary in order to guarantee life quality of care teams and residents as well as relatives. In an effort to form an evidence base for solid decision making, this epidemiological project was undertaken and in a first step, a common study protocol was developed (Auer et al, 2017). From a total resident pool of 1666 persons, 1085 (571 in Austria, 514 in the Czech Republic) persons signed a consent form and participated in the data collection. More than 70% of residents assessed were female and the population was on average 85 years old. A discrepancy between the presence of a medical diagnosis in the charts of the residents and the results of cognitive testing was found. In Austria, 85.2%, in the Czech Republic 53.0% of residents had a cognitive impairment. In Austria 80.0%, and in the Czech Republic 56.7% of residents had behavioural problems. With respect to pain, 44.8% of residents in Austria, and 51.5% of residents in the Czech Republic had mild to severe pain. 78.4% of Austrian and 74.5% of the residents in the Czech Republic had problems with mobility and both populations were in danger of malnutrition. In accordance with the open data initiative of the FWF, the data presented in Auer et al. (2018) were transferred to a public repository (Zenodo.org). In the submitted data paper (Höfler et al, 2019, under review), several measurements on the residents cognitive, functional, and behavioural status are described in order to facilitate the re-use of the data. A further publication (Holmerova et al 2018), analysed data of 404 residents from the Czech Republic sample who lived in nine randomly selected nursing homes. 68% of residents with pain did not receive any analgesic medication and 31% of residents were administered some analgesics and continued to report pain. In order to explore the needs of the care teams, focus group discussions were initiated in both countries. The topics addressed in the focus groups were far more complex than reported in the literature and are not limited to problems in time and funding. Hurdles of deficits in team management and work definition and sharing were voiced in a highly motivated and constructive manner. More research in this area is desperately needed.