Call for education on risk-taking in aged care

There is minimal chance of harm for residents who leave their facility without informing staff, raising questions over the basis of safety fears for those who wander, says researcher.

Marta Woolford, a research officer at Monash’s Department of Forensic Medicine, said her analysis showed very little was known about death and injury outcomes of aged care residents who leave without notifying staff.

This was surprising given the common perception that an unexplained absence is a high risk activity that leads to serious death and injury, Ms Woolford told Australia Ageing Agenda.

Ms Woolford is investigating the outcomes of unexplained absences in residential aged care as part of her PhD examining the “dignity of risk.”

“There is a plethora of literature out there identifying residents who leave without notification and interventions to prevent them from leaving… but there’s very little evidence that residents do get injured.”

Ms Woolford is in the final stages of a new study using national coronial data. It has found there were 28 deaths over 13 years from unexplained absences of aged care residents across Australia.

This was a very low figure, which could be due to the way deaths were recorded given they only included those reported to the coroner, or it may be that deaths related to unexplained absences were not very common, she said.

“That then opens up that whole question of where our fear comes from,” Ms Woolford said.

Currently, aged care providers are required by law to report “unexplained absences or missing residents” to the police, and then to the department within 24 hours of that.

International snapshot

In her published study, which was a review of existing research in the area, Ms Woolford found 1,440 individual unexplained absences across nine mostly US studies and a rate of 82 deaths and 61 injuries per 1,000 incidents.

However, the reality is much lower, Ms Woolford said, because all but one of the nine studies included people living in the community and each study involved only people with dementia.

“It is definitely over estimated because of the inclusion of community-dwelling older people and only persons with dementia,” Ms Woolford told AAA.

“Community-dwelling older people have different opportunities to leave their home so you are looking at two very different population groups. They should not be analysed together.”

In this study, extreme temperatures were the most common cause of death, most individuals left on foot and the majority were found in green vegetation and waterways within 1.6 kilometres of where they were last seen.

By comparison, in her forthcoming Australian study, most of the deaths occurred in or around summer while most people were found less than one kilometre from where they were last seen, Ms Woolford said.

“We found that most people in our cases drowned, which is contradictory to extreme temperatures,” she said.

Dignity of risk

Ms Woolford said she hoped the initial findings provided the first steps in challenging common perceptions around the risk of unexplained absences and that her forthcoming research would further inform aged care provider strategies.

“When I talk to the aged care sector they all know that residents should be able to walk outside freely, however, for them the problem is they have accreditation standards, public opinion and fear of risk.”

Education for aged care workers to provide a more realistic understanding of the risk in activities was needed, Ms Woolford said.

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