Views of people living with dementia and their families/care partners: helpful and unhelpful responses to behavioral changes.

OBJECTIVES: This study investigated the views of people living with dementia and their families/care partners on (i) what they find helpful or unhelpful regarding behavioral changes, i.e. which coping strategies they used for themselves and/or which responses from others, and (ii) what they consider to be appropriate terminology to describe behavioral changes. DESIGN & SETTING: One-on-one semi-structured interviews were conducted with people living with dementia and families/care partners face to face, online, or over the telephone. MEASUREMENTS: Data from open-ended questions were analyzed inductively. Common themes were derived from the data using an iterative approach. RESULTS: Twenty-one people living with dementia and 20 family members/care partners were interviewed. Four main themes were derived for helpful responses, and three main themes for unhelpful responses. Helpful responses included providing clear professional support pathways and supportive environments where people living with dementia can engage in physical, cognitive, social, and spiritual activities. Unhelpful responses included discriminatory treatment from others and use of medicalized terminology. Views toward terminology varied; people with lived experience most favored using "changed behaviors" over other terminology. Areas for improvement included targeting dementia stigma, societal education on dementia, and building confidence in people living with dementia by focusing on living well with dementia. CONCLUSION: Knowledge of the views of people living with dementia may assist healthcare professionals to provide more appropriate care for people living with dementia.

'You Lose Confidence in Being a Human Being, Never Mind Being a Parent': The Lived Experience of Mothers With Spinal Cord Injury.

Little research to date has explored the experiences of parenting among mothers with Spinal Cord Injury (SCI). The aim of the study was to explore the lived experiences of mothers with SCI. Semi-structured interviews were conducted with eight mothers and an interpretive phenomenological analysis was carried out. Two super-ordinate themes were identified. The first theme, entitled: 'A sit-down mummy: The visibility of differences as a mother with SCI' highlighted how mothers faced challenges when undertaking practical parenting tasks, thus making them feel less than their non-injured peers, and how they navigated the visible and physical intrusion of the wheelchairs in their relationships with their children. The second theme, entitled: 'What kind of mother? Being a good enough parent' reflected mothers' heightened sense of guilt with respect to unmet expectations of the self as mother, and the contrasting positive experiences of availing of support and finding new ways to connect with their children. Clinical implications, methodological considerations and future directions are discussed.

GP awareness, practice, knowledge and confidence: evaluation of the first nation-wide dementia-focused continuing medical education program in Australia.

BACKGROUND: Dementia is under-diagnosed in primary care. Timely diagnosis and care management improve outcomes for patients and caregivers. This research evaluated the effectiveness of a nationwide Continuing Medical Education (CME) program to enhance dementia-related awareness, practice, knowledge and confidence of general practitioners (GPs) in Australia. METHODS: Data were collected from self-report surveys by GPs who participated in an accredited CME program face-to-face or online; program evaluations from GPs; and process evaluations from workshop facilitators. CME participants completed surveys at one or more time-points (pre-, post-program, six to 9 months follow-up) between 2015 and 2017. Paired samples t-test was used to determine difference in mean outcome scores (self-reported change in awareness, knowledge, confidence, practice) between time-points. Multivariable regression analyses were used to investigate associations between respondent characteristics and key variables. Qualitative feedback was analysed thematically. RESULTS: Of 1352 GPs who completed a survey at one or more time-points (pre: 1303; post: 1017; follow-up: 138), mean scores increased between pre-CME and post-program for awareness (Mpost-pre = 0.9, p <  0.0005), practice-related items (Mpost-pre = 1.3, p <  0.0005), knowledge (Mpost-pre = 2.2, p <  0.0005), confidence (Mpost-pre = 2.1, p <  0.0005). Significant increases were seen in all four outcomes for GPs who completed these surveys at both pre- and follow-up time-points. Male participants and those who had practised for five or more years showed greater change in knowledge and confidence. Age, years in practice, and education delivery method significantly predicted post-program knowledge and confidence. Most respondents who completed additional program evaluations (> 90%) rated the training as relevant to their practice. These participants, and facilitators who completed process evaluations, suggested adding more content addressing patient capacity and legal issues, locality-specific specialist and support services, case studies and videos to illustrate concepts. CONCLUSIONS: The sustainability of change in key elements relating to health professionals' dementia awareness, knowledge and confidence indicated that dementia CME programs may contribute to improving capacity to provide timely dementia diagnosis and management in general practice. Low follow-up response rates warrant cautious interpretation of results. Dementia CME should be adopted in other contexts and updated as more research becomes available.

Feasibility of LifeFul, a relationship and reablement-focused culture change program in residential aged care.

BACKGROUND: The protective, custodial, task-oriented care provided in residential aged care facilitates decreases health and wellbeing of residents. The aim of the study was to conduct a feasibility study of LifeFul - a 12 month reablement program in residential aged care. METHODS: LifeFul was developed based on systematic reviews of reablement and staff behaviour change in residential aged care, and in consultation with aged care providers, consumers and clinicians. LifeFul includes: engaging and supporting facility leaders to facilitate organisational change, procedural changes including dedicated rostering, assigning each resident a 'focus' carer and focusing on the psychosocial care of residents part of handovers and staff training. The study was conducted in three Australian residential aged care facilities. A pre-post mixed methods design was used to evaluate recruitment and retention, fidelity and adherence, acceptability, enablers and barriers and suitability of outcome measures for the program. RESULTS: Eighty of 146 residents agreed to participate at baseline and 69 of these were followed up at 12 months. One hundred and four of 157 staff participated at baseline and 85 of 123 who were still working at the facilities participated at 12 months. Staff perceived the program to be acceptable, barriers included having insufficient time, having insufficient staff, negative attitudes, misunderstanding new procedures, and lack of sufficient leadership support. Quantitative data were promising in regards to residents' depression symptoms, functioning and social care related quality of life. CONCLUSION: It is feasible to deliver and evaluate LifeFul. The program could be improved through increased leadership training and support, and by focusing efforts on residents having a 'best week' rather than on completing a document each handover. TRIAL REGISTRATION: Registered prospectively on 22nd January 2016 on ANZCTR369802 .

Residents' Positive and Negative Relationship Networks in a Nursing Home.

Person-centered care involves consideration of long-term care residents' lived experience, including social relationships. The current cross-sectional study investigated co-resident social networks in three units of a 94-bed Australian nursing home, including an 18-bed dementia-specific unit (DSU). Six care staff were interviewed. Chart, self-reported social isolation, and staff-reported social engagement data were collected for 36 residents ages 63 to 94 who consented to full participation. Fifty-five additional residents were included in observations. Median positive-to-negative network size ratios within units were 1.5:1 (Unit 1), 0.7:1 (Unit 3), and 0:1 (DSU). Moderate positive correlations existed between: perceived social support and total positive relationships [ρ(25) = 0.44, p = 0.03]; social withdrawal and total negative relationships [ρ(36) = 0.51, p = 0.002]; and objective social isolation and total negative relationships [ρ(22) = -0.44, p = 0.042]. Number and quality of relationships were associated with resident social withdrawal, perceived support, and isolation. High prevalence of isolation and negative relationships demonstrate the need for interventions. [Journal of Gerontological Nursing, 42(11), 9-13.].

Potential benefits to staff from humor therapy with nursing home residents.

Life in residential care can be challenging for residents and staff. Bringing humor into this setting may benefit residents, creating a more productive, enjoyable work environment for staff. The potential effect of exposure to humor therapy on staff, both as active and incidental participants, as part of a randomized controlled trial of the effect of humor therapy for aged care residents was investigated in the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE). The intervention involved a humor program with professional performers (ElderClowns) and trained facility staff (LaughterBosses) for a minimum of nine 2-hour sessions over 12 weeks. Methods included a staff survey at three time points, interviews with LaughterBosses, and a satisfaction rating by facility managers. There were significant positive findings for some staff subgroups, including assistants in nursing/personal care assistants and staff older than 45. LaughterBoss interviews and intervention group manager ratings of staff work enthusiasm were positive.

Support for the Supporter: Paternal Postpartum Loneliness and Social Support During the COVID-19 Pandemic.

During the postpartum period, fathers may be at risk of increased stress and loneliness, which may be offset or buffered by the provision of social support. This study aimed to explore fathers' postpartum experiences of loneliness, perceived stress, and social support. A constructivist grounded theory approach was used to inform study design and analysis. Semistructured interviews were conducted to collect data from 12 fathers, living in the Republic of Ireland, who had an infant aged 6 months or younger. A grounded theory entitled "support for the supporter," describing fathers' experiences with social support, and loneliness during the postpartum period, was derived. Participants described experiencing increased financial pressure and having difficulty balancing the role of "breadwinner" with fatherhood. Participants described feeling excluded from maternity care and lacked avenues for information within the Irish health care system. Participants linked their experiences of loneliness to the lack of social support in the postpartum period. This study offers a novel insight into Irish fathers' experiences with maternity care during the COVID-19 pandemic. This study is the first to qualitatively explore paternal postpartum loneliness and provides a good foundation for future research and intervention in this area. Findings suggest that it would be wise to promote social support from other experienced fathers, friends, family, and from partners to reduce paternal postpartum loneliness.

Nonpharmacological approaches for pain and symptoms of depression in people with osteoarthritis: systematic review and meta-analyses.

People with osteoarthritis often experience pain and depression. These meta-analyses examined and compared nonpharmacological randomized controlled trials (RCTs) for pain and symptoms of depression in people living with osteoarthritis. RCTs published up until April 2022 were sourced by searching electronic databases EMBASE, PUBMED & MEDLINE, Web of Science, CINAHL and PEDro. Random-effects meta-analyses were performed to calculate pooled effect sizes (ES) and 95% confidence intervals (CI) for pain and depression. Subgroup analyses examined intervention subtypes. For pain, 29 interventions (n = 4382; 65 ± 6.9 years; 70% female), revealed a significant effect on reducing pain (ES = 0.43, 95% CI [0.25, 0.61], p < 0.001). Effect sizes were significant (p < 0.001) for movement meditation (ES = 0.52; 95% CI [0.35, 0.69]), multimodal approaches (ES = 0.37; 95% CI [0.22, 0.51]), and psychological therapy (ES = 0.21; 95% CI [0.11, 0.31]), and significant (p = 0.046) for resistance exercise (ES = 0.43, 95% CI [- 0.07, 0.94]. Aerobic exercise alone did not improve pain. For depression, 28 interventions (n = 3377; 63 ± 7.0 years; 69% female), revealed a significant effect on reducing depressive symptoms (ES = 0.29, 95% CI [0.08, 0.49], p < 0.001). Effect sizes were significant for movement meditation (ES = 0.30; 95% CI [0.06, 0.55], p = 0.008) and multimodal interventions (ES = 0.12; 95% CI [0.07, 0.18], p < 0.001). Resistance/aerobic exercise or therapy alone did not improve depressive symptoms. Mind-body approaches were more effective than aerobic/resistance exercise or therapy alone for reducing pain and depression in people with osteoarthritis.Systematic review registration: PROSPERO CRD42022338051.

Study protocol for a randomized controlled trial of humor therapy in residential care: the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE).

BACKGROUND: Humor therapy is a non-pharmacological intervention with potential to improve mood and quality of life for institutionalized older persons, including those with dementia. The primary aims of the Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) are to examine the effects of humor therapy on residents' mood, quality of life, social engagement, and agitation. METHODS: SMILE is a single-blinded cluster-randomized controlled trial where 398 consented residents in 35 residential aged care facilities will be allocated to receive humor therapy or usual care. Residents allocated to the intervention group will engage in humor therapy with professional performers (ElderClowns) and trained facility staff (LaughterBosses) for a minimum of nine two-hour sessions over 12 weeks as well as engaging humorously with LaughterBosses during the course of daily care. The usual care control group will not engage in any formal humor therapy. Researchers, blind to treatment allocation, will assess residents at baseline (week 0), post-intervention (week 13), and follow-up (week 26). The measurement suite includes the Cornell Scale for Depression in Dementia, the Dementia Quality of Life Scale, the Multidimensional Observation Scale for Elderly Subjects, the Cohen-Mansfield Agitation Inventory, and the Neuropsychiatric Inventory. Observations of residents' engagement will be recorded at each humor therapy session. CONCLUSIONS: SMILE is the first large rigorous study of humor therapy in aged care.

Psychological distress as a key component of psychosocial functioning in community-dwelling older people.

OBJECTIVES: To explore the key components representative of measures of psychosocial functioning with a focus on identifying the constituents of psychological distress in an Irish sample of community-dwelling older adults and to examine the relationship between these components and health outcomes such as frailty. METHOD: Cross-sectional observational study at the Technology Research for Independent Living (TRIL) Clinic, a comprehensive geriatric assessment facility in St. James's Hospital, Dublin. In this study, 579 participants were given eight primary assessments (Centre for Epidemiological Studies of Depression, Geriatric Adverse Life Events Scale, Pittsburgh Sleep Quality Index, De Jong-Gierveld Scale, Practitioner Assessment of Network Type, Eysenck Personality Inventory, Hospital Anxiety and Depression Scale, Lubben Social Network Scale) and a broad range of health and demographic secondary assessments. Principal factor analysis identified the core components relating to psychosocial functioning. Following this, the regression factors of these components were correlated with health outcomes. RESULTS: The first of three components identified accounted for 9.08% of the variance and related to a core internal component of psychological distress. The two other components related to external and physiological functioning, specifically social support networks and sleep. Spearman's Rho correlations indicated significant associations of walking speed, age, Berg Balance Scale and living alone with all three components. Additionally, the core component of psychological distress significantly correlated with the Fried Frailty Index, illness co-morbidity, ADL, IADL and nutrition. CONCLUSION: These results characterise the variation in psychosocial functioning in older adults and identifies psychological distress as a core facet of psychosocial functioning which has associations with frailty.

A prospective study of hepatitis B vaccination - a comparison of responders versus nonresponders.

Herein we present one of the largest single-center reports of the response of hemodialysis patients to a two-vaccine hepatitis B virus vaccination protocol in a European dialysis population. A hepatitis B recombinant DNA vaccine, HBvaxPRO, was given at a dose of 40 µg intramuscularly using a four-dose schedule at 0, 1, 2, and 12 months. Responses were (1) a titer >100 mIU/mL = patient immune, (2) a titer level 10-99 mIU/mL = give a booster dose and recheck level 2 months later, and (3) 0 ≤ 10 mIU/mL = repeat vaccination course using a different vaccine, Engerix-B. We compared responder groups in terms of titer levels for each vaccine and variables including age, gender, serum albumin, parathyroid hormone (PTH), calcium, phosphate, hemoglobin, years on dialysis, and type of dialysis access. Of the 176 patients who received the first vaccine course, 71 patients achieved immunity, that is, 40% uptake for the first vaccine. Of the 105 who failed, 72 received the second vaccine with 46 responders, that is, 64% uptake for the second vaccine. Overall, 143 of the 176 patients who entered the vaccination program completed the protocol with 117 achieving immunity, representing an 82% success rate. The only variable overall to show significance in achieving seroconversion was serum albumin (p = 0.03). Using a two-vaccine protocol, hepatitis B vaccination response was high in our population of end-stage renal disease patients.

Effective communication: Principle of Nursing Practice E.

This is the sixth article in a nine-part series describing the Principles of Nursing Practice developed by the Royal College of Nursing (RCN) in collaboration with patient and service user organisations, the Department of Health, the Nursing and Midwifery Council, nurses and other healthcare professionals. The article discusses Principle E, effective communication, and provides some examples of good practice.

Reconceptualising Behavioral and Psychological Symptoms of Dementia: Views of People Living With Dementia and Families/Care Partners.

Background: Behavioral and psychological symptoms of dementia (BPSD, also known as neuropsychiatric symptoms (NPS), changed behaviors and responsive behaviors), occur in up to 90 percent of people living with dementia (PLWD). These symptoms and behaviors strongly correlate with functional and cognitive impairment and contribute to ~30% of overall dementia costs. As decisions regarding care and strategies for BPSD are generally based on professional frames of reference, this study investigates whether the perspectives of PLWD and families/care partner on BPSD terminology can inform a more nuanced conceptualization of BPSD. Methods: PLWD and families/care partners participated in one-on-one semi-structured interviews. A thematic iterative approach was used to code the data and identify common themes until theoretical saturation was reached. Themes were compared between groups. Data were analyzed deductively in relation to pre-existing terminology regarding BPSD, and inductively to discover new ideas on use of such terminology as perceived by PLWD and others. Results: Forty-one volunteers were interviewed: 21 PLWD, mean age 71 yrs, mean Mini-Mental State Examination score 25, and 20 family members/care partners. Three main themes emerged from the data: (1) descriptions of BPSD from people with lived experience compared to clinical terms, (2) viewpoints on interpreting causes, and (3) experiences of concurrent BPSD. The experiences described and terms used by PLWD and families/care partners differed from terms used in existing professional frameworks (e.g., "disinhibition" described as 'loss of filter') and there were differences between PLWD and family members' interpretations of BPSD causes. Discussion/Conclusion: Reports from PLWD and families/carers describing their experiences of BPSD suggest a reconceptualization of BPSD terminology is needed to understand and de-stigmatize these symptoms and behaviors. For example, the term "agitated/hard to handle" would benefit by clearer, contextualized description, such as "frustrated with cognitive decline, discriminatory behavior and inadequate support systems." In better understanding individual expressions of BPSD, families, professionals and societies will be able to respond in ways that are helpful for PLWD. An informed, integrated understanding of BPSD and improved terminology use will have the potential to improve the quality of care and support for PLWD.

Cross-Lagged Modeling of Cognition and Social Network Size in the Sydney Memory and Ageing Study.

OBJECTIVES: This study assessed whether reciprocal relationships exist between cognitive function and the social network size of older adults, controlling for age, sex, education, medical conditions, and depressive symptoms. METHODS: Data were collected at biennial follow-ups over 6 years in the Sydney Memory and Ageing Study, a longitudinal cohort study including 1,037 community-based Sydney residents aged 70-90 years without dementia at baseline. We used random intercept cross-lagged panel models to investigate reciprocal associations between social network size and scores in each of 7 cognitive domains including a global score. RESULTS: Standardized models indicated that within-person deviation in expected language score predicted deviation in expected network size. Within-person deviation in prior expected social network size predicted deviation in expected executive function at year 6. Cross-lagged effects in models of both global cognition and memory, respectively, could not be attributed solely to within-person change. DISCUSSION: Findings support a co-constitutive view of cognitive function and social relationships in older age. Although both cognition and network size declined over time, slower than expected decline in language ability predicted less than expected contraction in social networks. A similar influence of network size on executive functioning indicated that relationships with friends and family outside of the home contributed significantly to the maintenance of higher order cognitive abilities in older late life. Diverse patterns of influence between cognitive domains and social network size over 6 years underscore the importance of assessing the complex and nuanced interplay between brain health and social relationships in older age.

Exploring the mediating effect of academic engagement on math and reading achievement for students who have experienced maltreatment.

BACKGROUND: Students who experience maltreatment tend to underperform academically relative to their peers, requiring an understanding of academically-related mechanisms that are potential intervention targets. Academic engagement, a multidimensional construct that is influential in students' investment in learning and the school context, is one such mechanism that has been associated with positive academic outcomes and develops through interactions between students and their environment. OBJECTIVE: The purpose of this study was to examine how maltreatment experiences and trauma symptoms were indirectly associated with academic achievement in adolescence through academic engagement. PARTICIPANTS AND SETTING: The study was conducting on a subsample of 583 youths from the National Study of Child and Adolescent Wellbeing II (NSCAW II) cohort. METHODS: Structural equation modeling was used to examine the indirect effect engagement on the relationship between maltreatment and trauma symptomology and academic achievement. RESULTS: Academic engagement significantly mediated trauma symptoms and later standardized reading (ß = -0.02; 95 % CI [-0.04, -0.0004]) and math (ß = -0.02; 95 % CI [-0.05, -0.0003]) achievement test scores. However, similar mediating effects were not found for engagement on maltreatment and later standardized reading (ß = -0.01; 95 % CI [-0.03, 0.01]) and math (ß = -0.01; 95 % CI [-0.03, 0.01]) achievement test scores. CONCLUSIONS: These findings suggest that variability in academic outcomes was indirectly associated with engagement but only for students who exhibited trauma symptoms rather than experiencing maltreatment alone. The findings suggest future researchers should consider engagement should as an academically-related mechanism to help students who were maltreated succeed academically.

Do suicidal thoughts and behavior persist following juvenile justice involvement?

INTRODUCTION: This study examines suicidal ideation and behavior of youth in the 3 months following their initial diversion appointment in the juvenile justice system. METHOD: Participants were 99 adolescents (72.7% female; 65% racial minority) between the ages of 12 and 18 (Mage = 15.06, SD = 1.35) and a parent/caregiver (80% female; 54% racial minority; Mage = 42.7 years, SD = 8.9 years). Participants were eligible if they endorsed two or more suicide items on a mental health screener (MAYSI-2) and were able to be contacted 3 months following initial court appointment. Youth and parent/caregiver responded to questionnaires assessing SI/SA, psychiatric symptoms, treatment motivation and engagement. RESULTS: Three months post-initial court appointment, more than half of youth (55.5%) continued to flag on the Suicide Ideation subscale of the MAYSI-2, though mean scores decreased from baseline to 3-months (t[97] = 5.74, p < 0.000, 95% CI [-0.79, 1.62] Cohen's d = 0.77). There were no significant differences in parent/youth treatment motivation or engagement regardless of SI at 3 months. CONCLUSIONS: Persistence of suicidal thoughts and behaviors beyond initial legal involvement highlights the importance of targeted suicide prevention interventions (beyond screening and referral to treatment) with justice-involved youth, even at first court contact.

Quantification of Smoking Characteristics Using Smartwatch Technology: Pilot Feasibility Study of New Technology.

BACKGROUND: While there have been many technological advances in studying the neurobiological and clinical basis of tobacco use disorder and nicotine addiction, there have been relatively minor advances in technologies for monitoring, characterizing, and intervening to prevent smoking in real time. Better understanding of real-time smoking behavior can be helpful in numerous applications without the burden and recall bias associated with self-report. OBJECTIVE: The goal of this study was to test the validity of using a smartwatch to advance the study of temporal patterns and characteristics of smoking in a controlled laboratory setting prior to its implementation in situ. Specifically, the aim was to compare smoking characteristics recorded by Automated Smoking PerceptIon and REcording (ASPIRE) on a smartwatch with the pocket Clinical Research Support System (CReSS) topography device, using video observation as the gold standard. METHODS: Adult smokers (N=27) engaged in a video-recorded laboratory smoking task using the pocket CReSS while also wearing a Polar M600 smartwatch. In-house software, ASPIRE, was used to record accelerometer data to identify the duration of puffs and interpuff intervals (IPIs). The recorded sessions from CReSS and ASPIRE were manually annotated to assess smoking topography. Agreement between CReSS-recorded and ASPIRE-recorded smoking behavior was compared. RESULTS: ASPIRE produced more consistent number of puffs and IPI durations relative to CReSS, when comparing both methods to visual puff count. In addition, CReSS recordings reported many implausible measurements in the order of milliseconds. After filtering implausible data recorded from CReSS, ASPIRE and CReSS produced consistent results for puff duration (R2=.79) and IPIs (R2=.73). CONCLUSIONS: Agreement between ASPIRE and other indicators of smoking characteristics was high, suggesting that the use of ASPIRE is a viable method of passively characterizing smoking behavior. Moreover, ASPIRE was more accurate than CReSS for measuring puffs and IPIs. Results from this study provide the foundation for future utilization of ASPIRE to passively and accurately monitor and quantify smoking behavior in situ.

In excellent e-health.

THE WHITE paper for NHS England, Equity and Excellence: Liberating the NHS, states that patients should have more information and data on all aspects of health care to enable them to share in care decisions.

Educating a health terminologist.

An overview of competencies and suggestions for educating healthcare terminologists is presented. This new role in healthcare informatics requires formal and informal education that pays particular attention to the adult learner. Knowledge of terminology and informatics standards development is critical, as well as knowledge about the use of terminology management servers.

Associations between clinical indicators of quality and aged-care residents' needs and consumer and staff satisfaction: the first Australian study.

Objectives To ascertain Australian multistate prevalence and incidence of five commonly collected clinical indicators of aged-care home quality and to measure associations between these clinical indicators and levels of care needs and consumer and staff satisfaction. Methods A retrospective analysis of national audit data collected from 426 facilities between 2015 and 2016 was performed. Regression models were used to examine associations between five clinical indicators (falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy) and level of care needs measured by the Aged Care Funding Instrument (ACFI) and consumer and care staff survey responses. Results With the exception of polypharmacy, commonly collected negative clinical outcomes were rare events. Compared with care homes with <25% of residents having high-level care needs (high ACFI), homes with 25<75% high-ACFI residents had more occurrences of all negative clinical outcomes except pressure injury. Homes with ≥75% high-ACFI residents reported the highest rates of polypharmacy (odds ratio 1.48, 95% confidence interval 1.39 - 1.57). Falls, unplanned weight loss and pressure injury were inversely associated with satisfaction scores adjusted for residents' level of care needs. Conclusions This first Australian study of multistate clinical indicator data suggests interpretation of clinical indicators of aged-care home quality requires consideration of the level of residents' care needs. What is known about the topic? Many Australian aged-care providers use quality indicators (QI) through benchmarking companies or in-house programs. The five most widely used aged-care clinical QIs in Australia are falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy. Prevalence and incidence of these QIs are highly variable among Australian studies. A consistent message in the international literature is that residents' clinical characteristics influence QI outcomes at baseline and may continue to influence outcomes over time. Study of associations between Australian aged-care home characteristics and QI outcomes has been limited. What does this paper add? This is the first Australian study of multistate clinical QI data. It is also the first to consider the level of resident care needs in the interpretation of clinical QI outcomes and exploration of the association between level of consumer and staff satisfaction and QI outcomes. What are the implications for practitioners? Understanding the connections between aged-care home characteristics, consumer and staff perceptions and clinical QIs is crucial in the meaningful interpretation of QI outcomes in context. With the recent introduction of the National Aged Care Quality Indicator Program, it is timely to review national policy, to gauge current quality of care and the measure of care quality in the sector, and to develop directions for possible research to inform and resolve debates regarding the potential influence and unplanned effects that such a program may have.