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Averting avoidable deaths of nursing home residents

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The safety of our older citizens can be improved by targeting known risk factors

How well are we caring for older, frail and vulnerable citizens in residential aged care facilities (RACFs)? The retrospective study of deaths in nursing homes during 2000–2013 reported in this issue of the MJA1 is an important review of the quality of care at the end of life. We could be doing better.

Ibrahim and colleagues reviewed the deaths of nursing home residents reported to coroners. The criteria for reporting deaths vary between states, but generally include any deaths from falls or other injuries, as well as other unexpected or “unnatural deaths”. This concept includes deaths resulting from injuries that:

directly caused the death, for example, a subdural haematoma sustained in a mechanical fall, or contributed to the death and without which the person would not have died … Deaths should still be regarded as unnatural even when the causative event occurred a substantial period prior to death. In those cases there is frequently some complication that actually causes the death but if it is attributable to the initial injury the death can be said to be unnatural and therefore reportable.2

Death after a fall is defined in all states as “a violent or otherwise unnatural…