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Int J Older People Nurs. 2019 May 7:e12237. doi: 10.1111/opn.12237. [Epub ahead of print]

Recommendations for the prevention of deaths among nursing home residents with unexplained absences.

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Health Law & Ageing Research Unit, Department of Forensic Medicine, Monash University School of Public Health & Preventive Medicine, Southbank, Victoria, Australia.
Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
VMIA: Risk Management & Insurance, Melbourne, Victoria, Australia.



Unexplained absences (UAs) contribute to the mortality and morbidity rates in the nursing home (NH) population. Valuing expert professional knowledge and skills is central to the achievement of improved care in NHs. This study developed and prioritised recommendations to prevent deaths of NH residents (NHRs) with UAs.


Two expert consultation forums using the modified nominal group technique to develop recommendations were conducted, followed by an online survey to prioritise the most important recommendations for implementation. A framework applying the temporal dimension ("pre-event," "event" and "post-event") of an internationally accepted injury prevention framework, Haddon's Matrix, was applied to the recommendations. Participants were purposively sampled and identified via aged care organisations; and were selected based on their experience in aged care practice, policy, research, elder rights, seniors' law, or missing persons search and rescue (SAR).


Forum one comprised six, and forum two comprised nine experts from mixed disciplines. Seven participants completed the online survey. Twenty recommendations to prevent future injury and death were developed, five of which were prioritised for implementation in the aged care sector. In order of priority, these include: universal UA definition; mandated SAR plan, early assessment of NHRs; unmet needs behavioural assessments; and participation in decision-making.


The recommendations cover the broad spectrum of complex issues raised in managing unexplained absences, and are a vital first step towards informing care providers, governments and SAR teams about how to prevent injury and death of NHRs in residents with UAs. Future research should explore how to translate and evaluate the recommendations into practice.


Haddon's matrix; injury prevention; morbidity; mortality; nominal group technique; residential aged care

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