Where's the evidence? a systematic review of economic analyses of residential aged care infrastructure.
Residential care infrastructure, in terms of the characteristics of the organisation (such as proprietary status, size, and location) and the physical environment, have been found to directly influence resident outcomes. This review aimed to summarise the existing literature of economic evaluations of residential care infrastructure.



A systematic review of English language articles using AgeLine, CINAHL, Econlit, Informit (databases in Health; Business and Law; Social Sciences), Medline, ProQuest, Scopus, and Web of Science with retrieval up to 14 December 2015. The search strategy combined terms relating to nursing homes, economics, and older people. Full economic evaluations, partial economic evaluations, and randomised trials reporting more limited economic information, such as estimates of resource use or costs of interventions were included. Data was extracted using predefined data fields and synthesized in a narrative summary to address the stated review objective.



Fourteen studies containing an economic component were identified. None of the identified studies attempted to systematically link costs and outcomes in the form of a cost-benefit, cost-effectiveness, or cost-utility analysis. There was a wide variation in approaches taken for valuing the outcomes associated with differential residential care infrastructures: 8 studies utilized various clinical outcomes as proxies for the quality of care provided, and 2 focused on resident outcomes including agitation, quality of life, and the quality of care interactions. Only 2 studies included residents living with dementia.



Robust economic evidence is needed to inform aged care facility design. Future research should focus on identifying appropriate and meaningful outcome measures that can be used at a service planning level, as well as the broader health benefits and cost-saving potential of different organisational and environmental characteristics in residential care.



International Prospective Register of Systematic Reviews (PROSPERO) registration number CRD42015015977 .
Flinders Health Economics Group, School of Medicine, Flinders University, Adelaide, SA, Australia. tiffany.easton@flinders.edu.au.|NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia. tiffany.easton@flinders.edu.au.|Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia. tiffany.easton@flinders.edu.au.
Tiffany
0000-0001-5302-1428
T
Easton
NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia.|Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.|Institute for Choice, Business School, University of South Australia, Adelaide, SA, Australia.
Rachel
R
Milte
NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia.|Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
Maria
M
Crotty
NHMRC Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People, Canberra, Australia.|Institute for Choice, Business School, University of South Australia, Adelaide, SA, Australia.
Julie
J
Ratcliffe
D000368:Aged; D003362:Cost-Benefit Analysis; D003704:Dementia / Q000191:economics* / Q000628:therapy; D006801:Humans; D009735:Nursing Homes / Q000191:economics*; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
Ageing; Economic evaluation; Infrastructure; Long-term care; Systematic review