51
|
Abstract
Older ICU survivors are often challenged with clusters of geriatric syndromes and functional decline. The purpose of this study was (a) to assess patterns of geriatric syndromes and functional status from admission to 6 months post discharge and (b) to examine the predictors of longitudinal functional status. This is a prospective cohort study. Demographic information, clinical variables, geriatric syndromes, and functional status were collected longitudinally. A total of 192 medical ICU older adult survivors were included in the analysis. Factors associated with reductions in functional status over 6 months were (a) institutionalized prior to hospitalization, (b) pressure sore before admission, (c) existing delirium, (d) impaired mobility at baseline, (e) increased APACHE II score upon ICU admission, and (f) use of mechanical ventilation during the ICU stay. Importantly, overweight was the only factor that was associated with increased functional level over 6 months.
Collapse
Affiliation(s)
- Hsin-Ju Tang
- National Cheng Kung University, Tainan, Taiwan, Republic of China
- Chi-Mei Medical Center, Tainan, Taiwan, Republic of China
| | | | - Chia-Ming Chang
- National Cheng Kung University, Tainan, Taiwan, Republic of China
- National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China
| | - Pei-Fang Su
- National Cheng Kung University, Tainan, Taiwan, Republic of China
| | - Ching-Huey Chen
- Chang Jung Christian University, Tainan City, Taiwan, Republic of China
| |
Collapse
|
52
|
Morris JN, Berg K, Topinkova E, Gray LC, Schachter E. Developing quality indicators for in-patient post-acute care. BMC Geriatr 2018; 18:161. [PMID: 29996767 PMCID: PMC6042453 DOI: 10.1186/s12877-018-0842-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/22/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND This paper describes an integrated series of functional, clinical, and discharge post-acute care (PAC) quality indicators (QIs) and an examination of the distribution of the QIs in skilled nursing facilities (SNF) across the US. The indicators use items available in interRAI based assessments including the MDS 3.0 and are designed for use in in-patient post-acute environments that use the assessments. METHODS Data Source: MDS 3.0 computerized assessments mandated for all patients admitted to US skilled nursing facilities (SNF) in 2012. In total, 2,380,213 patients were admitted to SNFs for post-acute care. Definition of the QI numerator, denominator and covariate structures were based on MDS assessment items. A regression strategy modeling the "discharge to the community" PAC QI as the dependent variable was used to identify how to bring together a subset of seven candidate PAC QIs for inclusion in a summary scale. Finally, the distributional property of the summary scale (the PAC QI Summary Scale) across all facilities was explored. RESULTS The risk-adjusted PAC QIs include indicators of improved status, including measures of early, middle, and late-loss functional performance, as well as measures of walking and changed clinical status and an overall summary functional scale. Many but not all patients demonstrated improvement from baseline to follow-up. However, there was substantial inter-state variation in the summary QI scores across the SNFs. CONCLUSIONS The set of PAC QIs consist of five functional, two discharge and eight clinical measures, and one summary scale. All QIs can be derived from multiple interRAI assessment tools, including the MDS 2.0, interRAI-LTCF, MDS 3.0, and the interRAI-PAC-Rehab. These measures are appropriate for wide distribution in and out of the United States, allowing comparison and discussion of practices associated with better outcomes.
Collapse
Affiliation(s)
- John N. Morris
- Institute for Aging Research, Hebrew Senior Life, Boston, USA
| | - Katherine Berg
- University of Toronto, Toronto, Canada
- Physical Therapy Centre of Excellence in Health Services/Health Policy Research and Training (CoHSTAR), Brown University, Providence, USA
| | - Eva Topinkova
- Department of Geriatric Medicine, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Faculty of Health and Social Sciences, South Bohemian University, Ceske Budejovice, Czech Republic
| | - Leonard C. Gray
- Geriatric Medicine at the University of Queensland Centre for Research in Geriatric Medicine, Brisbane, Australia
| | | |
Collapse
|
53
|
Identification of Fall Risk Factors Through Self-report and Physical Performance. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
54
|
Byrnes A, Worrall J, Young A, Mudge A, Banks M, Bauer J. Early post-operative diet upgrade in older patients may improve energy and protein intake but patients still eat poorly: an observational pilot study. J Hum Nutr Diet 2018; 31:818-824. [DOI: 10.1111/jhn.12572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- A. Byrnes
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
| | - J. Worrall
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
| | - A. Young
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Kelvin Grove QLD Australia
| | - A. Mudge
- Internal Medicine and Aged Care; Royal Brisbane and Women's Hospital; Herston QLD Australia
- Institute for Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove QLD Australia
- School of Medicine; The University of Queensland; St Lucia QLD Australia
| | - M. Banks
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
| | - J. Bauer
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
| |
Collapse
|
55
|
Burke RE, Jones J, Lawrence E, Ladebue A, Ayele R, Leonard C, Lippmann B, Matlock DD, Allyn R, Cumbler E. Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care. J Gen Intern Med 2018; 33:678-684. [PMID: 29427179 PMCID: PMC5910345 DOI: 10.1007/s11606-017-4298-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/06/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Despite a national focus on post-acute care brought about by recent payment reforms, relatively little is known about how hospitalized older adults and their caregivers decide whether to go to a skilled nursing facility (SNF) after hospitalization. OBJECTIVE We sought to understand to what extent hospitalized older adults and their caregivers are empowered to make a high-quality decision about utilizing an SNF for post-acute care and what contextual or process elements led to satisfaction with the outcome of their decision once in SNF. DESIGN Qualitative inquiry using the Ottawa Decision Support Framework (ODSF), a conceptual framework that describes key components of high-quality decision-making. PARTICIPANTS Thirty-two previously community-dwelling older adults (≥ 65 years old) and 22 caregivers interviewed at three different hospitals and three skilled nursing facilities. MAIN MEASURES We used key components of the ODSF to identify elements of context and process that affected decision-making and to what extent the outcome was characteristic of a high-quality decision: informed, values based, and not associated with regret or blame. KEY RESULTS The most important contextual themes were the presence of active medical conditions in the hospital that made decision-making difficult, prior experiences with hospital readmission or SNF, relative level of caregiver support, and pressure to make a decision quickly for which participants felt unprepared. Patients described playing a passive role in the decision-making process and largely relying on recommendations from the medical team. Patients commonly expressed resignation and a perceived lack of choice or autonomy, leading to dissatisfaction with the outcome. CONCLUSIONS Understanding and intervening to improve the quality of decision-making regarding post-acute care supports is essential for improving outcomes of hospitalized older adults. Our results suggest that simply providing information is not sufficient; rather, incorporating key contextual factors and improving the decision-making process for both patients and clinicians are also essential.
Collapse
Affiliation(s)
- Robert E Burke
- Denver-Seattle Center of Innovation at the Denver VA Medical Center, Denver, CO, USA.
- Hospital Medicine Section, Denver VA Medical Center, Denver, CO, USA.
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | | | - Emily Lawrence
- Denver-Seattle Center of Innovation at the Denver VA Medical Center, Denver, CO, USA
| | - Amy Ladebue
- Denver-Seattle Center of Innovation at the Denver VA Medical Center, Denver, CO, USA
| | - Roman Ayele
- Denver-Seattle Center of Innovation at the Denver VA Medical Center, Denver, CO, USA
| | - Chelsea Leonard
- Denver-Seattle Center of Innovation at the Denver VA Medical Center, Denver, CO, USA
| | - Brandi Lippmann
- Denver-Seattle Center of Innovation at the Denver VA Medical Center, Denver, CO, USA
| | - Daniel D Matlock
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Denver, CO, USA
- Adult and Child Consortium for Outcomes Research and Delivery Science, University of Colorado, Aurora, CO, USA
| | - Rebecca Allyn
- Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA
| | - Ethan Cumbler
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
56
|
Cohn JA, Shah AS, Goggins KM, Simmons SF, Kripalani S, Dmochowski RR, Schnelle JF, Reynolds WS. Health literacy, cognition, and urinary incontinence among geriatric inpatients discharged to skilled nursing facilities. Neurourol Urodyn 2018; 37:854-860. [PMID: 28762548 PMCID: PMC5794668 DOI: 10.1002/nau.23368] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/26/2017] [Indexed: 11/10/2022]
Abstract
AIMS To investigate the association between health literacy and cognition and nursing and patient-reported incontinence in a geriatric inpatient population transitioning to skilled nursing facilities (SNF). METHODS Health literacy, depression, and cognition were assessed via the Brief Health Literacy Screen (BHLS), Geriatric Depression Scale 5-item (GDS) and Brief Interview for Mental Status (BIMS), respectively. Multivariable logistic regression assessed the association between BHLS score and incontinence by: (1) nursing-reported urinary incontinence during hospitalization; and (2) patient self-reported "bladder accidents" in the post-enrollment study interview. RESULTS A total of 1556 hospitalized patients aged 65 and older met inclusion criteria, of whom 922 (59.3%) were women and 1480 had available BHLS scores. A total of 464 (29.8%) and 515 (33.1%) patients had nursing-reported and self-reported urinary incontinence, respectively. Nursing-reported incontinence was significantly associated with lower BHLS (ie, poorer health literacy) (aOR 0.93, 95%CI 0.89-0.99) and BIMS (ie, poorer cognition) (aOR 0.90, 95%CI 0.83-0.97) scores and need for assistance with toileting (aOR 7.08, 95%CI 2.16-23.21). Patient-reported incontinence was significantly associated with female sex (aOR 1.62, 95%CI 1.19-2.21), increased GDS score (ie, greater likelihood of depression) (aOR 1.22, 95%CI 1.10-1.36) and need for assistance with toileting (aOR 2.46, 95%CI 1.26-4.79). CONCLUSIONS Poorer health literacy and cognition are independently associated with an increased likelihood of nursing-reported urinary incontinence among geriatric inpatients transitioning to SNF. Practitioners should consider assessment of health literacy and cognition in frail patients at risk for urinary incontinence and that patient and nursing assessment may be required to capture the diagnosis.
Collapse
Affiliation(s)
- Joshua A Cohn
- Department of Urologic Surgery, Medical Center, North Nashville, Tennessee
| | - Avantika S Shah
- Department of Urologic Surgery, Medical Center, North Nashville, Tennessee
| | - Kathryn M Goggins
- Department of Urologic Surgery, Medical Center, North Nashville, Tennessee
| | - Sandra F Simmons
- Department of Urologic Surgery, Medical Center, North Nashville, Tennessee
| | - Sunil Kripalani
- Department of Urologic Surgery, Medical Center, North Nashville, Tennessee
| | - Roger R Dmochowski
- Department of Urologic Surgery, Medical Center, North Nashville, Tennessee
| | - John F Schnelle
- Department of Urologic Surgery, Medical Center, North Nashville, Tennessee
| | | |
Collapse
|
57
|
van Seben R, Reichardt LA, Essink DR, van Munster BC, Bosch JA, Buurman BM. “I Feel Worn Out, as if I Neglected Myself”: Older Patients’ Perspectives on Post-hospital Symptoms After Acute Hospitalization. THE GERONTOLOGIST 2018; 59:315-326. [DOI: 10.1093/geront/gnx192] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rosanne van Seben
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Lucienne A Reichardt
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Dirk R Essink
- Athena Institute, Faculty of Earth and Life Sciences, VU University, Amsterdam, the Netherlands
| | - Barbara C van Munster
- Department of Geriatrics, Gelre Hospitals, Apeldoorn, the Netherlands
- Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jos A Bosch
- Department of Clinical Psychology, University of Amsterdam, the Netherlands
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, Amsterdam, the Netherlands
- ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, the Netherlands
| |
Collapse
|
58
|
Tabue-Teguo M, Grasset L, Avila-Funes JA, Genuer R, Proust-Lima C, Péres K, Féart C, Amieva H, Harmand MGC, Helmer C, Salles N, Rainfray M, Dartigues JF. Prevalence and Co-Occurrence of Geriatric Syndromes in People Aged 75 Years and Older in France: Results From the Bordeaux Three-city Study. J Gerontol A Biol Sci Med Sci 2017; 73:109-116. [PMID: 28541397 DOI: 10.1093/gerona/glx068] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 04/10/2017] [Indexed: 11/13/2022] Open
Abstract
Background Geriatric syndromes (GSs) are often the result of cumulative insults to multiple organ systems and are considered common in older adults. However, their frequency and co-occurrence are not well known in the elderly population. This study aimed to determine the prevalence of several GSs and to analyze the co-occurrence of these syndromes in a general population of elderly individuals. Methods A cross-sectional analysis of 630 adults aged 75 years or older participating in the 10-year follow-up of the Bordeaux sample of the French Three-City Study was conducted. The following 10 GSs were assessed: physical frailty, dementia and cognitive impairment, depressive symptoms, polymedication, social isolation, thinness, falls, dependence, sensory deficit, and incontinence. The prevalence of the 10 GSs was estimated, and multiple correspondence analysis (MCA) models were used to explore the mutual associations between these GSs. Results The mean age of the participants was 83.3 years; 69% were women, and 80.5% [95% confidence interval (CI) = 76.3-82.7] had at least one GS. The most frequent GSs were polymedication (50.6% 95%CI = 46.7-54.5) and falls (43.1% 95%CI = 38.4-46.1). The MCA models identified two major dimensions of the 10 GSs: "Dementia-Dependence-Incontinence" and "Frailty-Depression-Isolation." Conclusions GSs were very common in this French elderly population and were grouped into two major dimensions: the "Dementia-Dependence-Incontinence" and "Frailty-Depression-Isolation."
Collapse
Affiliation(s)
- Maturin Tabue-Teguo
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France.,Institut des Maladies Neurodégénératives Clinique, Centre Hospitalier Universitaire de Bordeaux, France.,Centre Hospitalier Villeneuve-sur-Lot, France
| | - Leslie Grasset
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - José Alberto Avila-Funes
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France.,Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Robin Genuer
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - Cecile Proust-Lima
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - Karine Péres
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - Catherine Féart
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - Hélène Amieva
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France.,Institut des Maladies Neurodégénératives Clinique, Centre Hospitalier Universitaire de Bordeaux, France
| | - Magali González-Colaço Harmand
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - Catherine Helmer
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France
| | - Nathalie Salles
- Pôle gérontologie clinique, Centre Hospitalier Universitaire de Bordeaux, France
| | - Muriel Rainfray
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France.,Pôle gérontologie clinique, Centre Hospitalier Universitaire de Bordeaux, France
| | - Jean François Dartigues
- INSERM U 1219, Université de Bordeaux, France.,Institut de Santé Publique d'Epidémiologie et de Développement (ISPED), Université de Bordeaux, France.,Institut des Maladies Neurodégénératives Clinique, Centre Hospitalier Universitaire de Bordeaux, France
| |
Collapse
|
59
|
Zimmerman S, Sloane PD. JAMDA's New Editors-in-Chief Present a Vision for the Journal of Post-Acute and Long-Term Care Medicine. J Am Med Dir Assoc 2017; 19:1-3. [PMID: 29191766 DOI: 10.1016/j.jamda.2017.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Philip D Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| |
Collapse
|
60
|
Abstract
Research involving persons with cognitive changes associated with aging, including dementia, has increased dramatically in the past two decades, motivated in large part by an increasing number of older adults with such issues. Velzke in the paper that follows this introduction discusses why it is important and how to include older adults as participants in research. While focused primarily on elders and their caregivers in Scotland, the topic is a globally important one.
Collapse
Affiliation(s)
- Steven L Baumann
- 1 Professor, Hunter College of the City University of New York, New York, NY, USA
| |
Collapse
|
61
|
Cuevas-Esteban J, Iglesias-González M, Rubio-Valera M, Serra-Mestres J, Serrano-Blanco A, Baladon L. Prevalence and characteristics of catatonia on admission to an acute geriatric psychiatry ward. Prog Neuropsychopharmacol Biol Psychiatry 2017; 78:27-33. [PMID: 28533149 DOI: 10.1016/j.pnpbp.2017.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/08/2017] [Accepted: 05/14/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study aims to describe the prevalence of catatonia in a population of older acute psychiatric inpatients according to different diagnostic criteria. Secondary objectives are: to compare the catatonic symptom profile, prevalence, and severity, in respect to the underlying aetiology, and to evaluate the association between catatonic and somatic comorbidity. METHODS The study included 106 patients admitted to an acute geriatric psychiatry ward. Catatonia was assessed using the Bush Francis Catatonia Rating Scale (BFCRS). RESULTS Catatonia was highly prevalent (n=42; 39.6%), even when using restrictive diagnostic criteria: Fink and Taylor (n=19; 17.9%) and DSM 5 (n=22; 20.8%). Depression was the most frequent psychiatric syndrome among catatonic patients (n=18; 42.8%). Catatonia was more frequent in depression (48.6%) and delirium (66.7%). Affective disorders showed a higher risk than psychotic disorders to develop catatonia (OR=2.68; 95% CI 1.09-6.61). This association was not statistically significant when controlling for dementia and geriatric syndromes. The most prevalent catatonic signs were excitement (64.3%), verbigeration (61.9%), negativism (59.5%), immobility/stupor (57.1%), and staring (52.4%). CONCLUSIONS Catatonia in older psychiatric inpatients was highly prevalent. Depression was the most common psychiatric syndrome among catatonic patients, and catatonia was more frequent in depression and mania, as well as in delirium. Affective disorders were associated with a higher risk of developing catatonia compared to psychotic disorders. Somatic and cognitive comorbidity played a crucial aetiological role in catatonia in this series.
Collapse
Affiliation(s)
- Jorge Cuevas-Esteban
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain; School of Pharmacy, University of Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Consorcio de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luisa Baladon
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| |
Collapse
|
62
|
Burke RE, Lawrence E, Ladebue A, Ayele R, Lippmann B, Cumbler E, Allyn R, Jones J. How Hospital Clinicians Select Patients for Skilled Nursing Facilities. J Am Geriatr Soc 2017; 65:2466-2472. [PMID: 28682456 DOI: 10.1111/jgs.14954] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To understand how hospital-based clinicians evaluate older adults in the hospital and decide who will be transferred to a skilled nursing facility (SNF) for postacute care. DESIGN Semistructured interviews paired with a qualitative analytical approach informed by Social Constructivist theory. SETTING Inpatient care units in three hospitals. Purposive sampling was used to maximize variability in hospitals, units within hospitals, and staff on those units. PARTICIPANTS Clinicians (hospitalists, nurses, therapists, social workers, case managers) involved in evaluation and decision-making regarding postacute care (N = 25). MEASUREMENTS Central themes related to clinician evaluation and discharge decision-making. RESULTS Clinicians described pressure to expedite evaluation and discharge decisions, resulting in the use of SNFs as a "safety net" for older adults being discharged from the hospital. The lack of hospital-based clinician knowledge of SNF care practices, quality, or patient outcomes resulted in lack of a standardized evaluation process or a clear primary decision-maker. CONCLUSION Hospital clinician evaluation and decision-making about postacute care in SNFs may be characterized as rushed, without a clear system or framework for making decisions and uninformed by knowledge of SNF or patient outcomes in those discharged to SNFs. This leads to SNFs being used as a "safety net" for many older adults. As hospitals and SNFs are increasingly held jointly accountable for outcomes of individuals transitioning between hospitals and SNFs, novel solutions for improving evaluation and decision-making are urgently needed.
Collapse
Affiliation(s)
- Robert E Burke
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado.,Hospital Medicine Section, Department of Medicine, Denver Veterans Affairs Medical Center, Denver, Colorado.,Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | - Emily Lawrence
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Amy Ladebue
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Roman Ayele
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Brandi Lippmann
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Ethan Cumbler
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | - Rebecca Allyn
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
| | | |
Collapse
|
63
|
Carnahan JL, Slaven JE, Callahan CM, Tu W, Torke AM. Transitions From Skilled Nursing Facility to Home: The Relationship of Early Outpatient Care to Hospital Readmission. J Am Med Dir Assoc 2017. [PMID: 28647577 DOI: 10.1016/j.jamda.2017.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many adults are discharged to skilled nursing facilities (SNFs) prior to returning home from the hospital. Patient characteristics and factors that can help to prevent postdischarge adverse outcomes are poorly understood. OBJECTIVE To identify whether early post-SNF discharge care reduces likelihood of 30-day hospital readmissions. DESIGN Secondary data analysis using the Electronic Medical Record, Medicare, Medicaid and the Minimum Data Set. PARTICIPANTS/SETTING Older (age > 65 years), community-dwelling adults admitted to a safety net hospital in the Midwest for 3 or more nights and discharged home after an SNF stay (n = 1543). MEASUREMENTS The primary outcome was hospital readmission within 30 days of SNF discharge. The primary independent variables were either a home health visit or an outpatient provider visit within a week of SNF discharge. RESULTS Out of 8754 community-dwelling, hospitalized older adults, 3025 (34.6%) were discharged to an SNF, of whom 1543 (51.0%) returned home. Among the SNF to home group, a home health visit within a week of SNF discharge was associated with reduced hazard of 30-day hospital readmission [adjusted hazard ratio (aHR) 0.61, P < .001] but outpatient provider visits were not associated with reduced risk of hospital readmission (aHR = 0.67, P = .821). CONCLUSION For patients discharged from an SNF to home, the finding that a home health visit within a week of discharge is associated with reduced hazard of 30-day hospital readmissions suggests a potential avenue for intervention.
Collapse
Affiliation(s)
- Jennifer L Carnahan
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN; Indiana University (IU) School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN.
| | - James E Slaven
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN
| | - Christopher M Callahan
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN; Indiana University (IU) School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN
| | - Wanzhu Tu
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN
| | - Alexia M Torke
- Indiana University Center for Aging Research, Regenstrief Institute, Inc, Indianapolis, IN; Indiana University (IU) School of Medicine, Department of Medicine, Division of General Internal Medicine and Geriatrics, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN; Indiana University Purdue University Indianapolis Research in Palliative and End of Life Communication and Training (RESPECT) Center, Indianapolis, IN; Daniel F. Evans Center for Spiritual and Religious Values in Health Care, IU Health, Indianapolis, IN; Fairbanks Center for Medical Ethics, IU Health, Indianapolis, IN
| |
Collapse
|
64
|
Tang HJ, Tang HY(J, Hu FW, Chen CH. Changes of geriatric syndromes in older adults survived from Intensive Care Unit. Geriatr Nurs 2017; 38:219-224. [DOI: 10.1016/j.gerinurse.2016.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 09/26/2016] [Accepted: 10/27/2016] [Indexed: 01/21/2023]
|
65
|
Mudge AM, Banks MD, Barnett AG, Blackberry I, Graves N, Green T, Harvey G, Hubbard RE, Inouye SK, Kurrle S, Lim K, McRae P, Peel NM, Suna J, Young AM. CHERISH (collaboration for hospitalised elders reducing the impact of stays in hospital): protocol for a multi-site improvement program to reduce geriatric syndromes in older inpatients. BMC Geriatr 2017; 17:11. [PMID: 28068906 PMCID: PMC5223473 DOI: 10.1186/s12877-016-0399-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/15/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Older inpatients are at risk of hospital-associated geriatric syndromes including delirium, functional decline, incontinence, falls and pressure injuries. These contribute to longer hospital stays, loss of independence, and death. Effective interventions to reduce geriatric syndromes remain poorly implemented due to their complexity, and require an organised approach to change care practices and systems. Eat Walk Engage is a complex multi-component intervention with structured implementation, which has shown reduced geriatric syndromes and length of stay in pilot studies at one hospital. This study will test effectiveness of implementing Eat Walk Engage using a multi-site cluster randomised trial to inform transferability of this intervention. METHODS A hybrid study design will evaluate the effectiveness and implementation strategy of Eat Walk Engage in a real-world setting. A multisite cluster randomised study will be conducted in 8 medical and surgical wards in 4 hospitals, with one ward in each site randomised to implement Eat Walk Engage (intervention) and one to continue usual care (control). Intervention wards will be supported to develop and implement locally tailored strategies to enhance early mobility, nutrition, and meaningful activities. Resources will include a trained, mentored facilitator, audit support, a trained healthcare assistant, and support by an expert facilitator team using the i-PARIHS implementation framework. Patient outcomes and process measures before and after intervention will be compared between intervention and control wards. Primary outcomes are any hospital-associated geriatric syndrome (delirium, functional decline, falls, pressure injuries, new incontinence) and length of stay. Secondary outcomes include discharge destination; 30-day mortality, function and quality of life; 6 month readmissions; and cost-effectiveness. Process measures including patient interviews, activity mapping and mealtime audits will inform interventions in each site and measure improvement progress. Factors influencing the trajectory of implementation success will be monitored on implementation wards. DISCUSSION Using a hybrid design and guided by an explicit implementation framework, the CHERISH study will establish the effectiveness, cost-effectiveness and transferability of a successful pilot program for improving care of older inpatients, and identify features that support successful implementation. TRIAL REGISTRATION ACTRN12615000879561 registered prospectively 21/8/2015.
Collapse
Affiliation(s)
- Alison M Mudge
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia.
| | - Merrilyn D Banks
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Adrian G Barnett
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Irene Blackberry
- John Richards Initiative, Australian Institute of Primary Care and Ageing, La Trobe University, Albury-Wodonga, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Theresa Green
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | | | - Ruth E Hubbard
- Centre for Research in Geriatric Medicine, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Sharon K Inouye
- Harvard Medical School, Beth Israel Deaconess Medical Centre, Institute for Aging Research, Hebrew Senior Life, Boston, USA
| | - Sue Kurrle
- Cognitive Decline Partnership Centre, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Kwang Lim
- Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Prue McRae
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Nancye M Peel
- Centre for Research in Geriatric Medicine, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jessica Suna
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| | - Adrienne M Young
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, Australia
| |
Collapse
|
66
|
Burke RE, Cumbler E, Coleman EA, Levy C. Post-acute care reform: Implications and opportunities for hospitalists. J Hosp Med 2017; 12:46-51. [PMID: 28125831 DOI: 10.1002/jhm.2673] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Nearly all practicing hospitalists have firsthand experience discharging patients to post-acute care (PAC), which is provided by inpatient rehabilitation facilities, skilled nursing facilities, or home healthcare providers. Many may not know that PAC is poised to undergo transformative change, spurred by recent legislation resulting in a range of reforms. These reforms have the potential to fundamentally reshape the relationship between hospitals and PAC providers. They have important implications for hospitalists and will open up opportunities for hospitalists to improve healthcare value. In this article, the authors explore the reasons for PAC reform and the scope of the reforms. Then they describe the implications for hospitalists and hospitalists' opportunities to Choose Wisely and improve healthcare value for the rapidly growing number of vulnerable older adults transitioning to PAC after hospital discharge.
Collapse
Affiliation(s)
- Robert E Burke
- Research Section, Denver VA Medical Center, Denver, CO, USA
- Hospital Medicine Section, Denver VA Medical Center, Denver, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ethan Cumbler
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Eric A Coleman
- Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cari Levy
- Research Section, Denver VA Medical Center, Denver, CO, USA
- Division of Health Care Policy and Research, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
67
|
Saraf AA, Petersen AW, Simmons SF, Schnelle JF, Bell SP, Kripalani S, Myers AP, Mixon AS, Long EA, Jacobsen JML, Vasilevskis EE. Medications associated with geriatric syndromes and their prevalence in older hospitalized adults discharged to skilled nursing facilities. J Hosp Med 2016; 11:694-700. [PMID: 27255830 PMCID: PMC5048583 DOI: 10.1002/jhm.2614] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/25/2016] [Accepted: 04/28/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than 3 geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. OBJECTIVES Develop a list of medications associated with geriatric syndromes and describe their prevalence in patients discharged from acute care to SNFs. DESIGN Literature review and multidisciplinary expert panel discussion, followed by cross-sectional analysis. SETTING Academic medical center in the United States PARTICIPANTS: One hundred fifty-four hospitalized Medicare beneficiaries discharged to SNFs. MEASUREMENTS Development of a list of medications that are associated with 6 geriatric syndromes. Prevalence of the medications associated with geriatric syndromes was examined in the hospital discharge sample. RESULTS A list of 513 medications was developed as potentially contributing to 6 geriatric syndromes: cognitive impairment, delirium, falls, reduced appetite or weight loss, urinary incontinence, and depression. Medications included 18 categories. Antiepileptics were associated with all syndromes, whereas antipsychotics, antidepressants, antiparkinsonism, and opioid agonists were associated with 5 geriatric syndromes. In the prevalence sample, patients were discharged to SNFs with an overall average of 14.0 (±4.7) medications, including an average of 5.9 (±2.2) medications that could contribute to geriatric syndromes, with falls having the most associated medications at discharge at 5.5 (±2.2). CONCLUSIONS Many commonly prescribed medications are associated with geriatric syndromes. Over 40% of all medications ordered upon discharge to SNFs were associated with geriatric syndromes and could be contributing to the high prevalence of geriatric syndromes experienced by this population. Journal of Hospital Medicine 2016;11:694-700. © 2016 Society of Hospital Medicine.
Collapse
Affiliation(s)
- Avantika A Saraf
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alec W Petersen
- School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Sandra F Simmons
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
| | - John F Schnelle
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Susan P Bell
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil Kripalani
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amy P Myers
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Amanda S Mixon
- Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Emily A Long
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - J Mary Lou Jacobsen
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Eduard E Vasilevskis
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
- Geriatric Research, Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, Tennessee.
- Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| |
Collapse
|
68
|
Simmons SF, Bell S, Saraf AA, Coelho CS, Long EA, Jacobsen JML, Schnelle JF, Vasilevskis EE. Stability of Geriatric Syndromes in Hospitalized Medicare Beneficiaries Discharged to Skilled Nursing Facilities. J Am Geriatr Soc 2016; 64:2027-2034. [PMID: 27590032 DOI: 10.1111/jgs.14320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess multiple geriatric syndromes in a sample of older hospitalized adults discharged to skilled nursing facilities (SNFs) and subsequently to home to determine the prevalence and stability of each geriatric syndrome at the point of these care transitions. DESIGN Descriptive, prospective study. SETTING One large university-affiliated hospital and four area SNFs. PARTICIPANTS Fifty-eight hospitalized Medicare beneficiaries discharged to SNFs (N = 58). MEASUREMENTS Research personnel conducted standardized assessments of the following geriatric syndromes at hospital discharge and 2 weeks after SNF discharge to home: cognitive impairment, depression, incontinence, unintentional weight loss, loss of appetite, pain, pressure ulcers, history of falls, mobility impairment, and polypharmacy. RESULTS The average number of geriatric syndromes per participant was 4.4 ± 1.2 at hospital discharge and 3.8 ± 1.5 after SNF discharge. There was low to moderate stability for most syndromes. On average, participants had 2.9 syndromes that persisted across both care settings, 1.4 syndromes that resolved, and 0.7 new syndromes that developed between hospital and SNF discharge. CONCLUSION Geriatric syndromes were prevalent at the point of each care transition but also reflected significant within-individual variability. These findings suggest that multiple geriatric syndromes present during a hospital stay are not transient and that most syndromes are not resolved before SNF discharge. These results underscore the importance of conducting standardized screening assessments at the point of each care transition and effectively communicating this information to the next provider to support the management of geriatric conditions.
Collapse
Affiliation(s)
- Sandra F Simmons
- Divisions of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee. .,Divisions of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee. .,Center for Quality Aging, Department of Medicine, Vanderbilt University, Nashville, Tennessee.
| | - Susan Bell
- Divisions of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee.,Center for Quality Aging, Department of Medicine, Vanderbilt University, Nashville, Tennessee.,Geriatric Research, Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Avantika A Saraf
- Center for Quality Aging, Department of Medicine, Vanderbilt University, Nashville, Tennessee.,Geriatric Research, Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | | | - Emily A Long
- Center for Quality Aging, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - J M L Jacobsen
- Divisions of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee.,Center for Quality Aging, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - John F Schnelle
- Divisions of Geriatrics, Department of Medicine, Vanderbilt University, Nashville, Tennessee.,Divisions of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee.,Center for Quality Aging, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Eduard E Vasilevskis
- Divisions of Cardiovascular Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee.,Center for Quality Aging, Department of Medicine, Vanderbilt University, Nashville, Tennessee.,Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
69
|
Hsieh YP, Huang YC, Lan SJ, Ho CS. Factors related to the decision-making for moving the older adults into long-term care facilities in Taiwan. Geriatr Gerontol Int 2016; 17:1319-1327. [PMID: 27578367 DOI: 10.1111/ggi.12860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/07/2016] [Accepted: 05/25/2016] [Indexed: 11/28/2022]
Abstract
AIM To investigate the relationships between demographic characteristics of the elderly, type of long-term care (LTC) facilities, and the reasons for moving into LTC facilities. METHODS Research participants included people aged over 65 years, living in LTC facilities. A total of 1280 questionnaires were distributed to 111 LTC facilities in Taiwan; 480 questionnaires were retrieved, and 232 were included in the valid sample. The study used a non-linear canonical correlation analysis, which assesses the relationships among similar sets of categorical variables. RESULTS The results showed that the older adults in quadrant I were characterized by being involved in the decision-making regarding the choice of LTC facilities and received economic support from their children. The older adults in quadrant II mainly lived in LTC facilities to receive medical care, whereas those in quadrant III typically included individuals with low income, who did not choose to live in LTC facilities. Furthermore, those in quadrant IV had positive cognitions associated with LTC facilities. CONCLUSIONS We believe that the results of the present study will facilitate policy-making in the field of LTC, provide reference to the practitioners and the older adults, and identify the types of decisions older adults make when moving into LTC facilities, thus assisting older adults to improve their strategies regarding staying in LTC facilities. Geriatr Gerontol Int 2017; 17: 1319-1327.
Collapse
Affiliation(s)
- Yen-Ping Hsieh
- Department of Long Term Care, National Quemoy University, Kinmen, Taiwan
| | - Ying-Chia Huang
- Medical and Pharmaceutical Industry Technology and Development Center, New Taipei City, Taiwan
| | - Shou-Jen Lan
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Ching-Sung Ho
- Department of Long Term Care, National Quemoy University, Kinmen, Taiwan
| |
Collapse
|