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Saari ME, Giosa JL, Holyoke P, Heckman GA, Hirdes JP. Profiling the medical, functional, cognitive, and psychosocial care needs of adults assessed for home care in Ontario, Canada: The case for long-term 'life care' at home. PLoS One 2024; 19:e0300521. [PMID: 38558082 PMCID: PMC10984553 DOI: 10.1371/journal.pone.0300521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Calls to leverage routinely collected data to inform health system improvements have been made. Misalignment between home care services and client needs can result in poor client, caregiver, and system outcomes. To inform development of an integrated model of community-based home care, grounded in a holistic definition of health, comprehensive clinical profiles were created using Ontario, Canada home care assessment data. Retrospective, cross-sectional analyses of 2017-2018 Resident Assessment Instrument Home Care (RAI-HC) assessments (n = 162,523) were completed to group home care clients by service needs and generate comprehensive profiles of each group's dominant medical, functional, cognitive, and psychosocial care needs. Six unique groups were identified, with care profiles representing home care clients living with Geriatric Syndromes, Medical Complexity, Cognitive Impairment and Behaviours, Caregiver Distress and Social Frailty. Depending on group membership, between 51% and 81% of clients had identified care needs spanning four or more Positive Health dimensions, demonstrating both the heterogeneity and complexity of clients served by home care. Comprehensive clinical profiles, developed from routinely collected assessment data, support a future-focused, evidence-informed, and community-engaged approach to research and practice in integrated home-based health and social care.
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Affiliation(s)
- Margaret E. Saari
- SE Research Centre, SE Health, Markham, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Justine L. Giosa
- SE Research Centre, SE Health, Markham, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - George A. Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - John P. Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Han E, Kharrazi H, Shi L. Identifying Predictors of Nursing Home Admission by Using Electronic Health Records and Administrative Data: Scoping Review. JMIR Aging 2023; 6:e42437. [PMID: 37990815 PMCID: PMC10686617 DOI: 10.2196/42437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 11/23/2023] Open
Abstract
Background Among older adults, nursing home admissions (NHAs) are considered a significant adverse outcome and have been extensively studied. Although the volume and significance of electronic data sources are expanding, it is unclear what predictors of NHA have been systematically identified in the literature via electronic health records (EHRs) and administrative data. Objective This study synthesizes findings of recent literature on identifying predictors of NHA that are collected from administrative data or EHRs. Methods The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were used for study selection. The PubMed and CINAHL databases were used to retrieve the studies. Articles published between January 1, 2012, and March 31, 2023, were included. Results A total of 34 papers were selected for final inclusion in this review. In addition to NHA, all-cause mortality, hospitalization, and rehospitalization were frequently used as outcome measures. The most frequently used models for predicting NHAs were Cox proportional hazards models (studies: n=12, 35%), logistic regression models (studies: n=9, 26%), and a combination of both (studies: n=6, 18%). Several predictors were used in the NHA prediction models, which were further categorized into sociodemographic, caregiver support, health status, health use, and social service use factors. Only 5 (15%) studies used a validated frailty measure in their NHA prediction models. Conclusions NHA prediction tools based on EHRs or administrative data may assist clinicians, patients, and policy makers in making informed decisions and allocating public health resources. More research is needed to assess the value of various predictors and data sources in predicting NHAs and validating NHA prediction models externally.
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Affiliation(s)
- Eunkyung Han
- Ho-Young Institute of Community Health, Paju, Republic of Korea
- Asia Pacific Center For Hospital Management and Leadership Research, Johns Hopkins Bloomberg School of Public Health, BaltimoreMD, United States
| | - Hadi Kharrazi
- Department of Health Policy and Management, Johns Hopkins School of Public Health, BaltimoreMD, United States
- Division of Biomedical Informatics and Data Science, Johns Hopkins School of Medicine, BaltimoreMD, United States
| | - Leiyu Shi
- Department of Health Policy and Management, Johns Hopkins School of Public Health, BaltimoreMD, United States
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Fowokan A, Giosa JL, Saari M, Holyoke P. Mapping a comprehensive assessment tool to a holistic definition of health for person-centred care planning in home care: a modified eDelphi study. BMC Health Serv Res 2023; 23:1268. [PMID: 37974144 PMCID: PMC10655331 DOI: 10.1186/s12913-023-10203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Researchers in the Netherlands proposed the Pillars for Positive Health (PPH) as a broadly encompassing health definition to support more realistic and meaningful care planning for people living with chronic disease and other life-long health conditions. The PPH was subsequently converted to the My Positive Health (MPH) spider web visualization tool. This study sought to identify opportunities for more person-centred care planning at the point of care in home care, using the MPH tool as a framework to link comprehensive assessment and dialogue-based goal-setting. METHODS A modified eDelphi method was used to conduct domain mapping with a purposively sampled expert panel (n = 25). The panel consisted of researchers, health care providers, older adults and caregivers. A two-stage eDelphi process was conducted, with each stage consisting of three survey rounds. In the first stage, participants were asked to map 201 elements of the interRAI Home Care (interRAI HC) comprehensive assessment tool to the six MPH domains or "No pillar of best fit". The second stage focused on identifying opportunities to adapt or expand comprehensive assessment as it relates to the MPH domains. RESULTS In Stage 1, 189 of 201 elements reached consensus in domain mapping. These included: 80 elements for Bodily Functions, 32 for Daily Functioning, 32 for Mental Wellbeing, 24 for Quality of Life, 10 for Participation, and 1 for Meaningfulness. Ten elements were identified to have no pillar of best fit. The 12 elements that did not reach consensus in Stage 1 formed the basis for Stage 2, where expert panel participants proposed four new assessment elements in Meaningfulness and Participation and 11 additional descriptors across the six MPH domains. Of these, two elements and nine of the 11 descriptors reached consensus. CONCLUSION Findings show that elements of the interRAI HC are oriented toward the physical, functional, and mental health domains. Consequently, complementary assessment elements and/or tools may be needed to support comprehensive assessment of 'Meaningfulness' and 'Participation' in person-centred home and community care. Additional descriptors may also be needed to aid communication regarding the understanding and application of MPH domains.
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Affiliation(s)
- A Fowokan
- SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, L3R 6H3, Canada
| | - J L Giosa
- SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, L3R 6H3, Canada.
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - M Saari
- SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, L3R 6H3, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
| | - P Holyoke
- SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, L3R 6H3, Canada
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Mitchell L, Poss J, MacDonald M, Burke R, Keefe JM. Inter-provincial variation in older home care clients and their pathways: a population-based retrospective cohort study in Canada. BMC Geriatr 2023; 23:389. [PMID: 37365495 DOI: 10.1186/s12877-023-04097-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND In Canada, publicly-funded home care programs enable older adults to remain and be cared for in their home for as long as possible but they often differ in types of services offered, and the way services are delivered. This paper examines whether these differing approaches to care shape the pathway that home care clients will take. Older adult client pathways refer to trajectories within, and out of, the home care system (e.g., improvement, long term care (LTC) placement, death). METHODS A retrospective analysis of home care assessment data (RAI-HC was linked with health administrative data, long-term care admissions and vital statistics in Nova Scotia Health (NSH) and Winnipeg Regional Health Authority (WRHA). The study cohort consists of clients age 60 + years, admitted to home care between January 1, 2011 to December 31, 2013 and up to four years from baseline. Differences in home care service use, client characteristics and their pathways were tested across the two jurisdictions overall, and among the four discharge streams within jurisdictions using t-tests and chi-square tests of significance. RESULTS NS and WHRA clients were similar in age, sex, and marital status. NS clients had higher levels of need (ADL, cognitive impairment, CHESS) at base line and were more likely discharged to LTC (43% compared to 38% in WRHA). Caregiver distress was a factor correlated with being discharged to LTC. While a third remained as home care clients after 4 years; more than half were no longer in the community - either discharged to LTC placement or death. Such discharges occurred on average at around two years, a relatively short time period. CONCLUSIONS By following older clients over 4 years, we provide enhanced evidence of client pathways, the characteristics that influence these paths, as well as the length of time to the outcomes. This evidence is central to identification of clients at risk in the community and aids in planning for future home care servicing needs that will allow more older adults to remain living in the community.
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Affiliation(s)
| | - Jeffrey Poss
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | | | - Rosanne Burke
- Nova Scotia Centre On Aging, Mount Saint Vincent University, Halifax, NS, Canada
| | - Janice M Keefe
- Department of Family Studies and Gerontology and Director, Nova Scotia Centre On Aging, Mount Saint Vincent University, Halifax, NS, Canada
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Miyamori D, Yoshida S, Kashima S, Koike S, Ishii S, Okazaki Y, Ikeda K, Matsumoto M. How the 2018 Japan Floods Impacted Nursing Home Admissions for Older Persons: A Longitudinal Study Using the Long-Term Care Insurance Comprehensive Database. J Am Med Dir Assoc 2023; 24:368-375.e1. [PMID: 36587929 DOI: 10.1016/j.jamda.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES As disasters become more frequent because of global warming, countries across the world are seeking ways to protect vulnerable older populations. Although these conditions may increase nursing home admission (NHA) rates for older persons, we know of no studies that have directly tested this hypothesis. DESIGN This was a retrospective cohort study. SETTING AND PARTICIPANTS We analyzed data from long-term care insurance (LTCI) users in 3 Japanese prefectures that incurred heavy damage from the 2018 Japan Floods, which is the largest recorded flooding disaster in national history. Specifically, we extracted NHA data from the LTCI comprehensive database, both for disaster-affected and unaffected individuals. METHODS We employed the Cox proportional hazards model to calculate multivariate-adjusted hazard ratios (HRs) for NHAs within a 6-month period following the 2018 Japan Floods, with adjustments for potential confounding factors. RESULTS Of the 187,861 individuals who used LTCI services during the investigated period, we identified 2156 (1.1%) as disaster affected. The HR for NHA was significantly higher for disaster-affected (vs unaffected) individuals (adjusted HR 3.23: 95% CI 2.88‒3.64), and also higher than the HRs for older age (90-94 years vs 65-69 years: 2.29, CI 1.93‒2.70), cognitive impairment (severe impairment vs normal: 1.40, CI 1.25‒1.57), and physical function (bedridden vs independent: 2.27, CI 1.83‒2.70). According to our subgroup analyses, the adjusted HR for disaster-affected individuals unable to feed themselves was 6.00 (CI 3.68‒9.79), with a significant interaction between the 2 variables (P = .01). CONCLUSIONS AND IMPLICATIONS Natural disasters increase the risk of NHA for older persons, especially those who are unable to feed themselves. Health care providers and policymakers should understand and prepare for this emerging risk factor.
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Affiliation(s)
- Daisuke Miyamori
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan; Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Shuhei Yoshida
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan; Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Saori Kashima
- Environmental Health Sciences Laboratory, Graduate School of Advanced Science and Engineering, Hiroshima University, Hiroshima, Japan
| | - Soichi Koike
- Division of Health Policy and Management, Center for Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Shinya Ishii
- Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuji Okazaki
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan; Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kotaro Ikeda
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima, Japan; Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masatoshi Matsumoto
- Department of Community-Based Medical System, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Swan L, Martin N, Horgan NF, Warters A, O’Sullivan M. Assessing Sarcopenia, Frailty, and Malnutrition in Community-Dwelling Dependant Older Adults-An Exploratory Home-Based Study of an Underserved Group in Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16133. [PMID: 36498213 PMCID: PMC9736424 DOI: 10.3390/ijerph192316133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Adults of advanced age, with functional dependency, socioeconomic disadvantage, or a need for home care, are expected to be at high risk of sarcopenia, frailty and malnutrition, yet are likely to be underrepresented in research. We aimed to explore the assessment of sarcopenia, frailty, and malnutrition in-home, and to describe the practicality of performing these assessments. METHODS Home-based health assessments and post-study feedback surveys were conducted among community-dwelling older adults ≥65 years in receipt of state-funded home care (n = 31). Assessments included probable sarcopenia [hand-grip strength (HGS), chair rise-test, and SARC-F case-finding tool], the Mini Nutritional Assessment (MNA), and the Clinical Frailty Scale (CFS). RESULTS The study group was of mean age 83.2 ± 8.2 years, 74% were female and 23% lived in socioeconomically disadvantaged areas. Almost all met the criteria for probable sarcopenia (94%, n = 29/31), were frail or vulnerable by the CFS (97%, n = 30/31), and over a quarter were at risk of malnutrition (26%, n = 8). Participants had low physical activity (71.0%, n = 22/31), with a mean daytime average of 11.4 ± 1.6 h spent sitting. It was possible to assess probable sarcopenia (by HGS and SARC-F, but not the chair rise test), malnutrition (MNA), and frailty (CFS). Home-based research was a complex environment, and unearthed significant unmet need, prompting referrals to health services (36%, n = 11), in addition to technology assistance. The majority of participants (93%) reported a willingness to partake in future research. CONCLUSIONS Most community-dwelling older people in receipt of home support, assessed in this exploratory study, were at risk of probable sarcopenia, frailty, and low physical activity, with over a quarter were at risk of malnutrition. Our initial findings provide practical data for large scale studies and may inform the development of intervention studies aiming to support ageing in place.
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Affiliation(s)
- Lauren Swan
- Department of Clinical Medicine, Trinity College, D02 PN40 Dublin, Ireland
| | - Niamh Martin
- Older Person Services CHO9, Health Service Executive (HSE), D09 C8P5 Dublin, Ireland
| | - N Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Austin Warters
- Older Person Services CHO9, Health Service Executive (HSE), D09 C8P5 Dublin, Ireland
| | - Maria O’Sullivan
- Department of Clinical Medicine, Trinity College, D02 PN40 Dublin, Ireland
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Do You Feel Safe at Home? A Qualitative Study among Home-Dwelling Older Adults with Advanced Incurable Cancer. Healthcare (Basel) 2022; 10:healthcare10122384. [PMID: 36553908 PMCID: PMC9778052 DOI: 10.3390/healthcare10122384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/14/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022] Open
Abstract
Many older adults with cancer prefer to live at home, and home treatment and outpatient care have been recommended for such patients. To improve their mental health, it is important to identify the challenges that are faced by home-dwelling older adults with cancer. This study aimed to examine the impact of the home on older adults with advanced cancer who were receiving treatment and follow-up care. In a cross-sectional design with criterion-based sampling, eight qualitative interviews were transcribed and interpreted thematically. We identified three themes of home-safety management: good home-safety management, uncertain home-safety management, and home-safety management collapse. Moreover, we revealed eight sub-themes important to the participants' home-safety experience. Ensuring that older adults feel safe at home will afford them the opportunity to enjoy living at home, which in turn may alleviate their symptom burden and enhance their mental health.
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Young Y, Hsu WH, Chen YM, Chung KP, Chen HH, Kane C, Shayya A, Schumacher P, Yeh YP. Determinants associated with medical-related long-term care service use among community-dwelling older adults in Taiwan. Geriatr Nurs 2022; 48:58-64. [PMID: 36126442 DOI: 10.1016/j.gerinurse.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Medical-related long-term care (LTC) service use among community-dwelling older adults in Taiwan is resource-intensive, and planning is essential to promote aging-in-place. METHODS Administrative data from 4/1/2017 to 11/26/2019 among more than 14,000 residents were analyzed with generalized estimating equations (GEEs) to identify determinants of medical-related LTC service use. RESULTS Older adults using medical-related LTC services tended to be younger (79.9 vs. 80.7; p<.0001), male (42.7% vs. 38.5%; p<.0001), multi-morbid (3.1 vs. 2.5; p<.0001), and higher mean activities of daily living (ADL) disability (8.2 vs. 4.2; p<.0001), instrumental ADL (IADL) disability (11.0 vs. 9.1; p<.0001), and hospitalizations (1.1 vs. 0.4; p<.0001). Significant determinants of medical-related LTC services include age, education, stroke, coronary heart disease, diabetes, vision impairment, ADL disability, and prior hospitalization. DISCUSSION The success of LTC 2.0 will depend on ADL support and care coordination to manage chronic conditions such as diabetes, vision impairment, coronary heart disease, and stroke.
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Affiliation(s)
- Yuchi Young
- University at Albany, School of Public Health, Department of Health Policy, Management & Behavior, 1 University Place, Rensselaer, NY, 12144, USA.
| | - Wan-Hsiang Hsu
- University at Albany, School of Public Health, Department of Health Policy, Management & Behavior, 1 University Place, Rensselaer, NY, 12144, USA
| | - Ya-Mei Chen
- National Taiwan University, College of Public Health, 17, Hsu-Chou Road, Taipei, 100225, Taiwan
| | - Kuo-Piao Chung
- National Taiwan University, College of Public Health, 17, Hsu-Chou Road, Taipei, 100225, Taiwan
| | - Hsiu-Hsi Chen
- National Taiwan University, College of Public Health, 17, Hsu-Chou Road, Taipei, 100225, Taiwan; Changhua County Public Health Bureau, 162 Zhongshan Road, Section 2, Changhua City, Changhua, 500009, Taiwan
| | - Cassandra Kane
- University at Albany, School of Public Health, Department of Health Policy, Management & Behavior, 1 University Place, Rensselaer, NY, 12144, USA
| | - Ashley Shayya
- University at Albany, School of Public Health, Department of Health Policy, Management & Behavior, 1 University Place, Rensselaer, NY, 12144, USA
| | - Patrick Schumacher
- University at Albany, School of Public Health, Department of Health Policy, Management & Behavior, 1 University Place, Rensselaer, NY, 12144, USA
| | - Yen-Po Yeh
- Changhua County Public Health Bureau, 162 Zhongshan Road, Section 2, Changhua City, Changhua, 500009, Taiwan
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Horgan F, Cummins V, Skelton DA, Doyle F, O’Sullivan M, Galvin R, Burton E, Sorensen J, Jabakhanji SB, Townley B, Rooney D, Jackson G, Murphy L, Swan L, O’Neill M, Warters A. Enhancing Existing Formal Home Care to Improve and Maintain Functional Status in Older Adults: Results of a Feasibility Study on the Implementation of Care to Move (CTM) in an Irish Healthcare Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11148. [PMID: 36141422 PMCID: PMC9517683 DOI: 10.3390/ijerph191811148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
Background: Care to Move (CTM) provides a series of consistent 'movement prompts' to embed into existing movements of daily living. We explored the feasibility of incorporating CTM approaches in home care settings. Methods: Feasibility study of the CTM approach in older adults receiving home care. Recruitment, retention and attrition (three time points), adherence, costs to deliver and data loss analyzed and differentiated pre and post the COVID-19 pandemic. Secondary outcomes, including functional status, physical activity, balance confidence, quality of life, cost to implement CTM. Results: Fifty-five home care clients (69.6% of eligible sample) participated. Twenty were unable to start due to COVID-19 disruptions and health issues, leaving 35 clients recruited, mostly women (85.7%), mean age 82.8 years. COVID-19 disruption impacted on the study, there was 60% retention to T2 assessments (8-weeks) and 13 of 35 (37.1%) completed T3 assessments (6-months). There were improvements with small to medium effect sizes in quality of life, physical function, balance confidence and self-efficacy. Managers were supportive of the roll-out of CTM. The implementation cost was estimated at EUR 280 per carer and annual running costs at EUR 75 per carer. Conclusion: Embedding CTM within home support services is acceptable and feasible. Data gathered can power a definitive trial.
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Affiliation(s)
- Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Vanda Cummins
- Primary Care Physiotherapy Services CHO9, Health Service Executive, D09 C8P5 Dublin, Ireland
| | - Dawn A. Skelton
- Research Centre for Health (ReaCH), School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Frank Doyle
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Maria O’Sullivan
- Department of Clinical Medicine, Trinity College, D02 PN40 Dublin, Ireland
| | - Rose Galvin
- Ageing Research Centre, Health Research Institute, School of Allied Health, University of Limerick (UL), V94 T9PX Limerick, Ireland
| | - Elissa Burton
- School of Allied Health, Curtin University, Bentley, WA 6102, Australia
- enAble Institute, Curtin University, Bentley, WA 6102, Australia
| | - Jan Sorensen
- Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Samira Barbara Jabakhanji
- Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Bex Townley
- Later Life Training, Killin, Scotland FK21 8UT, UK
| | - Debbie Rooney
- North Dublin Home Care (NDHC), D03 A6Y0 Dublin, Ireland
| | - Gill Jackson
- North Dublin Home Care (NDHC), D03 A6Y0 Dublin, Ireland
| | - Lisa Murphy
- North Dublin Home Care (NDHC), D03 A6Y0 Dublin, Ireland
| | - Lauren Swan
- Department of Clinical Medicine, Trinity College, D02 PN40 Dublin, Ireland
| | - Mary O’Neill
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland
| | - Austin Warters
- Older Person Services CHO9, Health Service Executive (HSE), D09 C8P5 Dublin, Ireland
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Swan L, Horgan NF, Fan CW, Warters A, O’Sullivan M. Residential Area Socioeconomic Deprivation is Associated with Physical Dependency and Polypharmacy in Community-Dwelling Older Adults: An Analysis of Health Administrative Data in Ireland. J Multidiscip Healthc 2022; 15:1955-1963. [PMID: 36081581 PMCID: PMC9447443 DOI: 10.2147/jmdh.s380456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/24/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Socioeconomic disadvantage is associated with multiple adverse health outcomes in ageing. Whether this negative impact persists in populations of more advanced age and dependency is less clear. We aimed to determine the association between residential area deprivation and pre-specified health characteristics among community-dwelling dependent older adults. Methods We conducted a cross-sectional analysis of data from 1591 community-dwelling adults aged 65 years and older of mean age 83.9 ± 7.1 years and in receipt of state home support in Ireland. The HP Pobal Deprivation Index was used to categorize residential areas by socioeconomic deprivation. Health variables analysed included physical dependency (Barthel Index), polypharmacy (≥5 medications), previous acute hospital admission, cognitive impairment, and mental health diagnoses. Associations between residential area deprivation and prespecified health outcomes were explored in multivariable logistic regression analysis. Results In socioeconomically disadvantaged areas, high physical dependency was twice that observed in affluent areas (16.2% vs 6.9%, p = 0.009). Similarly, acute hospitalization, as the trigger for increased dependency, was more common in deprived settings (41.6% v 29.1%, p < 0.001). Polypharmacy was common in this population (67.6%), but significantly higher in deprived vs affluent settings (74.7% v 64.5%, p = 0.030). The findings persisted in multivariable analyses when adjusted for age and gender. While all participants were accessing home support, those in deprived areas were on average 6.5 years younger than in affluent areas. Associations between residential deprivation and mental health conditions or cognitive impairment, however, were not observed in this study. Conclusion Community-dwelling older adults living in socioeconomically disadvantaged areas experienced greater polypharmacy, high physical dependency, hospitalization-associated dependency, and a 6.5-year earlier need for state home support than in affluent settings. The findings suggest that health inequality persists in populations of more advanced age and dependency and highlight a need for further research as well as community-based health and social care initiatives.
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Affiliation(s)
- Lauren Swan
- Department of Clinical Medicine, Trinity College Dublin (TCD), Dublin, Ireland
- North Dublin Homecare Ltd, Dublin, Ireland
- Correspondence: Lauren Swan, Email
| | - N Frances Horgan
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Chie Wei Fan
- Department of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Austin Warters
- Older Person Services CHO9, Health Service Executive (HSE), Dublin, Ireland
| | - Maria O’Sullivan
- Department of Clinical Medicine, Trinity College Dublin (TCD), Dublin, Ireland
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Swan L, Horgan NF, Cummins V, Burton E, Galvin R, Skelton DA, Townley B, Doyle F, Jabakhanji SB, Sorensen J, Rooney D, Murphy L, Warters A, O’Sullivan M. Embedding Physical Activity Within Community Home Support Services for Older Adults in Ireland – A Qualitative Study of Barriers and Enablers. Clin Interv Aging 2022; 17:223-234. [PMID: 35299723 PMCID: PMC8922314 DOI: 10.2147/cia.s351431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/11/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction In Ireland, over 55,000 older adults are supported in their community by formal home support, amounting to an estimated 23 million care hours annually. There is a growing need to move beyond care, to more proactive approaches to maintain physical function. In a feasibility study, we delivered the “Care to Move” (CTM) program through existing home support services. This qualitative study aimed to explore the experience and perceptions of Health Care Assistants (HCAs), who were trained in and delivered the CTM program. Methods We conducted semi-structured telephone interviews with 22 HCAs [mean age 49.0 ± 10.7 years and female 21/22] involved in the delivery of the program with older adults [n = 35, mean age 82.8 (7.8) years]. Interview transcripts were coded and analyzed thematically to capture barriers and enablers to program delivery. Results Barriers and enablers were identified under three themes i) the CTM approach ii) the home support setting, iii) older adults and physical activity, with iv) delivering care in a crisis and v) future directions further identified. Overall, there was a positive perception of the program’s focus on “movement prompts and motivators”, the “fit” within home support services, and the training provided. Practical challenges of limited time and the task-orientated nature of home support were reported as recurring barriers for CTM. Many HCAs commented on the value and perceived positive benefits of the program for their clients. Though negative perceptions of older adults’ motivation or ability to engage with physical activity were noted. Risk, such as injury or pain, was identified but was not a dominant theme. Conclusion Our findings suggest that embedding physical activity initiatives within home support services could be feasible. Restructuring of services, engaging HCAs, and moving beyond traditional “task-oriented” care models to more personalised proactive approaches may facilitate this initiative and support aging in place. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/p10cN5fwsHo
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Affiliation(s)
- Lauren Swan
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- North Dublin Home Care (NDHC), Dublin, Ireland
| | - N Frances Horgan
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Vanda Cummins
- Primary Care Physiotherapy Services CHO9, Health Service Executive (HSE), Dublin, Ireland
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Rose Galvin
- School of Allied Health, Ageing Research Centre, University of Limerick (UL), Limerick, Ireland
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
- Later Life Training, Killin, UK
| | | | - Frank Doyle
- Department of Health Psychology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Samira B Jabakhanji
- Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcomes Research Centre (HORC), RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Lisa Murphy
- North Dublin Home Care (NDHC), Dublin, Ireland
| | - Austin Warters
- Older Person Services CHO9, Health Service Executive (HSE), Dublin, Ireland
| | - Maria O’Sullivan
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
- Correspondence: Maria O’Sullivan, Email
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Bloomfield K, Wu Z, Broad JB, Tatton A, Calvert C, Hikaka J, Boyd M, Peri K, Bramley D, Higgins AM, Connolly MJ. Factors associated with healthcare utilization and trajectories in retirement village residents. J Am Geriatr Soc 2021; 70:754-765. [PMID: 34910296 DOI: 10.1111/jgs.17602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/01/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To study healthcare utilization and trajectories, and associated factors, in older adults in retirement villages (RVs), also known as continuing care retirement communities. METHODS Prospective cohort study of 578 cognitively intact residents from 34 RVs in Auckland, New Zealand (NZ). MEASUREMENT InterRAI-Community Health Assessment (includes core items that may trigger functional supplement (FS) completion in those with higher needs, and generates clinical assessment protocols (CAPs) in those with potential unmet needs). OUTCOMES time to acute hospitalization, long-term care (LTC), and death during average 2.5 years follow-up. RESULTS Three hundred seven (53%) residents had acute hospitalizations, 65 (11%) moved to LTC, and 51 (9%) died over a mean of 2.5 years. Factors associated with increased risk of acute hospitalization included CAP-falls (high risk) triggered, number of comorbidities, not having left RV in 2 weeks prior, moderate/severe hearing impairment, CAP-cardiorespiratory conditions triggered, acute hospitalization in year prior and age, with significant hazard ratios (HR) ranging between 1.03 and 2.90. Factors associated with reduced risk of hospitalization included other (non-NZ) European ethnicity (HR 0.73, 95% CI 0.55-0.98, p = 0.04), presence of on-site clinic (HR 0.62, 95% CI 0.45-0.85, p = 0.003), no influenza vaccination (HR 0.56, 95% CI 0.38-0.83, p = 0.004). Factors associated with LTC transition included FS triggered (HR 3.84, 95% CI 1.92-7.66, p < 0.001), CAP-instrumental activities of daily living (IADL) (HR 2.62, 95% CI 1.22-5.62, p = 0.01), CAP-social relationship triggered (HR 2.00, 95% CI 1.13-3.55, p = 0.02), and age (HR 1.13, 95% CI 1.07-1.18 p < 0.001). Factors associated with mortality included number of comorbidities (HR 3.75, 95% CI 1.54-9.10, p = 0.004 for 3-5 comorbidities), CAP-IADL triggered (HR 3.05, 95% CI 1.30-7.16, p = 0.01), and age (HR 1.11, 95% CI 1.05-1.18, p < 0.001). CONCLUSION A large proportion of cognitively intact RV residents are admitted to hospital in mean 2.5 years of follow-up. Multiple factors were associated with acute hospitalization risk. On-site clinics were associated with reduced risk and should be considered in RV development.
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Affiliation(s)
- Katherine Bloomfield
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Cheryl Calvert
- Community and Long Term Conditions, Auckland District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Ann-Marie Higgins
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
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13
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Estimation of Life Expectancy for Dependent Population in a Multi-State Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111162. [PMID: 34769681 PMCID: PMC8582863 DOI: 10.3390/ijerph182111162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 11/29/2022]
Abstract
Population statistics show that there was an increase in life expectancy during the last century. However, this fact hides that this increase was not equal for all groups of the population. One of the most problematic cases for measuring this increase is that of the dependent population because of the absence of specific statistics. This paper describes a methodology for calculating life expectancy using multistate models that take into account the diversity of situations considered by Spanish legislation. For this purpose, statistical information contained in the national survey on disability and dependency (EDAD 2008) is used. The results suggest that life expectancies are lower than those of the general population and that they differ according to gender and intensity of suffering from this contingency. The calculations were made considering the legal framework currently existing in Spain. This fact conditions the definition of dependent person and, therefore, the set of individuals, their characteristics, and therefore, their final results.
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Carter L, O'Neill S, Austin PC, Keogh F, Pierce M, O'Shea E. Admission to long-stay residential care and mortality among people with and without dementia living at home but on the boundary of residential care: a competing risks survival analysis. Aging Ment Health 2021; 25:1869-1876. [PMID: 33317328 DOI: 10.1080/13607863.2020.1857698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Health policy in many countries is underpinned by a commitment to support dependent older people to remain in their own home for as long as possible and practicable. This study explores factors affecting both admission to long-stay residential care (LSRC) and mortality among people with and without dementia who are currently living at home with intensive formal care support. METHODS This is a cross-sectional study based on administrative data collected on 429 dependent older people in Ireland, 269 of whom were people with dementia. A cause-specific hazard model was used to investigate the hazard of admission to LSRC, while accounting for mortality as a competing risk and vice versa. RESULTS Admission to LSRC was higher for people with dementia relative to people without and for those receiving lower amounts of informal care. The hazard of mortality was significantly higher for older people aged 85+, whereas it was lower for individuals with a medium level of dependency relative to those with high levels of dependency. The hazard of mortality was also influenced by the amount of informal care provision. CONCLUSION People with dementia are more likely to be admitted to LSRC than people without. Care for people with dementia needs to be more specialised and personal, and intensity of provision should not be equated to the number of care hours on offer. Informal care provision may help to prevent admission to LSRC. Advanced age, physical dependency and informal care provision affect mortality, raising interesting issues in relation to resource allocation.
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Affiliation(s)
- L Carter
- Centre for Economic and Social Research on Dementia, Institute for Lifecourse and Society, National University of Ireland, Galway, Ireland
| | - S O'Neill
- J.E. Cairnes School of Business and Economics, Upper Newcastle, National University of Ireland, Galway, Ireland
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Institute of Health Management, Policy and Evaluation, University of Toronto, Toronto, Canada
| | - F Keogh
- Centre for Economic and Social Research on Dementia, Institute for Lifecourse and Society, National University of Ireland, Galway, Ireland
| | - M Pierce
- Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - E O'Shea
- Centre for Economic and Social Research on Dementia, Institute for Lifecourse and Society, National University of Ireland, Galway, Ireland
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15
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Boitrago SCODS, Souza ASO, Cunha PDO, Vieira MA, Caldeira AP, Carneiro JA, Costa FMD. Mortality in community-dwelling elderly: coefficient and associated factors. Rev Bras Enferm 2021; 74:e20200612. [PMID: 34259719 DOI: 10.1590/0034-7167-2020-0612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/25/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Analyze the coefficient, associated factors, and causes of mortality in community-dwelling elderly. METHOD Longitudinal and analytical study. Data collection, at baseline, was performed in the elderly's home. The first wave occurred after 42 months. Complementary data collection identified the cause of death. Variables analyzed: demographic, social, economic, and clinical. Logistic regression was used for data analysis. RESULTS The coefficient of mortality was 7.9%. The variables associated with mortality were longevity, inability to read, absence of religious practice, stroke, consultation, and hospitalization in the last 12 months. The main groups of primary causes of death were ill-defined and unspecified causes of mortality, respiratory system diseases, and neoplasms. CONCLUSION The coefficient of mortality in community-dwelling elderly was lower than national and international studies investigated.
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The effectiveness of smart home technologies to support the health outcomes of community-dwelling older adults living with dementia: A scoping review. Int J Med Inform 2021; 153:104513. [PMID: 34116363 DOI: 10.1016/j.ijmedinf.2021.104513] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 04/14/2021] [Accepted: 06/01/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To map the current state-of-knowledge about the effectiveness of smart home technologies to support the health outcomes of community-dwelling older adults living with dementia. DESIGN A scoping review following the methodological frameworks described by Arksey and O'Malley (2005) and Levac et al. (2010). DATA SOURCES Electronic databases and online sources were searched in April 2020 using database specific medical subject headings and keywords about 'smart homes' and 'dementia'. METHODS Empirical peer-reviewed articles were included if they were written in English; used a quantitative, qualitative, or mixed method design; and presented the effects of a smart home technology on the health outcomes of community-dwelling adults living with dementia. Methodological and reporting quality of studies was assessed using the Mixed Methods Appraisal Tool - Version 2018. RESULTS Five studies described evaluations of five smart home technology systems with a total of n = 617 community-dwelling people living with dementia. Collectively, studies showed potential effectiveness of the technologies on a range of health outcomes (physical activity, activities of daily living, sleep, anxiety, depression, agitation, irritability, risk of falls, cognitive functioning, night-time injury, unattended home exits). However, the overall methodological and reporting quality of studies was low and profiled a research field lacking in rigorous evaluation. CONCLUSIONS Based on current evidence, the success of smart home technologies to support people with dementia to live at home remains unclear. Recommendations are provided to inform future research into smart home technologies for community-based dementia care.
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Chesney TR, Haas B, Coburn N, Mahar AL, Davis LE, Zuk V, Zhao H, Wright F, Hsu AT, Hallet J. Association of frailty with long-term homecare utilization in older adults following cancer surgery: Retrospective population-based cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:888-895. [PMID: 32980211 DOI: 10.1016/j.ejso.2020.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/09/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Frailty is an important prognostic factor, and the association with postoperative dependence is important outcome to older adults. We examined the association of frailty with long-term homecare utilization for older adults following cancer surgery. METHODS In this population-based cohort study, we determined frailty status in all older adults (≥70 years old) undergoing cancer resection (2007-2017). Outcomes were receipt of homecare and intensity of homecare (days per month) over 5 years. We estimated the adjusted association of frailty with outcomes, and assessed interaction with age. RESULTS Of 82,037 patients, 6443 (7.8%) had frailty. Receipt and intensity of homecare was greater with frailty, but followed similar trajectories over 5 years between groups. Homecare receipt peaked in the first postoperative month (51.4% frailty, 43.1% no frailty), and plateaued by 1 year until 5 years (28.5% frailty, 12.8% no frailty). After 1 year, those with frailty required 4 more homecare days per month than without frailty (14 vs 10 days/month). After adjustment, frailty was associated with increased homecare receipt (hazard ratio 1.40; 95%CI 1.35-1.45), and increasing intensity each year (year 1 incidence rate ratio [IRR] 1.22, 95%CI 1.18-1.27 to year 5 IRR 1.47, 95%CI 1.35-1.59). The magnitude of the association of frailty with homecare receipt decreased with age (pinteraction <0.001). CONCLUSION While the trajectory of homecare receipt and intensity is similar between those with and without frailty, frailty is associated with increased receipt of homecare and increased intensity of homecare after cancer surgery across all age groups.
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Affiliation(s)
- Tyler R Chesney
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Barbara Haas
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Natalie Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E Davis
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Victoria Zuk
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Frances Wright
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada.
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Topriceanu CC, Wong A, Moon JC, Hughes AD, Bann D, Chaturvedi N, Patalay P, Conti G, Captur G. Evaluating access to health and care services during lockdown by the COVID-19 survey in five UK national longitudinal studies. BMJ Open 2021; 11:e045813. [PMID: 33737441 PMCID: PMC7978270 DOI: 10.1136/bmjopen-2020-045813] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/04/2021] [Accepted: 03/01/2021] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Access to health services and adequate care is influenced by sex, ethnicity, socioeconomic position (SEP) and the burden of comorbidities. Our study aimed to assess whether the COVID-19 pandemic further deepened these already existing health inequalities. DESIGN Cross-sectional study. SETTING Data were collected from five longitudinal age-homogenous British cohorts (born in 2000-2002, 1989-1990, 1970, 1958 and 1946). PARTICIPANTS A web survey was sent to the cohorts. Anybody who responded to the survey was included, resulting in 14 891 eligible participants. MAIN OUTCOMES MEASURED The survey provided data on cancelled surgical or medical appointments, and the number of care hours received in a week during the first UK COVID-19 national lockdown. INTERVENTIONS Using binary or ordered logistic regression, we evaluated whether these outcomes differed by sex, ethnicity, SEP and having a chronic illness. Adjustment was made for study design, non-response weights, psychological distress, presence of children or adolescents in the household, COVID-19 infection, key worker status, and whether participants had received a shielding letter. Meta-analyses were performed across the cohorts, and meta-regression was used to evaluate the effect of age as a moderator. RESULTS Women (OR 1.40, 95% CI 1.27 to 1.55) and those with a chronic illness (OR 1.84, 95% CI 1.65 to 2.05) experienced significantly more cancellations during lockdown (all p<0.0001). Ethnic minorities and those with a chronic illness required a higher number of care hours during the lockdown (both OR≈2.00, all p<0.002). SEP was not associated with cancellation or care hours. Age was not independently associated with either outcome in the meta-regression. CONCLUSION The UK government's lockdown approach during the COVID-19 pandemic appears to have deepened existing health inequalities, impacting predominantly women, ethnic minorities and those with chronic illnesses. Public health authorities need to implement urgent policies to ensure equitable access to health and care for all in preparation for a fourthwave.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Andrew Wong
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
- Cardiac Imaging Department, Barts Heart Center, London, UK
| | - Alun D Hughes
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - David Bann
- Center for Longitudinal Studies, Department of Social Science, University College London, London, UK
| | - Nishi Chaturvedi
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Praveetha Patalay
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Center for Longitudinal Studies, Department of Social Science, University College London, London, UK
| | - Gabriella Conti
- Department of Economics and UCL Social Research Institute, University College London, London, UK
| | - Gaby Captur
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Center for Inherited Heart Muscle Conditions, Cardiology Department, The Royal Free Hospital, London, UK
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Topriceanu CC, Wong A, Moon JC, Hughes AD, Bann D, Chaturvedi N, Patalay P, Conti G, Captur G. Evaluating access to health and care services during lockdown by the COVID-19 survey in five UK national longitudinal studies. BMJ Open 2021. [PMID: 33737441 DOI: 10.1101/2020.09.12.20191973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVE Access to health services and adequate care is influenced by sex, ethnicity, socioeconomic position (SEP) and the burden of comorbidities. Our study aimed to assess whether the COVID-19 pandemic further deepened these already existing health inequalities. DESIGN Cross-sectional study. SETTING Data were collected from five longitudinal age-homogenous British cohorts (born in 2000-2002, 1989-1990, 1970, 1958 and 1946). PARTICIPANTS A web survey was sent to the cohorts. Anybody who responded to the survey was included, resulting in 14 891 eligible participants. MAIN OUTCOMES MEASURED The survey provided data on cancelled surgical or medical appointments, and the number of care hours received in a week during the first UK COVID-19 national lockdown. INTERVENTIONS Using binary or ordered logistic regression, we evaluated whether these outcomes differed by sex, ethnicity, SEP and having a chronic illness. Adjustment was made for study design, non-response weights, psychological distress, presence of children or adolescents in the household, COVID-19 infection, key worker status, and whether participants had received a shielding letter. Meta-analyses were performed across the cohorts, and meta-regression was used to evaluate the effect of age as a moderator. RESULTS Women (OR 1.40, 95% CI 1.27 to 1.55) and those with a chronic illness (OR 1.84, 95% CI 1.65 to 2.05) experienced significantly more cancellations during lockdown (all p<0.0001). Ethnic minorities and those with a chronic illness required a higher number of care hours during the lockdown (both OR≈2.00, all p<0.002). SEP was not associated with cancellation or care hours. Age was not independently associated with either outcome in the meta-regression. CONCLUSION The UK government's lockdown approach during the COVID-19 pandemic appears to have deepened existing health inequalities, impacting predominantly women, ethnic minorities and those with chronic illnesses. Public health authorities need to implement urgent policies to ensure equitable access to health and care for all in preparation for a fourthwave.
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Affiliation(s)
- Constantin-Cristian Topriceanu
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Andrew Wong
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - James C Moon
- Institute of Cardiovascular Science, University College London, London, UK
- Cardiac Imaging Department, Barts Heart Center, London, UK
| | - Alun D Hughes
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - David Bann
- Center for Longitudinal Studies, Department of Social Science, University College London, London, UK
| | - Nishi Chaturvedi
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Praveetha Patalay
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Center for Longitudinal Studies, Department of Social Science, University College London, London, UK
| | - Gabriella Conti
- Department of Economics and UCL Social Research Institute, University College London, London, UK
| | - Gaby Captur
- School of Medicine, University College London, London, UK
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Center for Inherited Heart Muscle Conditions, Cardiology Department, The Royal Free Hospital, London, UK
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Mjørud M, Selbæk G, Bjertness E, Edwin TH, Engedal K, Knapskog AB, Strand BH. Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis. PLoS One 2020; 15:e0243513. [PMID: 33275638 PMCID: PMC7717539 DOI: 10.1371/journal.pone.0243513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/22/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times. Design Markov multistate survival analysis and flexible parametric models. Setting Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants’ address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data. Participants 2,938 home-dwelling persons with dementia, ages 40–97 years at time of diagnosis (mean 76.1, SD 8.5). Results During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group. Conclusion Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.
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Affiliation(s)
- Marit Mjørud
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- * E-mail:
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Espen Bjertness
- Faculty of Medicine, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Trine Holt Edwin
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut Engedal
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Bjørn Heine Strand
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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21
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Chesney TR, Haas B, Coburn NG, Mahar AL, Zuk V, Zhao H, Hsu AT, Hallet J. Immediate and Long-Term Health Care Support Needs of Older Adults Undergoing Cancer Surgery: A Population-Based Analysis of Postoperative Homecare Utilization. Ann Surg Oncol 2020; 28:1298-1310. [PMID: 32789531 DOI: 10.1245/s10434-020-08992-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/18/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Functional outcomes are central to decision-making by older adults (OA), but long-term risks after cancer surgery have not been described beyond 1 year for this population. This study aimed to evaluate long-term health care support needs by examining homecare use after cancer surgery for OA. METHODS This population-based study investigated adults 70 years of age or older with a new cancer diagnosis between 2007 and 2017 who underwent resection. The outcomes were receipt and intensity of homecare from postoperative discharge to 5 years after surgery. Time-to-event analysis with competing events was used. RESULTS Among 82,037 patients, homecare use was highest (43.7% of eligible patients) in postoperative month 1. The need for homecare subsequently decreased to stabilize between year 1 (13.9%) and year 5 (12.6%). Of the patients not receiving preoperative homecare, 10.9% became long-term users at year 5 after surgery. Advancing age, female sex, frailty, high-intensity surgery, more recent period of surgery, and receipt of preoperative homecare were associated with increased hazards of postoperative homecare. Intensity of homecare went from 10.3 to 10.1 days per patient-month between month 1 and year 1, reaching 12 days per patient-month at year 5. The type of homecare services changed from predominantly nursing care in year 1 (51.9%) to increasing personal support services from year 2 (69.6%) to year 5 (77.5%). CONCLUSION Receipt of homecare increased long-term after cancer surgery for OA, peaking in the first 6 months and plateauing thereafter at a new baseline. One tenth of the patients without preoperative homecare became long-term homecare users postoperatively, indicating changing health care needs focused on personal support services from year 2 to year 5.
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Affiliation(s)
- Tyler R Chesney
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Barbara Haas
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Natalie G Coburn
- Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Alyson L Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Victoria Zuk
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada. .,Sunnybrook Research Institute, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada.
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22
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Jeremic A, Nikolic D, Kostadinovic M, Milicevic MS. Predicting the Assisted Living Care Needs Using Machine Learning and Health State Survey Data. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5420-5423. [PMID: 33019206 DOI: 10.1109/embc44109.2020.9175661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Effective pain management can significantly improve quality of life and outcomes for various types of patients (e.g. elderly, adult, young) and often requires assisted living for a significant number of people worldwide. In order to improve our understanding of patients' response to pain and needs for assisted living we need to develop adequate data processing techniques that would enable us to understand underlying interdependencies. To this purpose in this paper we develop several different algorithms that can predict the need for medically assisted living outcomes using a large database obtained as a part of the national health survey. As a part of the survey the respondents provided detailed information about general health care state, acute and chronic problems as well as personal perception of pain associated with performing two simple talks: walking on the flat surface and walking upstairs. We model the correspondent responses using multinomial random variables and propose structured deep learning models based on maximum likelihood estimation and machine learning for information fusion. For comparison purposes we also implement fully connected deep learning network and use its results as benchmark measurements. We evaluate the performance of the proposed techniques using the national survey data and split them into two parts used for training and testing. Our preliminary results indicate that the proposed models can potentially be useful in forecasting the need for medically assisted living.
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23
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Aspell N, O'Sullivan M, O'Shea E, Irving K, Duffy C, Gorman R, Warters A. Predicting admission to long-term care and mortality among community-based, dependent older people in Ireland. Int J Geriatr Psychiatry 2019; 34:999-1007. [PMID: 30901483 PMCID: PMC6619240 DOI: 10.1002/gps.5101] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 03/17/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify factors that predict admission to long-term care (LTC) and mortality among community-based, dependent older people in Ireland, who were in receipt of formal home support. METHODS An audit was conducted of all community-dwelling older adults receiving government funded home support during 2017 in the Dublin North Central, Health Service Executive administrative area. Data were extracted from the Common Summary Assessment Report (CSAR), a mandatory form used in the provision of home support. Multiple logistic regression analysis was used to examine the factors associated with admission to LTC and mortality, with the results presented as odds ratios (OR) and 95% confidence intervals. RESULTS The audit comprised 1597 community-dwelling older adults with a mean age of 83.3 (SD: 7.2) years. The prevalence of transition to LTC and mortality was 8% and 9%, respectively, during the 12-month period. Factors significantly associated with admission to LTC were "cognitive dysfunction" [OR 2.10 (1.41-3.14), P < .001] and the intensity of home support [OR 1.05 (1.01-1.06), P < .003], as measured by weekly formal care hours. Physical dependency and advanced age (aged 95 years +) were significantly associated with mortality in this population (P < .001). CONCLUSION "Cognitive dysfunction" and intensity of formal home support were associated with transition to LTC, while physical dependency and advanced age were associated with mortality. Investment in personalised, cognitive-specific, services and supports are necessary to keep people with dementia and related cognitive impairments living at home for longer.
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Affiliation(s)
- Niamh Aspell
- North Dublin Homecare Ltd.DublinIreland,Services for Older People, Health Service ExecutiveCommunity Healthcare Organisation, Ballymun Healthcare FacilityDublinIreland
| | - Maria O'Sullivan
- Trinity College Dubin, Centre for Health SciencesSt. James' HospitalDublinIreland
| | - Eamon O'Shea
- Centre for Economic and Social Research on DementiaNational University of IrelandGalwayIreland
| | - Kate Irving
- School of Nursing and Human SciencesDublin City UniversityDublinIreland
| | - Chloe Duffy
- Trinity College Dubin, Centre for Health SciencesSt. James' HospitalDublinIreland
| | - Rebecca Gorman
- Trinity College Dubin, Centre for Health SciencesSt. James' HospitalDublinIreland
| | - Austin Warters
- Services for Older People, Health Service ExecutiveCommunity Healthcare Organisation, Ballymun Healthcare FacilityDublinIreland
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