Dementia care in Ontario, Canada: evidence of more timely diagnosis among persons with dementia receiving care at home compared with residential facilities

Identifying the long-term care beneficiaries: differences between risk factors of nursing homes and community-based services admissions

BACKGROUND

The Portuguese long-term care sector is classified into home and community-based services (HCBS) and three nursing home (NH) units: convalescence, medium term and rehabilitation, and long term and maintenance.

AIMS

To identify the main factors of admission into each care setting and explore to what extent these populations are different. 14,140 patients from NH and 6844 from HCBS were included from all over the country.

METHODS

A logistic regression was estimated to identify determinants of admission into NH care, using sociodemographic characteristics, medical conditions and dependence levels at admission as independent variables, and region of care, referral entity and placement process as control variables. Then, ordered logistic regression was used to identify the contribution of the above factors in each specific NH unit.

RESULTS

Being female, not being married, not having family/neighbour support, being literate, having mental illness, being cognitively or physically impaired are the main predictors of being admitted into a NH. Within the NH units, placements of the large majority of patients were accurately predicted, based on the available variables. However, for around half of the patients referred to long-term care units, the model expected placements into medium-term units, while for those admitted into short-stay units, the model returned that 29% could have benefited from being admitted into a medium-term care unit.

DISCUSSION AND CONCLUSIONS

Patients' accurate placement is a highly complex and challenging process, demanding more variables than the ones available for the model here presented. Our work confirms the need to collect other type of variables to improve the placement decision process.

Home care service utilisation by people with dementia-A retrospective cohort study of community nursing data in Australia

Progressive aged care reforms are shifting dementia care into the community. These efforts have been shown to prevent transition to residential aged care facilities and hospitals. There is a paucity of studies examining the utilisation of home care services for people living with dementia. This study aims to address the current knowledge gap by providing a comprehensive summary of older adults receiving home care and comparing service use for people with and without dementia. A retrospective secondary data analysis was conducted using routine data prospectively collected from a cohort (n = 2,703 with dementia matched to 9,224 without dementia; total 11,927) using a community home nursing service in metropolitan Melbourne, Australia, in 2014. Descriptive statistics compared individuals with and without dementia on client-level demographics and their episode of home care service use. A comparative analysis on select variables was also performed using a conditional Poisson regression to estimate relative risk (RR). Compared to older adults without dementia, people with dementia were more likely to be born overseas (RR 1.10, 95% CI [1.03-1.19]), require an interpreter (RR 1.41, 95% CI [1.26-1.59]), and live with family (RR 1.09 [1.01-1.16]). When examining an individual's episode of care, people with dementia were more likely to require acute care (RR 1.07, 95% CI [1.01-1.14]) and be discharged from home care with personal care services (RR 1.46, 95% CI [1.24-1.72]). People with dementia were less likely to be referred from a hospital (RR 0.73, 95% CI [0.69-0.77]), achieve their home care goals (RR 0.91, 95% CI [0.87-0.94]), or die while in receipt of home care services (RR 0.82, 95% CI [0.72-0.94]). Our findings suggest that people with dementia have different socio-demographic characteristics and interactions with home care services compared to people without dementia.

Is There an Association between Physical Activity and Sleep in Community-Dwelling Persons with Dementia: An Exploratory Study Using Self-Reported Measures?

Sleep disturbances are common in persons with dementia (PWD). While pharmacotherapy is widely used, non-pharmacological interventions are beginning to surface as first-line management strategies. This study sought to investigate if physical activity was associated with more favourable sleep patterns in PWD, and to compare the sleep quantity and quality between active and inactive PWD. We conducted an exploratory study to tackle these research questions. Self-reported telephone questionnaires were administered to 40 caregivers of PWD, who answered questions as proxies on behalf of their care recipient. Just over half (55%) of our participants met the criteria for being active. Walking was the most popular form of physical activity for both active and inactive PWD. Active PWD also preferred exercise classes and gardening, whereas inactive PWD favoured chair exercises. Compared to their inactive counterparts, active PWD were more likely to experience appropriate sleep quantity (p = 0.00). The active group also reported significantly better overall sleep quality (p = 0.003). Together, our findings suggest that physical activity may be associated with improved sleep in PWD. Future studies are warranted to investigate whether physical activity can be promoted as a safe and effective means to improve quality-of-life in this population.

No Place Like Home: A Systematic Review of Home Care for Older Adults in Canada

Les prévisions liées au vieillissement de la population canadienne impliquent que la demande en soins à domicile augmentera significativement. À ce jour, peu d’études ont été menées au Canada sur les soins à domicile pour les personnes âgées, notamment sur les caractéristiques des bénéficiaires de soins à domicile, les lacunes dans les services, ou les interventions permettant de répondre aux besoins des clients en matière de soins à domicile. Une revue systématique de sept bases de données électroniques a été réalisée pour les années 2000-2016 afin d’examiner les connaissances actuelles dans le domaine des soins à domicile pour les personnes âgées au Canada. Cette synthèse était centrée sur quatre principaux thèmes retrouvés dans la littérature : les prédicteurs au niveau de la personne âgée, les besoins de soins non comblés, les interventions, les enjeux et les défis dans les soins à domicile. Cette revue a mis en évidence plusieurs lacunes dans les connaissances liées aux soins à domicile pour les personnes âgées au Canada, considérant que plus de la moitié des études étaient centrées sur le contexte ontarien. Bien que des stratégies prometteuses aient été mises en évidence, davantage de recherche et d’évaluation des interventions et des résultats sont requises pour appuyer efficacement le système de soins à domicile au Canada, à court et à long terme.