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Horstman MJ, Evans TL, Guo C, Sonnenfeld M, Naik AD, Stevens A, Kunik ME. Needs of family caregivers of hospitalised adults with dementia during care transitions: a qualitative study in a US Department of Veterans Affairs Hospital. BMJ Open 2024; 14:e087231. [PMID: 39174071 PMCID: PMC11340712 DOI: 10.1136/bmjopen-2024-087231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/31/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVE To identify the needs of caregivers of hospitalised adults with dementia in the hospital and during care transitions. DESIGN Pragmatic qualitative inquiry with semi-structured interviews. SETTING Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, USA. PARTICIPANTS 12 family caregivers (family member (n=11); friend (n=1)) and 15 health professionals (hospital medicine physicians (n=4), inpatient nurse case managers (n=2), social workers (n=4), outpatient geriatrics providers (n=2), a primary care provider (n=1), geriatric psychiatrists (n=2)) were interviewed. Caregivers were recruited while their care recipient was hospitalised and were interviewed at least 2 weeks after the care recipient was discharged from the hospital. Health professionals were eligible for the study if they provided care to patients with dementia in the inpatient or outpatient setting. RESULTS Four recommendations emerged from the analysis: (1) engage caregivers as partners in the care team, (2) provide dementia-specific information and training, (3) connect caregivers to home and community-based services and (4) provide care navigation and support for the caregiver posthospitalisation. CONCLUSIONS Hospital care transitions are challenging for caregivers of hospitalised adults living with dementia. Care transition interventions designed to support caregivers with tailored, dementia-specific information and services are needed.
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Affiliation(s)
- Molly J Horstman
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Tracy L Evans
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Crystal Guo
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Mandi Sonnenfeld
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Aanand D Naik
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
- Institute on Aging, University of Texas Health Science Center, Houston, Texas, USA
| | - Alan Stevens
- Department of Medicine, Baylor Scott and White Health, Temple, Texas, USA
| | - Mark E Kunik
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
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Mah J, Rockwood K, Stevens S, Keefe J, Andrew MK. Do Interventions Reducing Social Vulnerability Improve Health in Community Dwelling Older Adults? A Systematic Review. Clin Interv Aging 2022; 17:447-465. [PMID: 35431543 PMCID: PMC9012306 DOI: 10.2147/cia.s349836] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Social vulnerability occurs when individuals have been relatively disadvantaged by the social determinants of health. Complex interventions that reduce social vulnerability have the potential to improve health in older adults but robust evidence is lacking. Objective To identify, appraise and synthesize evidence on the effectiveness of complex interventions targeting reduction in social vulnerability for improving health related outcomes (mortality, function, cognition, subjective health and healthcare use) in older adults living in the community. Methods A mixed methods systematic review was conducted. Five databases and targeted grey literature were searched for primary studies of all study types according to predetermined criteria. Data were extracted from each distinct intervention and quality was assessed using the Mixed Methods Appraisal Tool. Effectiveness data were synthesized using vote counting by direction of effect, combining p values and Albatross plots. Results Across 38 included studies, there were 34 distinct interventions categorized as strengthening social supports and communities, helping older adults and their caregivers navigate health and social services, enhancing neighbourhood and built environments, promoting education and providing economic stability. There was evidence to support positive influences on function, cognition, subjective health, and reduced hospital utilization. The evidence was mixed for non-hospital healthcare utilization and insufficient to determine effect on mortality. Conclusion Despite high heterogeneity and varying quality of studies, attention to reducing an older adult's social vulnerability assists in improving older adults' health.
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Affiliation(s)
- Jasmine Mah
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Susan Stevens
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Janice Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Melissa K Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
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Bouldin ED, Taylor CA, Knapp KA, Miyawaki CE, Mercado NR, Wooten KG, McGuire LC. Unmet needs for assistance related to subjective cognitive decline among community-dwelling middle-aged and older adults in the US: prevalence and impact on health-related quality of life. Int Psychogeriatr 2021; 33:689-702. [PMID: 32883384 PMCID: PMC8630807 DOI: 10.1017/s1041610220001635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To estimate the prevalence of unmet needs for assistance among middle-aged and older adults with subjective cognitive decline (SCD) in the US and to evaluate whether unmet needs were associated with health-related quality of life (HRQOL). DESIGN Cross-sectional. SETTING US - 50 states, District of Columbia, and Puerto Rico. PARTICIPANTS Community-dwelling adults aged 45 years and older who completed the Cognitive Decline module on the 2015--2018 Behavioral Risk Factor Surveillance System reported experiencing SCD and always, usually, or sometimes needed assistance with day-to-day activities because of SCD (n = 6,568). MEASUREMENTS We defined SCD as confusion or memory loss that was happening more often or getting worse over the past 12 months. Respondents with SCD were considered to have an unmet need for assistance if they sometimes, rarely, or never got the help they needed with day-to-day activities. We measured three domains of HRQOL: (1) mental (frequent mental distress, ≥14 days of poor mental health in the past 30 days), (2) physical (frequent physical distress, ≥14 days of poor physical health in the past 30 days), and (3) social (SCD always, usually, or sometimes interfered with the ability to work, volunteer, or engage in social activities outside the home). We used log-binomial regression models to estimate prevalence ratios (PRs). All estimates were weighted. RESULTS In total, 40.2% of people who needed SCD-related assistance reported an unmet need. Among respondents without depression, an unmet need was associated with a higher prevalence of frequent mental distress (PR = 1.55, 95% CI: 1.12-2.13, p = 0.007). Frequent physical distress and social limitations did not differ between people with met and unmet needs. CONCLUSIONS Middle-aged and older adults with SCD-related needs for assistance frequently did not have those needs met, which could negatively impact their mental health. Interventions to identify and meet the unmet needs among people with SCD may improve HRQOL.
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Affiliation(s)
- Erin D Bouldin
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| | - Christopher A Taylor
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kenneth A Knapp
- Department of Public Health, New York Medical College, Valhalla, NY, USA
| | | | - Nicholas R Mercado
- Department of Medicine, Donald and Barbara Zucker School of Medicine, Hofstra University/Northwell, Hempstead, NY, USA
- School of Health Professions and Human Services, Hofstra University, Hempstead, NY, USA
- Division of Medical Ethics, Northwell Health, New York, NY, USA
| | - Karen G Wooten
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lisa C McGuire
- Alzheimer's Disease and Healthy Aging Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kitzman H, DaGraca B, Mamun A, Collinsworth A, Halloran K, Masica A. Embedded Health Systems Science as a driver of care improvement within an integrated delivery organization. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2021; 8 Suppl 1:100497. [PMID: 34175103 DOI: 10.1016/j.hjdsi.2020.100497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 10/23/2020] [Accepted: 11/03/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Embedded Health Systems Science (HSS) has the potential to reduce gaps between research and delivery of evidence-based medicine. Models are needed to guide the development of embedded HSS in health care delivery organizations particularly with the rise of value-based care. METHODS The development of HSS infrastructure at a large nonprofit health care delivery organization is described, along with an embedded HSS diabetes study to illustrate the integration of program specific data, electronic health records, and health care system data infrastructure. To compare diabetes outcomes across four evidenced-based programs, a control group was developed from EHR data using propensity score matching. Mixed effect adjusted models were used to estimate reductions in hemoglobin A1c (HbA1c) and body weight. RESULTS Adjusted analyses using an EHR derived comparison group demonstrated significantly different findings than unadjusted pre to post analyses. The embedded HSS study indicates that appropriate statistical methods, staff with required expertise, and integration with health system data infrastructure are needed to develop timely and rigorous HSS outcomes that effectively improve patient care. CONCLUSIONS Embedded HSS has the potential to inform value-based care models and contribute to evidence-based medicine approaches that improve patient care. Although developing system wide integrated data structures and staff with the appropriate skills requires substantial effort, the outcome is more reliable evaluations that lead to higher quality and higher value care. IMPLICATIONS Health care delivery organizations can improve patient care by dedicating resources to embed HSS into its routine operations.
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Affiliation(s)
- Heather Kitzman
- Baylor Scott and White Health and Wellness Center, Baylor Scott and White Health, Dallas, TX, USA.
| | - Briget DaGraca
- Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, TX, USA
| | - Abdullah Mamun
- Baylor Scott and White Health and Wellness Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Ashley Collinsworth
- Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, TX, USA
| | - Kenneth Halloran
- Baylor Scott and White Health and Wellness Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Andrew Masica
- Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, TX, USA; Texas Health Resources, Arlington, TX, USA
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Coe NB, Konetzka RT, Berkowitz M, Blecker E, Van Houtven CH. The Effects of Home Care Provider Mix on the Care Recipient: An International, Systematic Review of Articles from 2000 to 2020. Annu Rev Public Health 2021; 42:483-503. [PMID: 33395544 DOI: 10.1146/annurev-publhealth-090419-102354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this systematic review, we examine the literature from 2000 to 2020 to ascertain whether we can make strong conclusions about the relative benefit of adding informal care or formal care providers to the care mix among individuals receiving care in the home, specifically focusing on care recipient outcomes. We evaluate how informal care and formal care affect (or are associated with) health care use of care recipients, health care costs of care recipients, and health outcomes of care recipients. The literature to date suggests that informal care, either alone or in concert with formal care, delivers improvements in the health and well-being of older adults receiving care. The conclusions one can draw about the effects of formal care are less clear.
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Affiliation(s)
- Norma B Coe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4884, USA; , ,
| | - R Tamara Konetzka
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois 60637-1447, USA;
| | - Melissa Berkowitz
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4884, USA; , ,
| | - Emily Blecker
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4884, USA; , ,
| | - Courtney H Van Houtven
- Department of Population Health Sciences, Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina 27708, USA; .,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, North Carolina 27705, USA
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Anderson EW, White KM. "This Is What Family Does": The Family Experience of Caring for Serious Illness. Am J Hosp Palliat Care 2017; 35:348-354. [PMID: 28662594 PMCID: PMC5768255 DOI: 10.1177/1049909117709251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: As the demographics of caregiving in United States evolve toward multigenerational, distributed family structures, the ways in which individuals and their families experience serious illness are changing. As part of a project to create an innovative model of supportive care for serious illness, a series of user interviews were conducted, forming the basis for this article. Objective: To understand the experience of caregiving for individuals with serious illness from an intergenerational family perspective. Methods: Twelve semistructured group interviews were conducted with patients, families, and professionals. Transcript data were analyzed with descriptive coding, looking for major themes and subthemes related to family experiences. Results: Seventy-three individuals participated in group interview sessions. While both families and individuals encountered caregiving challenges, the family unit experienced care in several unique ways. It accommodated differences in temperament and readiness, managed internal conflict, and strived to emerge as a cohesive unit. Individual struggles were often magnified or, more often, ameliorated by family context. Caregiving itself formed a legacy for future generations. Finally, care was seen as bidirectional, being tendered both by the family caregivers and in turn by the patient. Conclusions: When talking about care for serious illness, individuals report both rewards and challenges, often in a family context. The family enterprise manages a loved one’s care, negotiates the health-care system, and adjusts its own internal dynamics. Integrating the family narrative provides a more balanced view of the family system that provides the day-to-day care for individuals with serious illness.
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Affiliation(s)
- Eric W Anderson
- 1 Division of Applied Research, Late Life Supportive Care, Allina Health, Minneapolis, MN, USA
| | - Katie M White
- 2 Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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