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Tay R, Tan JY, Lim B, Hum AY, Simpson J, Preston N. Factors associated with the place of death of persons with advanced dementia: A systematic review of international literature with meta-analysis. Palliat Med 2024; 38:896-922. [PMID: 39092850 DOI: 10.1177/02692163241265231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND Many individuals with advanced dementia die in hospital, despite preferring home death. Existing evidence of factors affecting their place of death is inconsistent. To inform policies/practices for meeting needs/preferences, systematically establishing the evidence is pertinent, particularly given the exponential rise in advanced dementia prevalence. AIM To identify factors influencing where people with advanced dementia die. DESIGN AND DATA SOURCES This systematic review with meta-analysis was registered on PROSPERO (CRD42022366722). Medline, CINAHL, PsycINFO, SocINDEX and a grey literature database, Overton, were searched on 21/12/2022, supplemented by hand-searching/citation tracking. Papers reporting quantitative data on factors associated with place of death in advanced dementia were included and appraised using QualSyst. Data were analysed using random effects with the certainty of evidence determined using the GRADE criteria. RESULTS Thirty-three papers involving >5 million individuals (mean age = 89.2 years) were included. Long-term care setting deaths were relatively common but hospice deaths were rarer. Marriage's association with home death underscores social networks' importance, while younger age's and male gender's associations with hospital death demonstrate patients' and families' interdependency. Pneumonia/COPD's opposing effects on hospital deaths with cancer/functional impairment highlight the challenges of advanced dementia care. Unlike hospital/nursing home bed availability's lack of effect, capitated funding (fixed-amount-per-patient-per-period) decreased hospital death likelihood. CONCLUSION This comprehensive review of place of death determinants highlight the profound challenges of advanced dementia end-of-life care. Given that bed capacity did not affect place of death, a capitation-based, integrated palliative care model would appear more likely to meet patients' needs in a resource-constrained environment.
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Affiliation(s)
- RiYin Tay
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
- The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
- Dover Park Hospice, Singapore, Singapore
| | - Joyce Ys Tan
- The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - BinYan Lim
- The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore
| | - Allyn Ym Hum
- The Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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Kostev K, Michalowsky B, Bohlken J. In-Hospital Mortality in Patients with and without Dementia across Age Groups, Clinical Departments, and Primary Admission Diagnoses. Brain Sci 2024; 14:455. [PMID: 38790435 PMCID: PMC11118056 DOI: 10.3390/brainsci14050455] [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: 03/22/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Studies have reported higher in-hospital mortality rates in patients living with dementia (PlwD) with limited evidence across age groups, clinical departments, and admission diagnoses. The aim of this study was to compare the in-hospital mortality rate of PlwD with patients without dementia across groups, clinical departments, and admission diagnoses. METHODS This case-control study included patients aged ≥ 60 years hospitalized in 1 of 14 German hospitals between January 2019 and July 2023. PlwD were matched to patients without dementia. The associations between dementia and in-hospital mortality across groups were assessed using univariable logistic regression analyses. RESULTS 15,956 patients with and 15,956 without dementia were included (mean age: 83.9 years, 60.7% female). PlwD had a significantly higher in-hospital mortality rate (14.0% vs. 11.7%; OR 1.24, 95% CI: 1.16-1.32) than non-dementia controls. The highest excess mortality rate was observed in the youngest age group (60-70 years: 10.9% vs. 5.7%; OR: 2.05, 95% CI: 1.30-3.24), decreased with age, and became non-significant in the oldest age group (≥90 years: 16.2% vs. 17.3%; OR: 0.93, 95% CI: 0.80-1.08). Significant differences were found for digestive system disorders (OR: 1.59; 95% CI: 1.15-1.89), cardiovascular and cerebrovascular disorders (OR: 1.51; 95% CI: 1.30-1.75), endocrine, nutritional, and metabolic diseases (OR: 1.42; 95% CI: 1.06-1.90), and pneumonia (OR: 1.20; 95% CI: 1.04-1.37), as well as for all clinic departments except for geriatric departments. CONCLUSION The excess mortality rate was highest in younger age groups, where the general mortality and complication rate is relatively low in the general population. Appropriate approaches are needed, especially in non-geriatric wards.
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Affiliation(s)
- Karel Kostev
- Epidemiology, IQVIA, 60549 Frankfurt, Germany
- University Clinic, Philipps-University, 35043 Marburg, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock/Greifswald, Patient-Reported Outcomes & Health Economics Research, 17487 Greifswald, Germany
| | - Jens Bohlken
- Institute of Social Medicine, Occupational Health and Public Health, Faculty of Medicine, 04103 Leipzig, Germany
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O'Sullivan A, Alvariza A, Öhlén J, Ex Håkanson CL. The influence of care place and diagnosis on care communication at the end of life: bereaved family members' perspective. Palliat Support Care 2021; 19:664-671. [PMID: 33781369 DOI: 10.1017/s147895152100016x] [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: 11/05/2022]
Abstract
OBJECTIVE To investigate the influence of care place and diagnosis on care communication during the last 3 months of life for people with advanced illness, from the bereaved family members' perspective. METHOD A retrospective survey design using the VOICES(SF) questionnaire with a sample of 485 bereaved family members (aged: 20-90 years old, 70% women) of people who died in hospital was employed to meet the study aim. RESULTS Of the deceased people, 79.2% had at some point received care at home, provided by general practitioners (GPs) (52%), district nurses (36.7%), or specialized palliative home care (17.9%), 27.4% were cared for in a nursing home and 15.7% in a specialized palliative care unit. The likelihood of bereaved family members reporting that the deceased person was treated with dignity and respect by the staff was lowest in nursing homes (OR: 0.21) and for GPs (OR: 0.37). A cancer diagnosis (OR: 2.36) or if cared for at home (OR: 2.17) increased the likelihood of bereaved family members reporting that the deceased person had been involved in decision making regarding care and less likely if cared for in a specialized palliative care unit (OR: 0.41). The likelihood of reports of unwanted decisions about the care was higher if cared for in a nursing home (OR: 1.85) or if the deceased person had a higher education (OR: 2.40). SIGNIFICANCE OF RESULTS This study confirms previous research about potential inequalities in care at the end of life. The place of care and diagnosis influenced the bereaved family members' reports on whether the deceased person was treated with respect and dignity and how involved the deceased person was in decision making regarding care.
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Affiliation(s)
- Anna O'Sullivan
- Department of Healthcare Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anette Alvariza
- Department of Healthcare Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Stockholm, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
- The Palliative Centre, Sahlgrenska University Hospital Västra Götaland Region, Gothenburg, Sweden
| | - Cecilia Larsdotter Ex Håkanson
- Department of Healthcare Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
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Janbek J, Taudorf L, Musaeus CS, Frimodt-Møller N, Laursen TM, Waldemar G. Increased short- and long-term mortality following infections in dementia: a nationwide registry-based cohort study. Eur J Neurol 2020; 28:411-420. [PMID: 33065766 DOI: 10.1111/ene.14595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Mortality following infections in dementia has not yet been comprehensively explored. The aim of this cohort study was to investigate the short- and long-term mortality following infections in dementia. METHODS Follow-up was from 1 January 2000 or the 65-year birthday until death, immigration, or 31 December 2015. Exposure was incident dementia and a first infection. The outcome was all-cause mortality. Mortality rate ratios (MRRs) were calculated using Poisson regression in 4 exposure groups (dementia yes/no, infection yes/no) by sex, infection site, and time since infection. RESULTS 1,496,436 people were followed with 12,739,135 person-years. MRR in dementia/infection was 6.52 (95% confidence interval: 6.43-6.60) and was increased for infections of all sites. Increased mortality was short term (30 days) and long term (10 years). CONCLUSIONS Increased mortality in people with dementia identifies them as a particularly vulnerable group that needs clinical attention.
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Affiliation(s)
- J Janbek
- Danish Dementia Research Centre, Section 8007, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - L Taudorf
- Danish Dementia Research Centre, Section 8007, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - C S Musaeus
- Danish Dementia Research Centre, Section 8007, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - N Frimodt-Møller
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - T M Laursen
- National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - G Waldemar
- Danish Dementia Research Centre, Section 8007, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Davies JM, Sleeman KE, Leniz J, Wilson R, Higginson IJ, Verne J, Maddocks M, Murtagh FEM. Socioeconomic position and use of healthcare in the last year of life: A systematic review and meta-analysis. PLoS Med 2019; 16:e1002782. [PMID: 31013279 PMCID: PMC6478269 DOI: 10.1371/journal.pmed.1002782] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/14/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Low socioeconomic position (SEP) is recognized as a risk factor for worse health outcomes. How socioeconomic factors influence end-of-life care, and the magnitude of their effect, is not understood. This review aimed to synthesise and quantify the associations between measures of SEP and use of healthcare in the last year of life. METHODS AND FINDINGS MEDLINE, EMBASE, PsycINFO, CINAHL, and ASSIA databases were searched without language restrictions from inception to 1 February 2019. We included empirical observational studies from high-income countries reporting an association between SEP (e.g., income, education, occupation, private medical insurance status, housing tenure, housing quality, or area-based deprivation) and place of death, plus use of acute care, specialist and nonspecialist end-of-life care, advance care planning, and quality of care in the last year of life. Methodological quality was evaluated using the Newcastle-Ottawa Quality Assessment Scale (NOS). The overall strength and direction of associations was summarised, and where sufficient comparable data were available, adjusted odds ratios (ORs) were pooled and dose-response meta-regression performed. A total of 209 studies were included (mean NOS quality score of 4.8); 112 high- to medium-quality observational studies were used in the meta-synthesis and meta-analysis (53.5% from North America, 31.0% from Europe, 8.5% from Australia, and 7.0% from Asia). Compared to people living in the least deprived neighbourhoods, people living in the most deprived neighbourhoods were more likely to die in hospital versus home (OR 1.30, 95% CI 1.23-1.38, p < 0.001), to receive acute hospital-based care in the last 3 months of life (OR 1.16, 95% CI 1.08-1.25, p < 0.001), and to not receive specialist palliative care (OR 1.13, 95% CI 1.07-1.19, p < 0.001). For every quintile increase in area deprivation, hospital versus home death was more likely (OR 1.07, 95% CI 1.05-1.08, p < 0.001), and not receiving specialist palliative care was more likely (OR 1.03, 95% CI 1.02-1.05, p < 0.001). Compared to the most educated (qualifications or years of education completed), the least educated people were more likely to not receive specialist palliative care (OR 1.26, 95% CI 1.07-1.49, p = 0.005). The observational nature of the studies included and the focus on high-income countries limit the conclusions of this review. CONCLUSIONS In high-income countries, low SEP is a risk factor for hospital death as well as other indicators of potentially poor-quality end-of-life care, with evidence of a dose response indicating that inequality persists across the social stratum. These findings should stimulate widespread efforts to reduce socioeconomic inequality towards the end of life.
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Affiliation(s)
- Joanna M. Davies
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Katherine E. Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Javiera Leniz
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Rebecca Wilson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Julia Verne
- Health Intelligence, Public Health England, Bristol, United Kingdom
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
| | - Fliss E. M. Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, United Kingdom
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
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Nakanishi M, Yamasaki S, Nishida A. In-hospital dementia-related deaths following implementation of the national dementia plan: observational study of national death certificates from 1996 to 2016. BMJ Open 2018; 8:e023172. [PMID: 30559156 PMCID: PMC6303640 DOI: 10.1136/bmjopen-2018-023172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine changes in places of dementia-related death following implementation of the national dementia plan and other policy initiatives. DESIGN Observational study. SETTING Japan between October 1996 and September 2016. Four major changes in health and social care systems were identified: (1) the public long-term care insurance programme (April 2000); (2) community centres as a first access point for older residents (April 2006); (3) medical care system for older people (April 2008) and (4) the national dementia plan (April 2013). PARTICIPANTS 9 60 423 decedents aged 65 years or older whose primary cause of death was Alzheimer's disease, vascular or other types of dementia or senility. MAIN OUTCOME MEASURES Place of death which was classified into 'hospital', 'intermediate geriatric care facility' (rehabilitation facility aimed at home discharge), 'nursing home' or 'own home'. RESULTS The annual number of deaths at hospital was consistently increased over time from 1996 to 2016 (age-adjusted OR: 6.01; 95% CI 5.81 to 6.21 versus home deaths). Controlling for individual characteristics, regional supply of hospital and nursing home beds and other changes in health and social care systems, death from dementia following the national dementia plan was likely to occur in hospital (adjusted OR: 1.21; 95% CI 1.18 to 1.24), intermediate geriatric care facility (adjusted OR: 1.53; 95% CI 1.48 to 1.58) or nursing home (adjusted OR: 1.64; 95% CI 1.60 to 1.69) rather than at home. CONCLUSIONS As the number of deaths from dementia increased over the decades, in-hospital deaths increased regardless of the national dementia plan. Further strategies should be explored to improve the availability of palliative and end-of-life care at patients' places of residence.
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Affiliation(s)
- Miharu Nakanishi
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Syudo Yamasaki
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Atsushi Nishida
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Fogg C, Griffiths P, Meredith P, Bridges J. Hospital outcomes of older people with cognitive impairment: An integrative review. Int J Geriatr Psychiatry 2018; 33:1177-1197. [PMID: 29947150 PMCID: PMC6099229 DOI: 10.1002/gps.4919] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 04/03/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To summarise existing knowledge of outcomes of older hospital patients with cognitive impairment, including the type and frequency of outcomes reported, and the additional risk experienced by this patient group. METHODS Integrative literature review. Health care literature databases, reports, and policy documents on key websites were systematically searched. Papers describing the outcomes of older people with cognitive impairment during hospitalisation and at discharge were analysed and summarised using integrative methods. RESULTS One hundred four articles were included. A range of outcomes were identified, including those occurring during hospitalisation and at discharge. Older people with a dementia diagnosis were at higher risk from death in hospital, nursing home admission, long lengths of stay, as well as intermediate outcomes such as delirium, falls, dehydration, reduction in nutritional status, decline in physical and cognitive function, and new infections in hospital. Fewer studies examined the relationship of all-cause cognitive impairment with outcomes. Patient and carer experiences of hospital admission were often poor. Few studies collected data relating to hospital environment, eg, ward type or staffing levels, and acuity of illness was rarely described. CONCLUSIONS Older people with cognitive impairment have a higher risk of a variety of negative outcomes in hospital. Prevalent intermediate outcomes suggest that changes in care processes are required to ensure maintenance of fundamental care provision and greater attention to patient safety in this vulnerable group. More research is required to understand the most appropriate ways of doing this and how changes in these care processes are best implemented to improve hospital outcomes.
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Affiliation(s)
- Carole Fogg
- Research and InnovationPortsmouth Hospitals NHS TrustPortsmouthUK
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
- School of Health Sciences and Social Work, Faculty of ScienceUniversity of PortsmouthPortsmouthUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Peter Griffiths
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
| | - Paul Meredith
- Research and InnovationPortsmouth Hospitals NHS TrustPortsmouthUK
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
| | - Jackie Bridges
- National Institute of Health Research Collaboration for Leadership in Applied Health Research and CareWessexUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
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Moon F, McDermott F, Kissane D. Systematic Review for the Quality of End-of-Life Care for Patients With Dementia in the Hospital Setting. Am J Hosp Palliat Care 2018; 35:1572-1583. [DOI: 10.1177/1049909118776985] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Patients with dementia may receive suboptimal end-of-life care in hospital settings reflecting broader debate around the palliative status of dementia syndromes. Objectives: To synthesize literature describing the quality of end-of-life care for patients with dementia dying in hospital. Methods: An integrative review assessed the quality of 26 articles concerning medical, nursing, and psychosocial care of patients with dementia dying in hospital settings. Results: Literature reflects a growing awareness of the need to consider a palliative approach to end-of-life care for patients with dementia in hospital. Patients with dementia are less likely to receive aggressive care at the end of life, but provision of palliative care interventions is inconsistent. Health-care professionals highlighted the need for greater education around identification and management of problematic symptoms at the end of life. Engagement of family caregivers is essential in optimizing end-of-life care, and further research is required to ascertain their experiences around decision-making. Conclusion: Although patients with dementia appear to receive less aggressive treatment at the end of life, the provision of palliative care and symptom management may be inadequate.
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Affiliation(s)
- Felicity Moon
- Department of Social Work, Monash Health And Monash University, Caulfield, Victoria, Australia
| | - Fiona McDermott
- Department of Social Work, Monash University, Caulfield East, Victoria, Australia
| | - David Kissane
- Department of Psychiatry, Monash Health and Monash University, Clayton, Victoria, Australia
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Nakanishi M, Niimura J, Nishida A. Factors associated with end-of-life by home-visit nursing-care providers in Japan. Geriatr Gerontol Int 2016; 17:991-998. [DOI: 10.1111/ggi.12822] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/06/2016] [Accepted: 04/07/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Miharu Nakanishi
- Mental Health and Nursing Research Team, Department of Psychiatry and Behavioral Science; Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
| | - Junko Niimura
- Mental Health and Nursing Research Team, Department of Psychiatry and Behavioral Science; Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
| | - Atsushi Nishida
- Mental Health Promotion Project, Department of Psychiatry and Behavioral Science; Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
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Reyniers T, Deliens L, Pasman HR, Morin L, Addington-Hall J, Frova L, Cardenas-Turanzas M, Onwuteaka-Philipsen B, Naylor W, Ruiz-Ramos M, Wilson DM, Loucka M, Csikos A, Rhee YJ, Teno J, Cohen J, Houttekier D. International Variation in Place of Death of Older People Who Died From Dementia in 14 European and non-European Countries. J Am Med Dir Assoc 2015; 16:165-71. [DOI: 10.1016/j.jamda.2014.11.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/04/2014] [Indexed: 11/25/2022]
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Rolland Y, Resnick B, Katz PR, Little MO, Ouslander JG, Bonner A, Geary CR, Schumacher KL, Thompson S, Martin FC, Wilbers J, Zúñiga F, Ausserhofer D, Schwendimann R, Schüssler S, Dassen T, Lohrmann C, Levy C, Whitfield E, de Souto Barreto P, Etherton-Beer C, Dilles T, Azermai M, Bourgeois J, Orrell M, Grossberg GT, Kergoat H, Thomas DR, Visschedijk J, Taylor SJ, Handajani YS, Widjaja NT, Turana Y, Rantz MJ, Skubic M, Morley JE. Nursing Home Research: The First International Association of Gerontology and Geriatrics (IAGG) Research Conference. J Am Med Dir Assoc 2014; 15:313-25. [DOI: 10.1016/j.jamda.2014.03.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/07/2014] [Indexed: 11/25/2022]
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