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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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2
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Quinlan C, McKibbin C, Cuffney C, Brownson R, Brownson C, Clark J, Osvold L. Barriers to Aging in Place for Rural, Institutionalized Older Adults: A Qualitative Exploration. Clin Gerontol 2022; 45:1167-1179. [PMID: 32981469 DOI: 10.1080/07317115.2020.1820651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Although the majority of older adults wish to "age in place" in their communities, rural contexts pose challenges to maintaining long-term independence. The purpose of this study was to develop an understanding of the experiences of rural older adults who live in Skilled Nursing Facilities (SNFs) and thus have not aged in place. By retrospectively analyzing their pre-institution care situation, we aim to generate foundational knowledge on the barriers to aging in place in rural settings. METHODS A series of individual and group interviews was conducted in SNFs across seven rural communities. A grounded, thematic analysis was used to interpret interview findings, and coding was informed by the socio-ecological model (SEM). RESULTS Participants were 32 adults with a mean age of 72 years (SD = 5.7 years) and an average SNF residence of 3.9 years. Two themes emerged as primary barriers to successful aging in place: (1) Caregiver-related support issues and (2) Present focus, or lack of advanced care-planning. CONCLUSIONS Findings suggest the importance of specifically supporting caregivers, to ease burden and allow for increased agency for rural older adults. A lack of access to caregiver supports and other services limits the ability of community-dwelling rural older adults to age in place or plan for the future. CLINICAL IMPLICATIONS Existing networks of rural community resources and innovative solutions should be leveraged to improve access to services for older adults and their informal caregivers.
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Affiliation(s)
- Claire Quinlan
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
| | | | - Cari Cuffney
- Wyoming Department of Family Services, Cheyenne, Wyoming, USA
| | - Ross Brownson
- Division of Public Health Sciences and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carol Brownson
- Division of Public Health Sciences and Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeff Clark
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
| | - Lisa Osvold
- Aging Division, Department of Health, Cheyenne, Wyoming, USA
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3
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Bouzid W, Tavassoli N, Berbon C, Qassemi S, Bounes V, Azema O, Shourick J, Nourhashémi F. Impact of a personalised care plan for the elderly calling emergency medical services after a fall at home: The RISING-DOM multi-centre randomised controlled trial protocol. BMC Geriatr 2022; 22:182. [PMID: 35246053 PMCID: PMC8894840 DOI: 10.1186/s12877-022-02850-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 02/16/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A growing number of emergency calls are made each year for elderly people who fall. Many of them are not taken to hospital or are rapidly discharged from the Emergency Department (ED). Evidence shows that, with no further support, this vulnerable population is particularly at risk of injuries, dependency and death. This study aims to determine the effectiveness of a comprehensive geriatric assessment and a tailored intervention in the elderly calling on an Emergency Medical Service (EMS) for a fall at home, but not conveyed to the ED or rapidly discharged from it (less than 24 h from hospitalisation), to the time to institutionalisation or death. METHODS Rising-Dom is a two-arm randomised (ratio 1:1), interventional, multi-centre and open study. Community-dwelling elderly people (≥ 70 years) who call an EMS for a fall at home are recruited. The intervention group receives home visits by a nurse with a comprehensive fall risk assessment and a personalised intervention care plan with a planned follow-up (six nurse home visits and five nurse phone calls). Subjects enrolled in the usual care-control group continue to receive their routine care for the prevention or treatment of diseases. Primary (time to institutionalisation or death) and secondary (unscheduled hospitalisations, additional EMS calls relating to falls, functional decline and quality of life) outcome data will be collected for both groups through five phone calls made by Clinical Research Associates (CRA) blind to the participants' group during the follow-up period (24-months). Twelve hospital centres in the South-West of France are participating in the study as study sites. The inclusion period started in October 2019 and will end in March 2022. By the end of this period, 1,190 subjects are expected to be enrolled. DISCUSSION Studies on elderly home falls have rarely concerned people who were not taken to hospital. The Rising-Dom intervention scheme should enhance understanding of features related to this vulnerable population and investigate the impact of a nurse care at home on delaying death and institutionalisation. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT04132544. Registration date: 18/10/2019. SPONSOR University Hospital, Toulouse. https://www.clinicaltrials.gov/ct2/show/NCT04132544?term=rising-dom&draw=2&rank=1.
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Affiliation(s)
- Wafa Bouzid
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
| | - Neda Tavassoli
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Caroline Berbon
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Soraya Qassemi
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Vincent Bounes
- Pôle Médecine d'Urgence, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Olivier Azema
- Observatoire Régional Des Urgences d'Occitanie (ORU Occitanie), Hôpital La Grave, Place Lange, 31300, Toulouse, France
| | - Jason Shourick
- Unité de Soutien Méthodologique À La Recherche (USMR), Service d'Epidémiologie Clinique Et de Santé Publique, CHU de Toulouse, Toulouse, France
- CERPOP, UMR 1295, INSERM - Université de Toulouse III, Toulouse, France
| | - Fati Nourhashémi
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- CERPOP, UMR 1295, INSERM - Université de Toulouse III, Toulouse, France
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Blais AA, Tremblay C, Guarnaccia L, Tremblay L, Laflamme-Thibault S, Côté S, Tremblay P, Bouchard J, da Silva RA. The Importance of Adapting Functional Test Instructions for Older Adults with Neurocognitive Disorders. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2021.1920654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Audrey-Ann Blais
- Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Cynthia Tremblay
- Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Laury Guarnaccia
- Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Léane Tremblay
- Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Sandrine Laflamme-Thibault
- Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
| | - Sharlene Côté
- Centre intégré de santé et services sociaux du Saguenay-Lac-Saint-Jean (CIUSSS SLSJ), Saguenay, Québec, Canada
| | - Patrice Tremblay
- Centre intégré de santé et services sociaux du Saguenay-Lac-Saint-Jean (CIUSSS SLSJ), Saguenay, Québec, Canada
| | - Julie Bouchard
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Laboratoire de recherche BioNR, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
- Centre intégré de santé et services sociaux du Saguenay-Lac-Saint-Jean (CIUSSS SLSJ), Saguenay, Québec, Canada
| | - Rubens A. da Silva
- Programme de physiothérapie de l’Université McGill offert en extension à l’Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
- Département des Sciences de la Santé, Centre intersectoriel en santé durable, Laboratoire de recherche BioNR, Université du Québec à Chicoutimi (UQAC), Saguenay, Québec, Canada
- Centre intégré de santé et services sociaux du Saguenay-Lac-Saint-Jean (CIUSSS SLSJ), Saguenay, Québec, Canada
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Vieira ER, Cavalcanti FADC, Civitella F, Hollifield M, Caceres S, Carreno J, Gaillard T, Huffman FG, Mora JC, Queiroga MR. Effects of Exercise and Diet on Body Composition and Physical Function in Older Hispanics with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158019. [PMID: 34360312 PMCID: PMC8345658 DOI: 10.3390/ijerph18158019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022]
Abstract
Type 2 Diabetes mellitus (DM2) affects 9.3% of the U.S. population. Health disparities are evident in DM2; twice as many Hispanics as non-Hispanic Whites have DM2. The objective of this study was to pilot test the feasibility of implementing and evaluating trends of nutrition and exercise interventions to improve diabetes management and physical function in 29 disadvantaged older Hispanics with DM2. We delivered combined diet and exercise (n = 8) and diet-only (n = 6) interventions and compared the results to a control/no intervention group (n = 15). We cluster-randomized the participants into the three arms based on the senior center they attended. The interventions were delivered twice a week for 3 months (24 sessions) and assessments were conducted pre and post intervention. The results indicate the feasibility of implementing the interventions and slight improvements in both intervention groups compared to the control group. The diet-only group tended to have larger improvements on body composition measures (especially in muscle mass), while the diet + exercise group tended to have larger improvements on physical function (especially in chair stands). There was a high rate of attrition, especially in the diet + exercise group, but those who completed the intervention tended to have improvements in body composition and physical function.
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Affiliation(s)
- Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
- Correspondence:
| | | | - Fernanda Civitella
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
| | - Monica Hollifield
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33179, USA; (M.H.); (F.G.H.)
| | - Stephanie Caceres
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
| | - Jorge Carreno
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
| | - Trudy Gaillard
- Department of Undergraduate Nursing, Florida International University, Miami, FL 33179, USA;
| | - Fatma G. Huffman
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33179, USA; (M.H.); (F.G.H.)
| | - Jorge Camilo Mora
- Department of Humanities, Health and Society, Florida International University, Miami, FL 33179, USA;
| | - Marcos Roberto Queiroga
- Department of Physical Education, Midwestern Parana State University, Guarapuava 85040-167, PR, Brazil;
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Chaudhry YP, Puvanesarajah V, Oni JK, Sterling RS, Khanuja HS. A Fall Within 3 Months Before Total Joint Arthroplasty is Associated With Adverse Outcomes in Elderly Patients. J Arthroplasty 2021; 36:1246-1250. [PMID: 33190996 DOI: 10.1016/j.arth.2020.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/05/2020] [Accepted: 10/14/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Falls are associated with morbidity and death in the elderly. The consequences of falls after total joint arthroplasty (TJA) are known, but the consequences of preoperative falls are unclear. We assessed associations between preoperative fall history and hospital readmission rates and discharge disposition after primary TJA. METHODS We queried the National Surgical Quality Improvement Program Geriatric Pilot Project for cases of primary total hip arthroplasty (THA) (n = 3671) and total knee arthroplasty (TKA) (n = 6194) performed between 2014 and 2018 for patients aged ≥65 years. Patient characteristics, comorbidities, functional status indicators, and 30-day outcomes were compared among patients with falls occurring within 3 months, from >3 to 6 months, and from >6 to 12 months before surgery, and patients with no falls in the year before surgery. The timing of falls was assessed for independent associations with hospital readmission and discharge to a skilled care facility (SCF). Alpha = 0.05. RESULTS Patients who fell within 3 months before surgery had greater odds of SCF discharge (for THA, odds ratio [OR] 2.5, 95% confidence interval [CI] 1.8-3.4; for TKA, OR 1.8, 95% CI 1.4-2.3) and hospital readmission (for THA, OR 1.8, 95% CI 1.1-3.0; for TKA, OR 2.4, 95% CI 1.6-3.5) compared with the no-fall cohort. No such associations were observed for the other two fall cohorts. CONCLUSION Falls within 3 months before primary TJA are associated with SCF discharge and readmission for patients aged ≥65 years. Fall history screening should be included in preoperative evaluation. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yash P Chaudhry
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Varun Puvanesarajah
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Julius K Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Robert S Sterling
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD
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King BJ, Brown R, Steege L, Wang H, Kuo FL, Brown C. Ambulation Patterns Post-Discharge in Older Adults Identified as Fall Risk: A Descriptive Pilot Study. Res Gerontol Nurs 2019; 12:113-119. [DOI: 10.3928/19404921-20190131-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/03/2018] [Indexed: 11/20/2022]
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8
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Lubetkin EI, Jia H. Burden of disease due to sleep duration and sleep problems in the elderly. Sleep Health 2018; 4:182-187. [DOI: 10.1016/j.sleh.2017.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 12/15/2022]
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9
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Predicting long-term nursing home transfer from MI choice waiver program. Geriatr Nurs 2016; 37:446-452. [DOI: 10.1016/j.gerinurse.2016.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/13/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
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10
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Vieira ER, Tappen R, Engstrom G, da Costa BR. Rates and factors associated with falls in older European Americans, Afro-Caribbeans, African-Americans, and Hispanics. Clin Interv Aging 2015; 10:1705-10. [PMID: 26604718 PMCID: PMC4629952 DOI: 10.2147/cia.s91120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate rates and factors associated with older adult falls in different ethnic groups. PARTICIPANTS AND METHODS Information on demographics, medical and falls history, and pain and physical activity levels was collected from 550 community-dwelling older adults (75±9 years old, 222 European Americans, 109 Afro-Caribbeans, 106 African-Americans, and 113 Hispanics). RESULTS Taking medications for anxiety (risk ratio [RR] =1.4, 95% confidence interval [CI] =1.1-2.0), having incontinence (RR =1.4, 95% CI =1.1-1.8, P=0.013), back pain (RR =1.4, 95% CI =1.0-1.8), feet swelling (RR =1.3, 95% CI =1.1-1.7), and age ≥75 years (RR =1.3, 95% CI =1.0-1.6) were associated with falls. The associations were stronger for Afro-Caribbeans, but they presented approximately 40% lower prevalence of falls than the other groups. CONCLUSION Taking anxiety medication, incontinence, back pain, feet swelling, and age ≥75 years were associated with falls, and Afro-Caribbeans presented lower prevalence of falls. These findings need to be taken into consideration in clinical interventions in aging.
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Affiliation(s)
- Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, FL, USA ; Department of Neuroscience, Florida International University, Miami, FL, USA
| | - Ruth Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Gabriella Engstrom
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Bruno R da Costa
- Department of Physical Therapy, Florida International University, Miami, FL, USA
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Castora-Binkley M, Meng H, Hyer K. Predictors of Long-Term Nursing Home Placement Under Competing Risk: Evidence from the Health and Retirement Study. J Am Geriatr Soc 2014; 62:913-8. [DOI: 10.1111/jgs.12781] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Melissa Castora-Binkley
- School of Aging Studies; College of Behavioral and Community Sciences; University of South Florida; Tampa Florida
| | - Hongdao Meng
- School of Aging Studies; College of Behavioral and Community Sciences; University of South Florida; Tampa Florida
| | - Kathryn Hyer
- School of Aging Studies; College of Behavioral and Community Sciences; University of South Florida; Tampa Florida
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12
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A Model of Risk Reduction for Older Adults Vulnerable to Nursing Home Placement. Res Theory Nurs Pract 2014; 28:162-92. [DOI: 10.1891/1541-6577.28.2.162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Because of the cost of nursing home care and desire of older adults to stay in their homes, it is important for health care providers to understand the factors that place older adults at risk for nursing home placement. This integrative review of 12 years of research, as published in 148 articles, explores the risk factors for nursing home placement of older adults. Using the framework of the vulnerable populations conceptual model developed by Flaskerud and Winslow (1998), we explored factors related to resource availability, relative risks, and health status. Important factors include socioeconomic status, having a caregiver, the availability and use of home- and community-based support services, race, acute illness particularly if hospitalization is required, medications, dementia, multiple chronic conditions, functional disability, and falls. Few intervention studies were identified. Development of evidence-based interventions and creation of policies to address modifiable risk factors are important next steps.
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