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Kreitzer N, Fink S, Adeoye O, Kurowski G B, Wade S, Sucharew H, Bakas T. Caregiver Wellness after Traumatic Brain Injury (CG-Well): Protocol for a randomized clinical trial. Contemp Clin Trials Commun 2024; 41:101356. [PMID: 39280784 PMCID: PMC11400608 DOI: 10.1016/j.conctc.2024.101356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 08/01/2024] [Accepted: 08/22/2024] [Indexed: 09/18/2024] Open
Abstract
Introduction After injury, survivors of moderate to severe traumatic brain injury (msTBI) depend on informal family caregivers. Upwards of 77 % of family caregivers experience poor outcomes, such as adverse life changes, poor health-related quality of life, and increased depressive symptoms. Caregivers frequently report minimal support or training to prepare them for their new role. The majority of previously developed caregiver and caregiver/survivor dyad interventions after msTBI focus on providing information to either survivors only, or to long-term caregivers, rather than to the new caregiver. This manuscript describes the protocol of an ongoing randomized control trial, Caregiver Wellness after TBI (CG-Well), developed to provide education, support, and skill-building to caregivers of adults with msTBI, beginning when the survivor is early in the clinical course. Methods Within two weeks of admission to the ICU, participants are randomized to CG-Well online modules (intervention group, n = 50 dyads) or information, support, and referral (ISR) e-bulletins that exist in the public domain (control group, n = 50 dyads) over the first six months after their family member's msTBI. Both groups receive regular phone calls. The primary outcome is intervention satisfaction at six months. Results Enrollment began in March 2022 and is projected to complete October 2024. We have enrolled approximately 70 % of participants at this time. Primary analysis completion is anticipated April 2025. Discussion This RCT is designed to evaluate caregiver satisfaction by addressing the need for tailored supportive care for caregivers of msTBI beginning during the ICU admission. Trial registration Clinicaltrials. gov Registration Number: NCT05307640.
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Affiliation(s)
- Natalie Kreitzer
- Department of Emergency Medicine, University of Cincinnati, Medical Sciences Building Room 1654 231, Albert Sabin Way, PO Box 670769, Cincinnati, OH, 45267-0769, USA
| | - Stephanie Fink
- Department of Emergency Medicine, University of Cincinnati, Medical Sciences Building Room 1654 231, Albert Sabin Way, PO Box 670769, Cincinnati, OH, 45267-0769, USA
| | - Opeolu Adeoye
- Department of Emergency Medicine, Washington University, 660 S. Euclid Ave., Campus Box 8072, Saint Louis, MO, 63110, USA
| | - Brad Kurowski G
- Departments of Pediatrics and Neurology and Rehabilitation Medicine, Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3026, USA
| | - Shari Wade
- Departments of Pediatrics and Neurology and Rehabilitation Medicine, Division of Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3026, USA
| | - Heidi Sucharew
- Department of Emergency Medicine, University of Cincinnati, Medical Sciences Building Room 1654 231, Albert Sabin Way, PO Box 670769, Cincinnati, OH, 45267-0769, USA
| | - Tamilyn Bakas
- College of Nursing, 3110 Vine St., 45221, University of Cincinnati, Cincinnati, OH, USA
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Wang S, Temkin-Greener H, Simning A, Konetzka RT, Cai S. Outcomes After Community Discharge From Skilled Nursing Facilities: The Role of Medicaid Home and Community-Based Services. J Appl Gerontol 2024; 43:1536-1543. [PMID: 38581163 PMCID: PMC11368621 DOI: 10.1177/07334648241242942] [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] [Indexed: 04/08/2024] Open
Abstract
This study investigated the association between Medicaid Home and Community-Based Services (HCBS) generosity and post-discharge outcomes among dual-eligible beneficiaries discharged from skilled nursing facilities (SNFs). We linked multiple national datasets for duals discharged from SNFs between 2010 and 2013. Accounting for SNF fixed effects, we estimated the effect of HCBS generosity, measured by its breadth and intensity, on the likelihood of remaining in the community, risks of death, nursing home (NH) admission, and hospitalizations within 30 and 180 days after SNF discharge. We found that higher HCBS generosity was associated with an increased likelihood of remaining in the community. HCBS breadth and intensity were both significantly associated with reduced risks of NH admission, while higher HCBS intensity was related to a reduced risk of acute hospitalizations within 30 days after discharge. Our findings suggest that more generous HCBS programs may facilitate smoother transitions and sustainable community living following SNF discharge.
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Affiliation(s)
- Sijiu Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | - Adam Simning
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | | | - Shubing Cai
- School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
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Tsuchiya-Ito R, Mitsutake S, Kitamura S, Taguchi R, Takeuchi Y, Hattori S, Hamada S. Housing Adaptations and Long-Term Care Facility Admissions Among Older Adults With Care Needs in Japan. J Am Med Dir Assoc 2024:105290. [PMID: 39353575 DOI: 10.1016/j.jamda.2024.105290] [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: 04/26/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 10/04/2024]
Abstract
OBJECTIVES Housing adaptations may contribute to aging in place for older adults with care needs by reducing the risk of long-term care facility (LTCF) admissions, but this association remains unclear. We examined the association between housing adaptations and LTCF admissions among older adults with care needs. DESIGN Retrospective cohort study using data from a Japanese municipality. SETTING/PARTICIPANTS Adults aged ≥65 years who were newly certified with care needs under the public long-term care insurance system between April 2014 and March 2016. METHODS The study exposure was the implementation of insurance-covered housing adaptations (maximum covered cost: ∖200,000) during the 2 years after certification. Based on this exposure, participants were assigned to a non-implementation group (no housing adaptations), sub-maximum cost group (housing adaptations below the maximum cost), or maximum cost group (housing adaptations at the maximum cost). A Fine-Gray subdistribution hazards model was used to analyze the associations between the exposure groups and new LTCF admissions after adjusting for various risk factors. Death was regarded as a competing risk, and participants were followed until March 2022. RESULTS Among 4610 participants, 1261 (27.3%) had implemented housing adaptations. Among these, 943 (74.8%) were in the sub-maximum cost group and 318 (25.2%) were in the maximum cost group. During the follow-up period (median: 51 months), the incidence of LTCF admission was 3.9/1000 person-months in the non-implementation group, 3.8/1000 person-months in the sub-maximum cost group, and 2.8/1000 person-months in the maximum cost group. The adjusted subdistribution hazard ratio of LTCF admission (reference: non-implementation) was 0.90 (95% CI: 0.75-1.08) for the sub-maximum cost group and 0.67 (0.49-0.93) for the maximum cost group. CONCLUSIONS AND IMPLICATIONS Housing adaptations can support aging in place for older adults with care needs. Health care professionals and policymakers should consider the suitability of housing environments to reduce the risk of institutionalization.
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Affiliation(s)
- Rumiko Tsuchiya-Ito
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan; Research Department, Dia Foundation for Research on Ageing Societies, Tokyo, Japan.
| | - Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan; Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Satomi Kitamura
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Reina Taguchi
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Yoshinori Takeuchi
- Department of Data Science, School of Data Science, Association of International Arts and Sciences, Yokohama City University, Yokohama, Japan
| | - Shinji Hattori
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Shota Hamada
- Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan; Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan; Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Corrao G, Franchi M, Porcu G, Tratsevich A, Bonaugurio AS, Zucca G, Cereda D, Leoni O, Bertolaso G. Predicting the risk of nursing home placement of elderly persons using a population-based stratification score. Public Health 2024; 236:224-229. [PMID: 39276560 DOI: 10.1016/j.puhe.2024.08.030] [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: 02/29/2024] [Revised: 08/27/2024] [Accepted: 08/31/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVE To develop and validate a novel score predictive of nursing home placement in elderly. STUDY DESIGN Population-based case-control study based on healthcare utilization databases of Lombardy, a region of Northern Italy. METHODS The 2.4 million citizens aged ≥65 years who on January 1, 2018 lived outside nursing home formed the target population. Cases were citizens who experienced nursing home admission (the outcome of interest) until December 31, 2019. Cases were matched 1:1 by gender, age, and municipality of residence to one control. Conditional logistic regression was fitted to select candidate predictors (the exposure to 69 clinical conditions and 11 social and healthcare services) independently associated with the outcome. The model was built from the 26,156 cases, and as many controls (training set), and applied to a validation set (15,807 case-control couples). Predictive performance was assessed by discrimination and calibration. RESULTS Twenty-one factors were identified as predictive of nursing home admission and were included in the "Elderly Nursing Home Placement" (ENHP) score. Mental health disorders and chronic neurological illnesses contributed most to prediction of nursing home admission. ENHP performance showed an area under the receiver operating characteristic curve of 0.77 and a remarkable calibration of observed and predicted outcome risk. CONCLUSIONS A simple score derived from data used for public health management may reliably predict the risk of nursing home placement in elderly. Its use by healthcare decision makers allows to accurately identify high-risk individuals who need home services, thereby avoiding admission to nursing homes.
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Affiliation(s)
- Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Welfare Department, Lombardy Region, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Section of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
| | - Gloria Porcu
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Section of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Alina Tratsevich
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Section of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Andrea Stella Bonaugurio
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Section of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giulio Zucca
- Welfare Department, Lombardy Region, Milan, Italy
| | - Danilo Cereda
- General Directorate, Regional Welfare Service, Lombardy Region, Milan, Italy
| | - Olivia Leoni
- General Directorate, Regional Welfare Service, Lombardy Region, Milan, Italy
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Macedo AC, Bitencourt FV, Faria AOVD, Bizzi IH, Durço DDFPÂ, Azevedo CB, Morris M, Ferreira KDS, De Souza LC, Velly AM. Prevalence of orofacial pain in individuals with mild cognitive impairment or dementia: A systematic review and meta-analysis. Gerodontology 2024; 41:335-345. [PMID: 38247027 DOI: 10.1111/ger.12740] [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] [Accepted: 01/03/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND This systematic review investigated the prevalence of orofacial pain in patients with mild cognitive impairment (MCI) or dementia. MATERIALS AND METHODS The search was conducted in five databases (Medline (Ovid), Embase (Ovid), CINAHL, Scopus and LILACS), in three grey literature sources and in included articles' reference lists. Three independent reviewers performed study selection, quality appraisal and data extraction. The risk of bias was assessed with the National Institutes of Health tool. Prevalence was calculated using the random-effects model. Subgroup analysis and meta-regression were used to explore the heterogeneity of results. RESULTS The database and grey literature search led to 12 246 results, from which nine studies were included; a further four were selected through citation searching. The total sample comprised 6115 patients with dementia and 84 with MCI. All studies had high risk of bias. The overall estimated pooled prevalence of orofacial pain among dementia participants was 19.0% (95% CI, 11.0%-27.0%; I 2, 97.1%, P < .001). Only one study included MCI participants, among which the prevalence of orofacial pain was 20.5%. Subgroup analysis demonstrated that the different sources of diagnosis might explain the heterogeneity. A higher prevalence of orofacial pain was observed in dementia participants aged over 80 years or living in nursing homes. Meta-regression analysis showed a nonlinear relationship between age and the prevalence of orofacial pain. CONCLUSIONS The pooled data from the primary studies revealed that 2 out of 10 patients with dementia have orofacial pain. Further research is needed to clarify the magnitude in individuals with MCI.
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Affiliation(s)
- Arthur C Macedo
- Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada
| | - Fernando Valentim Bitencourt
- Department of Dentistry and Oral Health, Section for Periodontology, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | | | - Isabella Harb Bizzi
- Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Claudia Britto Azevedo
- Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Martin Morris
- Schulich Library of Science and Engineering, McGill University, Montréal, Québec, Canada
| | | | | | - Ana Miriam Velly
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montréal, Québec, Canada
- Dentistry Department, Lady Davis Institute, Jewish General Hospital, Montreal, Québec, Canada
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Webster-Dekker KE, Lu Y, Perkins SM, Ellis J, Gates M, Otis L, Winton R, Hacker E. Factors associated with change in activities of daily living performance in home health care patients with diabetes. Geriatr Nurs 2024; 59:543-548. [PMID: 39153463 DOI: 10.1016/j.gerinurse.2024.07.009] [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: 03/19/2024] [Revised: 06/27/2024] [Accepted: 07/14/2024] [Indexed: 08/19/2024]
Abstract
Older adults with diabetes are at risk for impairments in activities of daily living (ADL) performance. Home health (HH) services help patients regain their ability to perform ADLs following hospitalization, but there may be disparities in ADL improvement. We aimed to identify factors associated with change in ADL performance from the start of HH care to discharge in HH patients with diabetes age ≥65. This secondary analysis used Outcome and Assessment Information Set-D data collected by a HH agency. The sample (n = 1350) had a mean age of 76.3 (SD 7.3). Black/African American race and bowel incontinence/ostomy were associated with less ADL improvement. The following factors were associated with greater ADL improvement: having a caregiver who needed training/support, surgical wounds, pain that interfered with activity, confusion, and better scores in prior functioning. Overall, most patients improved their ADL performance while receiving HH care, but there are disparities that should be addressed.
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Affiliation(s)
| | - Yvonne Lu
- Indiana University School of Nursing, 600 Barnhill Drive, Indianapolis, IN 46220, USA.
| | - Susan M Perkins
- Indiana University School of Medicine, Department of Biostatistics and Health Data Science, 410W. 10th Street, Indianapolis, IN 46202, USA.
| | - Jennifer Ellis
- Aveanna Healthcare, 400 Interstate N Pkwy #1600, Atlanta, GA 30339, USA
| | - Maria Gates
- Aveanna Healthcare, 400 Interstate N Pkwy #1600, Atlanta, GA 30339, USA
| | - Laurie Otis
- Aveanna Healthcare, 400 Interstate N Pkwy #1600, Atlanta, GA 30339, USA
| | - Rebecca Winton
- CenterWell Home Health, 3350 Riverwood Parkway SE #1400, Atlanta, GA 30339, USA
| | - Eileen Hacker
- The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd., Houston, TX 77230, USA.
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Bolster-Foucault C, Vedel I, Busa G, Hacker G, Sourial N, Quesnel-Vallée A. Social inequity in ageing in place among older adults in Organisation for Economic Cooperation and Development countries: a mixed studies systematic review. Age Ageing 2024; 53:afae166. [PMID: 39137063 PMCID: PMC11321251 DOI: 10.1093/ageing/afae166] [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: 12/05/2023] [Revised: 03/11/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Most older adults wish to remain in their homes and communities as they age. Despite this widespread preference, disparities in health outcomes and access to healthcare and social support may create inequities in the ability to age in place. Our objectives were to synthesise evidence of social inequity in ageing in place among older adults using an intersectional lens and to evaluate the methods used to define and measure inequities. METHODS We conducted a mixed studies systematic review. We searched MEDLINE, EMBASE, PsycINFO, CINAHL and AgeLine for quantitative or qualitative literature that examined social inequities in ageing in place among adults aged 65 and older in Organisation for Economic Co-operation and Development (OECD) member countries. Results of included studies were synthesised using qualitative content analysis guided by the PROGRESS-Plus framework. RESULTS Of 4874 identified records, 55 studies were included. Rural residents, racial/ethnic minorities, immigrants and those with higher socioeconomic position and greater social resources are more likely to age in place. Women and those with higher educational attainment appear less likely to age in place. The influence of socioeconomic position, education and social resources differs by gender and race/ethnicity, indicating intersectional effects across social dimensions. CONCLUSIONS Social dimensions influence the ability to age in place in OECD settings, likely due to health inequalities across the lifespan, disparities in access to healthcare and support services, and different preferences regarding ageing in place. Our results can inform the development of policies and programmes to equitably support ageing in place in diverse populations.
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Affiliation(s)
- Clara Bolster-Foucault
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Giovanna Busa
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Georgia Hacker
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Nadia Sourial
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Amélie Quesnel-Vallée
- Department of Equity, Ethics and Policy, McGill University, Montreal, QC, Canada
- Department of Sociology, McGill University, Montreal, QC, Canada
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Kler SE, Diaz-Ramirez LG, Ryskina KL, Jeon SY, Patel K, Cudjoe TKM, Ritchie CS, Harrison KL, Boscardin WJ, Brown RT. Geriatric conditions and healthcare utilization among older adults living in subsidized housing. J Am Geriatr Soc 2024; 72:2446-2459. [PMID: 38847363 PMCID: PMC11323158 DOI: 10.1111/jgs.18979] [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: 12/07/2023] [Revised: 04/13/2024] [Accepted: 04/27/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Nearly 2.9 million older Americans with lower incomes live in subsidized housing. While regional and single-site studies show that this group has higher rates of healthcare utilization compared to older adults in the general community, little is known about healthcare utilization nationally nor associated risk factors. METHODS We conducted a retrospective cohort study of Medicare beneficiaries aged ≥65 enrolled in the National Health and Aging Trends Study in 2011, linked to Medicare claims data, including individuals living in subsidized housing and the general community. Participants were followed annually through 2020. Outcomes were hospitalization, short-term skilled nursing facility (SNF) utilization, long-term care utilization, and death. Fine-Gray competing risks regression analysis was used to assess the association of subsidized housing residence with hospitalization and nursing facility utilization, and Cox proportional hazards regression analysis was used to assess the association with death. RESULTS Among 6294 participants (3600 women, 2694 men; mean age, 75.5 years [SD, 7.0]), 295 lived in subsidized housing at baseline and 5999 in the general community. Compared to older adults in the general community, those in subsidized housing had a higher adjusted subdistribution hazard ratio [sHR] of hospitalization (sHR 1.21; 95% CI, 1.03-1.43), short-term SNF utilization (sHR 1.49; 95% CI, 1.15-1.92), and long-term care utilization (sHR 2.72; 95% CI, 1.67-4.43), but similar hazard of death (HR, 0.86; 95% CI, 0.69-1.08). Individuals with functional impairment had a higher adjusted subdistribution hazard of hospitalization and short-term SNF utilization and individuals with dementia and functional impairment had a higher hazard of long-term care utilization. CONCLUSIONS Older adults living in subsidized housing have higher hazards of hospitalization and nursing facility utilization compared to those in the general community. Housing-based interventions to optimize aging in place and mitigate risk of nursing facility utilization should consider risk factors including functional impairment and dementia.
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Affiliation(s)
- Sarah E. Kler
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - L. Grisell Diaz-Ramirez
- Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, California, USA
| | - Kira L. Ryskina
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sun Young Jeon
- Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | - Kanan Patel
- Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | - Thomas K. M. Cudjoe
- Division of Geriatric Medicine and Gerontology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Krista L. Harrison
- Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
| | - W. John Boscardin
- Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, California, USA
| | - Rebecca T. Brown
- Division of Geriatrics, University of California San Francisco, San Francisco, California, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Geriatric Medicine, Perelman School of Medicine at the University of Pennsylvania, 3615 Chestnut Street, Philadelphia, Pennsylvania, USA
- Geriatrics and Extended Care, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Lai A, Griffith LE, Kuspinar A, Turchyn JS, Richardson J. Impact of Care-Recipient Relationship Type on Quality of Life in Community-Dwelling Older Adults With Dementia Over Time. J Geriatr Psychiatry Neurol 2024; 37:294-306. [PMID: 37950653 PMCID: PMC11089829 DOI: 10.1177/08919887231215044] [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] [Received: 05/28/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023]
Abstract
INTRODUCTION Maintaining quality of life (QoL) has been identified as the primary goal of care services for person living with dementia (PLWD). METHODS A secondary analysis was conducted on five rounds of the National Health and Aging Trends Study (NHATS) over 4 years. A generalized estimating equation (GEE) was used to examine the prediction of relationship type on older adults' QoL through four domains: mental health, general health, functional limitations, and pain. RESULTS older adults cared for by an adult-child or multiple caregivers predicted increased risk for functional limitations after adjustment for their socio-demographic and dementia status (IRR = 1.53, CI [1.26, 1.86]; IRR = 1.36, CI [1.14, 1.61], respectively). The interaction between the relationship type and education was significant. Older adults with a high school education or below, who were cared for by an adult child, had a significantly higher risk of increasing functional limitations over 4 years compared to those cared for by a spouse/partner (contrast = .50, P = .01, 95% CI [.07, .93]; contrast=.52, P = .03, 95% CI [.03, 1.02]; respectively). Similarly, older adults with a high school education, who were cared for by multiple caregivers, also experienced a significantly higher risk of increasing functional limitations than those cared for by a spouse/partner (contrast = .44, P = .03, 95% CI [.02, .85]). CONCLUSION Our findings provide evidence of the significant contribution of relationship type on PLWD's QoL changes over time. They also help to prioritize resource allocation while addressing PLWD's demands by socio-demographics such as education level.
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Affiliation(s)
- Aiping Lai
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | | | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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10
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Pinto JO, Pontes D, Dores AR, Peixoto B, Barbosa F. Activities of Daily Living Inventory (ADLI): Proposal of a new instrument and preliminary data. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-18. [PMID: 38913789 DOI: 10.1080/23279095.2024.2367741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
The evaluation of Activities of Daily Living (ADL) has become a critical issue in neuropsychology, but existing instruments for evaluating ADL have some limitations. This work aims to propose a new instrument to evaluate ADL, the ADL Inventory (ADLI), for which we present preliminary data. The ADLI was developed based on a comprehensive model of the stages of test development and following a combined framework of the World Health Organization's International Classification of Functioning, Disability, and Health and the American Occupational Therapy Association models. Besides sociodemographic information, ADLI includes 144 items, organized into four sections: (a) basic ADL; (b) IADL; (c) advanced ADL; and (d) factors influencing functionality. The main characteristics of ADLI are: having self- and informant-report forms; including items focused on different sensory and neurocognitive functions; individualizing the progression along items considering the person's functionality; considering the impact of several factors on functionality; and using a large response scale. Preliminary data of predictive and convergent validity for ADLI are presented. The preliminary study comprised 15 older adults. The Addenbrooke's Cognitive Examination - III, the Barthel Index, and the Instrumental Activities of Daily Living (IADL) Scale were applied to determine the predictive and convergent validity of ADLI.
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Affiliation(s)
- Joana O Pinto
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic of Porto, Porto, Portugal
- Department of Social, Behavioral Sciences of University Institute of Health Sciences- CESPU, Gandra, Portugal
- Center for Rehabilitation Research, ESS, Polytechnic of Porto, Porto, Portugal
- Lusófona University, Porto, Portugal
| | - Diogo Pontes
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Artemisa R Dores
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- ESS, Polytechnic of Porto, Porto, Portugal
- Center for Rehabilitation Research, ESS, Polytechnic of Porto, Porto, Portugal
| | - Bruno Peixoto
- Department of Social, Behavioral Sciences of University Institute of Health Sciences- CESPU, Gandra, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, University Institute of Health Sciences - CESPU, Porto, Portugal
- UCIBIO - Applied Molecular Biosciences Unit, Translational Toxicology Research Laboratory, University Institute of Health Sciences (1H-TOXRUN, IUCS-CESPU), Porto, Portugal
| | - Fernando Barbosa
- Laboratory of Neuropsychophysiology, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
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11
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Declercq IJN, Leontjevas R, Verboon P, De Vriendt P, Gerritsen DL, van Hooren S. A bayesian network meta-analysis to explore modifying factors in randomized controlled trials: what works for whom to reduce depression in nursing home residents? BMC Geriatr 2024; 24:518. [PMID: 38872075 DOI: 10.1186/s12877-024-05117-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Reviews of depression interventions in nursing home residents resulted in positive findings. However, because of the heterogeneity of the studies, it remains unclear what works for whom. Considering moderator effects may contribute to a comprehensive understanding of depression treatment in residents. Therefore, this study aims to review depression interventions, examining moderator effects of (1) residents' factors, and (2) components specific of interventions. METHODS A Bayesian network meta-analysis of randomized controlled trials primarily aimed at reducing depressive symptoms among residents was conducted. First, intervention types, e.g., exercise interventions, were compared to care as usual. Second, meta-regression analyses were conducted for moderator effects of residents' factors (i.e., severity of depressive symptoms, physical dependency, and cognitive impairment) and components identified as specific to an intervention (e.g., music, creativity, positivity). RESULTS Our search across six databases resulted in 118 eligible studies: 16 on neurobiological interventions, 102 on non-pharmacological interventions. Compared to care as usual, cognitive interventions, such as cognitive behavioral therapy and goal-oriented therapy, showed the strongest effects (MD = -1.00, 95% CrI [-1.40 to -0.66]). Furthermore, the severity of depressive symptoms moderated the effect of interventions (ƅ = -0.63, CrI 95% [-1.04 to -0.22]), while none of fifteen identified intervention-specific components did. In residents with a depression diagnosis, there were larger effect sizes for interventions including daily structure, psychoeducation, healthy food, creativity, positivity, and an activating/encouraging environment, whereas interventions focusing on distraction and relaxation had larger effect sizes in those residents without. CONCLUSIONS By examining the moderator effects, we provided an integrative perspective on the observed variations in effects across different target groups, and components of depression interventions. This approach underscores the complex nature of interventions, emphasizing the need for continued transdisciplinary research, and the exploration of potential moderators. Future investigations should carefully assess residents' factors and choose interventions and their components accordingly.
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Affiliation(s)
- Ine J N Declercq
- Department of Primary and Community Care, Radboud University Medical Center, Gelderland, 6500 HBNijmegen, The Netherlands.
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands.
- Department of Gerontology and Frailty in Ageing (FRIA) and Mental Health and Wellbeing (MENT) Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Ruslan Leontjevas
- Department of Primary and Community Care, Radboud University Medical Center, Gelderland, 6500 HBNijmegen, The Netherlands
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Peter Verboon
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Patricia De Vriendt
- Department of Gerontology and Frailty in Ageing (FRIA) and Mental Health and Wellbeing (MENT) Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Debby L Gerritsen
- Department of Primary and Community Care, Radboud University Medical Center, Gelderland, 6500 HBNijmegen, The Netherlands
| | - Susan van Hooren
- Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
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12
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Prusynski RA, Gold LS, Rundell SD. Utilization and Potential Disparities in Access to Physical Therapy for Spine Pain in the Long-Term Care Population. Arch Phys Med Rehabil 2024:S0003-9993(24)01051-7. [PMID: 38866228 DOI: 10.1016/j.apmr.2024.05.032] [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: 05/02/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE To determine the frequency of physical therapy (PT) services and potential disparities in receiving PT among Medicare fee-for-service beneficiaries with a history of spine pain who live in long-term care (LTC) settings. DESIGN Secondary cross-sectional analysis of Medicare administrative data on beneficiaries with a history of spine pain from 2017-2019. We identified LTC residents using a validated algorithm, then identified and described PT episodes that occurred after the LTC index date. To identify potential disparities in access to PT services, we performed multivariable logistic regression to determine resident demographic, clinical, and community factors associated with receiving PT. SETTING Not applicable. PARTICIPANTS Medicare fee-for-service LTC residents aged ≥65 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Receiving PT services. RESULTS Of the 999,495 LTC residents with a history of spine pain, 49.6% received PT. Only 12.1% of PT episodes specifically treated spine pain. The odds of receiving PT were higher for residents with pain in multiple spine regions or neuropathic pain (OR, 1.27; 95% confidence interval CI, 1.26-1.29) and for residents with inpatient admissions (OR, 1.76; 95% CI, 1.75-1.78). Odds of receiving PT were lower for residents from minoritized racial and ethnic groups, and for residents with dementia (OR, 0.89; 95% CI, 0.88-0.90), depression (OR, 0.95; 95% CI, 0.94-0.96), or who lived in urban or more socioeconomically deprived areas. CONCLUSIONS Although nearly half of LTC residents with histories of spine pain received PT services, most PT was not for spine pain. There are potential disparities in access to PT for LTC residents from minoritized groups living in urban and more deprived areas. Further work should examine PT outcomes and remove barriers to PT for LTC residents with histories of spine pain.
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Affiliation(s)
- Rachel A Prusynski
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, Seattle WA; Department of Health Services and Population Health, University of Washington Seattle, WA.
| | - Laura S Gold
- Evidence and Research (CLEAR) Center for Musculoskeletal Disorders, the University of Washington Clinical Learning, Seattle, WA
| | - Sean D Rundell
- Department of Rehabilitation Medicine, Division of Physical Therapy, University of Washington, Seattle WA; Evidence and Research (CLEAR) Center for Musculoskeletal Disorders, the University of Washington Clinical Learning, Seattle, WA
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13
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Brown RT, Zamora K, Rizzo A, Spar MJ, Fung KZ, Santiago L, Campbell A, Nicosia FM. Improving measurement of functional status among older adults in primary care: A pilot study. PLoS One 2024; 19:e0303402. [PMID: 38739582 PMCID: PMC11090365 DOI: 10.1371/journal.pone.0303402] [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: 11/04/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
Despite its importance for clinical care and outcomes among older adults, functional status-the ability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs)-is seldom routinely measured in primary care settings. The objective of this study was to pilot test a person-centered, interprofessional intervention to improve identification and management of functional impairment among older adults in Veterans Affairs (VA) primary care practices. The four-component intervention included (1) an interprofessional educational session; (2) routine, standardized functional status measurement among patients aged ≥75; (3) annual screening by nurses using a standardized instrument and follow-up assessment by primary care providers; and (4) electronic tools and templates to facilitate increased identification and improved management of functional impairment. Surveys, semi-structured interviews, and electronic health record data were used to measure implementation outcomes (appropriateness, acceptability and satisfaction, feasibility, fidelity, adoption/reach, sustainability). We analyzed qualitative interviews using rapid qualitative analysis. During the study period, all 959 eligible patients were screened (100% reach), of whom 7.3% (n = 58) reported difficulty or needing help with ≥1 ADL and 11.8% (n = 113) reported difficulty or needing help with ≥1 IADL. In a chart review among a subset of 50 patients with functional impairment, 78% percent of clinician notes for the visit when screening was completed had content related to function, and 48% of patients had referrals ordered to address impairments (e.g., physical therapy) within 1 week. Clinicians highly rated the quality of the educational session and reported increased ability to measure and communicate about function. Clinicians and patients reported that the intervention was appropriate, acceptable, and feasible to complete, even during the COVID pandemic. These findings suggest that this intervention is a promising approach to improve identification and management of functional impairment for older patients in primary care. Broader implementation and evaluation of this intervention is currently underway.
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Affiliation(s)
- Rebecca T. Brown
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Kara Zamora
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Anael Rizzo
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Malena J. Spar
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Kathy Z. Fung
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Lea Santiago
- San Francisco VA Health Care System, San Francisco, California, United States of America
| | - Annie Campbell
- Martinez VA Medical Center, Martinez, California, United States of America
| | - Francesca M. Nicosia
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, California, United States of America
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14
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Lohne FK, Fimland MS, Rasmussen CL, Liaset IF, Fischer H, Redzovic S. Is patients' activities of daily living self-care score in Norwegian home care a proxy for workers standing at work? BMC Health Serv Res 2024; 24:565. [PMID: 38724977 PMCID: PMC11080116 DOI: 10.1186/s12913-024-10897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 03/25/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Prolonged standing at work may contribute to increased risk of musculoskeletal pain in home care workers. Patients' activities of daily living (ADL) score may be a proxy for home care workers' standing time at work. The objective of the present study was to investigate the association between patients' ADL self-care score, and workers standing time. METHODS This cross-sectional study measured time spent standing, sitting and in physical activity for seven days using thigh-worn accelerometers, among 14 home care workers. Patients' ADL self-care scores are routinely adjusted by home care nurses, and time intervals of home care visits are stored in home care services electronic patient journal. We collected ADL self-care scores and start and end time points of visits, and categorized ADL self-care scores as low (ADL ≤ 2.0), medium (ADL > 2.0 to 3.0) or high (ADL > 3.0). Physical behavior data were transformed to isometric log-ratios and a mixed-effect model was used to investigate differences in physical behavior between the three ADL self-care score categories. RESULTS We analyzed 931 patient visits and found that high ADL self-care scores were associated with longer standing times relative to sitting and physical activity, compared to low ADL score (0.457, p = 0.001). However, no significant differences in time spent standing were found between high and medium ADL patient visits (0.259, p = 0.260), nor medium and low (0.204, p = 0.288). High ADL score patients made up 33.4% of the total care time, despite only making up 7.8% of the number of patients. CONCLUSION Our findings suggest that caring for patients with high ADL self-care score requires workers to stand for longer durations and that this group of patients constitute a significant proportion of home care workers' total work time. The findings of this study can inform interventions to improve musculoskeletal health among home care workers by appropriate planning of patient visits.
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Affiliation(s)
- Fredrik Klæboe Lohne
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Marius Steiro Fimland
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Unicare Helsefort Rehabilitation Centre, Rissa, Norway
| | | | - Ingeborg Frostad Liaset
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Heike Fischer
- Trondheim municipality, Bergheim home care service, Postboks 2300 Torgarden, Trondheim, 7004, Norway
| | - Skender Redzovic
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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15
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Folkerts AK, Seven ÜS, Guicheteau J, Dichter MN, Hellmich M, Köpke S, Kalbe E. Cognitive stimulation for people with dementia in nursing homes: a protocol for a feasibility study examining a new 24/7 approach (CogStim24). BMJ Open 2024; 14:e078369. [PMID: 38724048 PMCID: PMC11086365 DOI: 10.1136/bmjopen-2023-078369] [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: 08/02/2023] [Accepted: 03/28/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Based on the available evidence, cognitive stimulation is recommended as an intervention for people with dementia (PwD). Currently, cognitive stimulation is regularly offered as a group programme in care facilities. However, some residents, such as those who are bedridden, cannot participate. Furthermore, group programmes were not feasible during the pandemic. A concept that accompanies everyday life and enables cognitive stimulation in everyday communication (ie, '24/7') has been missing. Therefore, this feasibility study aims to (1) assess the feasibility of a new continuous 24/7 cognitive stimulation programme (CogStim24) based on a process evaluation and (2) examine the possible effects of CogStim24 on the primary outcome of global cognition in PwD and further PwD-related and staff-related outcomes. METHODS AND ANALYSIS The complex CogStim24 programme is developed to be conducted as an everyday intervention during routine care including cognitively stimulating techniques, such as reminiscence therapy, multisensory stimulation and physical activity. In this unblinded single-arm study with pre-assessments and post-assessments, four nursing homes with a total of N=20 nursing and care staff will participate in an 11-week CogStim24 training programme. The intervention will be conducted to N=60 PwD. Neuropsychological assessments will be conducted pre-staff and post-staff training, as well as after a 6-week implementation phase. A process evaluation will be performed. ETHICS AND DISSEMINATION Ethics approval was obtained from the ethics committee of the Faculty of Medicine of the University of Cologne, Cologne, Germany. Although cognitive stimulation is known to be effective for enhancing global cognition and quality of life in PwD, it is currently undersupplied to PwD. Therefore, CogStim24 has the potential to reach many more PwD. This study has the potential to serve as a basis for a large multicentre cluster randomised controlled trial. An interdisciplinarity team and mixed-methods approach will help generate information on the practicality and mechanisms of impact of CogStim24. This is important for the further development of the intervention and for facilitating its implementation. The study results will be disseminated via presentations at scientific conferences and meetings for healthcare professionals and PwD and their relatives. Several manuscripts presenting results of the different study parts will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00024381.
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Affiliation(s)
- Ann-Kristin Folkerts
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ümran Sema Seven
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julie Guicheteau
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin N Dichter
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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16
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Liu R, Wyk BV, Quiñones AR, Allore HG. Longitudinal Care Network Changes and Associated Healthcare Utilization Among Care Recipients. Res Aging 2024; 46:327-338. [PMID: 38261524 DOI: 10.1177/01640275241229162] [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] [Indexed: 01/25/2024]
Abstract
This study examines caregiver networks, including size, composition, and stability, and their associations with the likelihood of hospitalization and skilled-nursing facility (SNF) admissions. Data from the National Health and Aging Trends Study linked to Center for Medicare and Medicaid Services data were analyzed for 3855 older adults across five survey waves. Generalized estimating equation models assessed the associations. The findings indicate each additional paid caregiver was associated with higher adjusted risk ratios (aRR) for hospitalization (aRR = 1.24, 95% CI 1.10-1.41) and SNF admission (aRR = 1.28, 95% CI 1.06-1.54) among care recipients, a pattern that is also observed with the addition of unpaid caregivers (hospitalization: aRR = 1.13, 95% CI 1.06-1.20; SNF: aRR = 1.12, 95% CI 1.02-1.23). These results suggest that policies and approaches to enhance the quality and coordination of caregivers may be warranted to support improved outcomes for care recipients.
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Affiliation(s)
- Ruotong Liu
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Brent Vander Wyk
- Department of Biostatistics, Yale University, New Haven, CT, USA
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
- OHSU-PSU School of Public Health, Portland, OR, USA
| | - Heather G Allore
- Department of Biostatistics, Yale University, New Haven, CT, USA
- Department of Internal Medicine, Yale University, New Haven, CT, USA
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17
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Im J, Abedini NC, Wong ES. Disability and Place of Death in Older Americans: The Moderating Role of Household Wealth. J Pain Symptom Manage 2024; 67:411-419.e3. [PMID: 38340907 DOI: 10.1016/j.jpainsymman.2024.02.001] [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] [Received: 12/05/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
CONTEXT Home-based deaths are increasing, yet, how wealth influences where people die in the presence of disability remains unknown. OBJECTIVE To examine place of death by help with (instrumental) activities of daily living (I/ADLs) at the end of life (EOL) and the modifying role of wealth. METHODS Retrospective study of decedents from the Health and Retirement Study (n = 13,210). The exposure was intensity of help with I/ADLs at the EOL (no help/ lower intensity/higher intensity). The outcome was place of death (hospital/nursing home/home). Household wealth was an effect modifier with six categories: ≤$0, first-fifth quintile. Covariates included age, gender, race, marital status at the EOL, last place of residence, and receipt of hospice care. We used multinomial logit regression models with estimates reported as average marginal effects (AMEs). RESULTS Mean age was 79.8 years; 53.2% were female. In the adjusted models, compared to not receiving help at EOL, receiving higher-intensity help was associated with a lower probability of dying in a hospital (AME = -3.8 percentage points (pp), 95% CI = -6.3 to -1.3) and a higher probability of dying at home (AME = 3.6 pp, 95% CI = 1.4-5.7). Associations were most pronounced among decedents in the top two wealth quintiles; older adults who received higher-intensity help had a lower probability of dying in a hospital (AME = -9.0 pp, 95% CI = -14.8 to -3.1), and a higher probability of dying at home (AME = 8.4 pp, 95% CI = 3.8-13.0). CONCLUSION Receiving higher intensity of help with I/ADLs was associated with lower likelihood of dying in a hospital, and higher likelihood of dying at home, particularly among older adults with greater wealth.
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Affiliation(s)
- Jennifer Im
- Department of Health Systems and Population Health (J.I., E.S.W.), University of Washington, Hans Rosling Center for Population Health, 3980 15th Ave. NE, Fourth Floor Box 351621, Seattle, Washington 98195, USA; Cambia Palliative Care Center of Excellence (J.I., N.C.A.), Harborview Medical Center, 325 9th Avenue, Box 359762, Seattle, Washington 98104, USA.
| | - Nauzley C Abedini
- Cambia Palliative Care Center of Excellence (J.I., N.C.A.), Harborview Medical Center, 325 9th Avenue, Box 359762, Seattle, Washington 98104, USA; Department of Medicine (N.C.A.), University of Washington, Harborview Medical Center, 325 9th Avenue, Box 359755, Seattle, Washington 98104, USA
| | - Edwin S Wong
- Department of Health Systems and Population Health (J.I., E.S.W.), University of Washington, Hans Rosling Center for Population Health, 3980 15th Ave. NE, Fourth Floor Box 351621, Seattle, Washington 98195, USA
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18
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Carnahan JL, Pickett AC. Postacute Care and Long-term Care for LGBTQ+ Older Adults. Clin Geriatr Med 2024; 40:321-331. [PMID: 38521602 PMCID: PMC10960930 DOI: 10.1016/j.cger.2023.10.005] [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] [Indexed: 03/25/2024]
Abstract
LGBTQ + older adults have a high likelihood of accessing nursing home care. This is due to several factors: limitations performing activities of daily living and instrumental activities of daily living, restricted support networks, social isolation, delay seeking assistance, limited economic resources, and dementia. Nursing home residents fear going in the closet, which can have adverse health effects. Cultivating an inclusive nursing home culture, including administration, staff, and residents, can help older LGBTQ + adults adjust and thrive in long-term care.
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Affiliation(s)
- Jennifer L Carnahan
- Indiana University Center for Aging Research, Regenstrief Institute, 1101 West 10th Street, Indianapolis, IN 46202, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Roudebush VA Medical Center, Indianapolis, IN, USA.
| | - Andrew C Pickett
- Department of Health & Wellness Design, Indiana University Bloomington, 1719 East 10th Street, Bloomington, IN 47408, USA
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19
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Cooper-Stanbury M. Regional Variation in Lifetime Probability of Admission to Residential Aged Care in Australia. J Aging Health 2024:8982643241248207. [PMID: 38769846 DOI: 10.1177/08982643241248207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVES This paper aims to apply a novel demographic technique to update - and extend to sub-national regions - estimates of the lifetime probability of admission to residential aged care. METHODS Making optimal use of Australian data sources on aged care usage, mortality and population, this study adopts a two-population life table approach to produce an updated set of national probability estimates and first-time regional estimates. RESULTS The probability of admission generally increases with age: nationally, lifetime probability at age 65 is 50% for women and 37% for men, rising to 55% and 46%, respectively, at age 85. This general pattern varied somewhat across regions. DISCUSSION The regional results point to inequities in the uptake of care, thereby informing providers, governments, aged care advocates and anyone interested in equity of access.
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20
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Moreno-Martin P, Minobes-Molina E, Carbó-Cardeña A, Masó-Aguado M, Solé-Casals M, Torrents-Solé M, Bort-Roig J, Amblàs-Novellas J, Gómez-Batiste X, Jerez-Roig J. Exploring Early, Middle, and Late Loss in Basic Activities of Daily Living among Nursing Home Residents: A Multicenter Observational Study. Healthcare (Basel) 2024; 12:810. [PMID: 38667572 PMCID: PMC11050254 DOI: 10.3390/healthcare12080810] [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: 02/13/2024] [Revised: 03/22/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
Nursing home (NH) residents commonly face limitations in basic activities of daily living (BADLs), following a hierarchical decline. Understanding this hierarchy is crucial for personalized care. This study explores factors associated with early, middle, and late loss in BADLs among NH residents. A multicenter cross-sectional study was conducted in 30 NHs in Catalonia, Spain. Dependent variables were related to limitations in BADLs: early loss (self-care-related BADLs: personal hygiene, dressing, or bathing), middle loss (mobility-related BADLs: walking or wheelchair handling, toileting, and transferring), and late loss (eating). Independent variables were based on a comprehensive geriatric assessment and institutional factors. Logistic regression was used for the multivariate analyses. The study included 671 older adults. Early loss in BADLs was significantly associated with urinary incontinence, cognitive impairment, and falls. Middle loss in BADLs was linked to fecal incontinence, urinary incontinence, ulcers, and cognitive impairment. Late loss in BADLs was associated with fecal incontinence, the NH not owning a kitchen, neurological disease, cognitive impairment, dysphagia, polypharmacy, and weight loss. These findings highlight the need to address geriatric syndromes, especially cognitive impairment and bladder/bowel incontinence. Monitoring these syndromes could effectively anticipate care dependency. The presence of kitchens in NHs may help to address limitations to eating, allowing for potential personalized meal adaptation.
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Affiliation(s)
- Pau Moreno-Martin
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
| | - Eduard Minobes-Molina
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
- Spanish Society of Geriatrics and Gerontology, C. Príncipe de Vergara, 57-59, 28006 Madrid, Spain
| | - Aina Carbó-Cardeña
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
| | - Montse Masó-Aguado
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
| | - Montserrat Solé-Casals
- Central Catalonia Chronicity Research Group (C3RG), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (M.S.-C.); (J.A.-N.); (X.G.-B.)
| | | | - Judit Bort-Roig
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
- Sport and Physical Activity Research Group, Faculty of Health Sciences and Welfare, University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Jordi Amblàs-Novellas
- Central Catalonia Chronicity Research Group (C3RG), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (M.S.-C.); (J.A.-N.); (X.G.-B.)
- Faculty of Medicine and Chair in Palliative Care, University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Xavier Gómez-Batiste
- Central Catalonia Chronicity Research Group (C3RG), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (M.S.-C.); (J.A.-N.); (X.G.-B.)
- Faculty of Medicine and Chair in Palliative Care, University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Javier Jerez-Roig
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic—Central University of Catalonia (UVic-UCC), 08500 Vic, Spain; (P.M.-M.); (A.C.-C.); (M.M.-A.); (J.J.-R.)
- Institute for Research and Innovation in Life and Health Sciences in Central Catalonia (IRIS-CC), 08500 Vic, Spain;
- Institute of Sport Science and Innovations, Lithuanian Sports University, 44221 Kaunas, Lithuania
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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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22
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Wang Y, Zhang Q, Huang L, Zeng F. Factors related to satisfaction with community-based home aging services in Shandong, China. Front Public Health 2024; 12:1298669. [PMID: 38450131 PMCID: PMC10916510 DOI: 10.3389/fpubh.2024.1298669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/26/2024] [Indexed: 03/08/2024] Open
Abstract
Purpose This study investigated the satisfaction of current community-based home care services and its factors in adults aged ≥60 years. Methods Using stratified cluster random sampling, we surveyed 1,494 older adults in Jinan and Qingdao, Shandong province, between 2021 and 2023. The baseline and satisfaction surveys were designed by our research team, and the questionnaires were conducted in the form of structured interviews. Kruskal-Wallis H-test and Logistic regression analysis were used to explore the influencing factors of satisfaction. Results The satisfaction was mainly affected by age (p = 0.007), marital status (p < 0.001), pre-retirement occupation (p = 0.003), economic source (p < 0.001), and mode of residence (p = 0.001) in the study of 1,494 older adults. Under the influence of multiple factors, the evaluation of older adults services, married [OR = 4.039, 95% CI: 1.176-13.877] were more inclined to be average, and their occupations were agriculture, forestry, animal husbandry, fishery, and water production workers [OR = 0. 237, 95% CI: 0.068-0.819] and production and transportation equipment operators and related personnel [OR = 0.153, 95% CI: 0.024-0.966] or [OR = 0.153, 95% CI: 0.029-0.820] tended to be more dissatisfied. Conclusion The satisfaction level of community-based home care services is relatively high among older adults, and it is mainly affected by factors such as age, marital status, pre-retirement occupation, source of financial resources, and mode of residence. Addressing the emotional needs of older adults, lowering the cost of aging, and integrating health care and aging seamlessly are among the ongoing challenges that we need to tackle.
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Affiliation(s)
| | | | | | - Fanshuo Zeng
- Rehabilitation Medicine Center, The Second Hospital of Shandong University, Jinan, China
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23
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Burrell LV, Rostad HM, Wentzel-Larsen T, Raknes Sogstad MK. Allocation of Adult Day Care Services to Different User Groups: A Register-Based Cross-Sectional Study. Health Serv Insights 2024; 17:11786329241231003. [PMID: 38332842 PMCID: PMC10851712 DOI: 10.1177/11786329241231003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
The international policy of active ageing emphasises activities and social relations for long-term care recipients, for example through adult day care. Knowledge about who are allocated such services is, however, sparse. We aimed to investigate characteristics that contribute to determine allocation of adult day care for care recipients with and without dementia. This study selected all 250 687 individuals who received long-term care services on 31 December 2019 from the Norwegian Register for Primary Health Care. We added municipal level data from the Municipality-State-Reporting register and a national survey. Multilevel analyses comparing allocation of adult day care services to other services found that municipal clustering was around 20%. Care recipients who lived alone had higher odds of receiving adult day care, while the odds of receiving adult day care decreased as age increased. Disability level and gender were also significantly associated with allocation of adult day care, but in different directions for different user groups. As the unrestricted revenues of municipalities increased, the odds of allocating adult day care to people without dementia decreased. Other municipality characteristics did not significantly impact the allocation of adult day care. In conclusion, individual characteristics were more influential in allocation of adult day care than municipality characteristics, and the results uncovered clear differences between care recipients with and without dementia.
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Affiliation(s)
- Lisa Victoria Burrell
- Centre for Care Research, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Hanne Marie Rostad
- Centre for Care Research, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Tore Wentzel-Larsen
- Centre for Care Research, Norwegian University of Science and Technology, Gjøvik, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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24
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Reyes-Farias D, Finucane E, Watson A, Resnick B, Reid C, Gupta S, Jahan M, Sadovnikov K, Brown RT. "You Need to Keep It Going, Mind, Body, and Spirit": Older Adults' Perspectives on Aging in Place in Subsidized Housing. J Health Care Poor Underserved 2024; 35:159-185. [PMID: 38661865 PMCID: PMC11047029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
In the U.S., more than one million older adults with low incomes live in apartment buildings subsidized by the Low-Income Housing Tax Credit. Although this population experiences disproportionate rates of nursing home admission, little is known about residents' perspectives on factors that influence their ability to live independently in these settings. Fifty-eight residents aged 62 and older and eight study partners participated in qualitative interviews about their perspectives on living independently in subsidized housing, including barriers and facilitators. We analyzed transcripts using a hybrid inductive and deductive approach to qualitative thematic analysis. Barriers and facilitators for living independently in subsidized housing related to the influence of the social and physical environment on individuals' experiences of living independently, including factors unique to subsidized housing. Findings suggest how interventions to optimize functional status and promote independence among older adults living in subsidized housing can build on existing strengths of the subsidized housing environment to improve outcomes.
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Affiliation(s)
- David Reyes-Farias
- Division of Geriatric Medicine, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erin Finucane
- School of Nursing, University of Pennsylvania,
Philadelphia, Pennsylvania
| | - Amanda Watson
- School of Nursing, University of Pennsylvania,
Philadelphia, Pennsylvania
| | - Barbara Resnick
- School of Nursing, University of Maryland, Baltimore,
Maryland
| | - Carolina Reid
- College of Environmental Design, University of California,
Berkeley, California
| | - Sonia Gupta
- Division of Geriatric Medicine, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Momana Jahan
- Division of Geriatric Medicine, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Rebecca T. Brown
- Division of Geriatric Medicine, Perelman School of
Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute for Health Economics, University of
Pennsylvania, Philadelphia, Pennsylvania
- Geriatrics and Extended Care Program, Corporal Michael J.
Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Center for Health Equity Research and Promotion, Corporal
Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia,
Pennsylvania
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25
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Deardorff WJ, Jeon SY, Barnes DE, Boscardin WJ, Langa KM, Covinsky KE, Mitchell SL, Lee SJ, Smith AK. Development and External Validation of Models to Predict Need for Nursing Home Level of Care in Community-Dwelling Older Adults With Dementia. JAMA Intern Med 2024; 184:81-91. [PMID: 38048097 PMCID: PMC10696518 DOI: 10.1001/jamainternmed.2023.6548] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/09/2023] [Indexed: 12/05/2023]
Abstract
Importance Most older adults living with dementia ultimately need nursing home level of care (NHLOC). Objective To develop models to predict need for NHLOC among older adults with probable dementia using self-report and proxy reports to aid patients and family with planning and care management. Design, Setting, and Participants This prognostic study included data from 1998 to 2016 from the Health and Retirement Study (development cohort) and from 2011 to 2019 from the National Health and Aging Trends Study (validation cohort). Participants were community-dwelling adults 65 years and older with probable dementia. Data analysis was conducted between January 2022 and October 2023. Exposures Candidate predictors included demographics, behavioral/health factors, functional measures, and chronic conditions. Main Outcomes and Measures The primary outcome was need for NHLOC defined as (1) 3 or more activities of daily living (ADL) dependencies, (2) 2 or more ADL dependencies and presence of wandering/need for supervision, or (3) needing help with eating. A Weibull survival model incorporating interval censoring and competing risk of death was used. Imputation-stable variable selection was used to develop 2 models: one using proxy responses and another using self-responses. Model performance was assessed by discrimination (integrated area under the receiver operating characteristic curve [iAUC]) and calibration (calibration plots). Results Of 3327 participants with probable dementia in the Health and Retirement Study, the mean (SD) age was 82.4 (7.4) years and 2301 (survey-weighted 70%) were female. At the end of follow-up, 2107 participants (63.3%) were classified as needing NHLOC. Predictors for both final models included age, baseline ADL and instrumental ADL dependencies, and driving status. The proxy model added body mass index and falls history. The self-respondent model added female sex, incontinence, and date recall. Optimism-corrected iAUC after bootstrap internal validation was 0.72 (95% CI, 0.70-0.75) in the proxy model and 0.64 (95% CI, 0.62-0.66) in the self-respondent model. On external validation in the National Health and Aging Trends Study (n = 1712), iAUC in the proxy and self-respondent models was 0.66 (95% CI, 0.61-0.70) and 0.64 (95% CI, 0.62-0.67), respectively. There was excellent calibration across the range of predicted risk. Conclusions and Relevance This prognostic study showed that relatively simple models using self-report or proxy responses can predict need for NHLOC in community-dwelling older adults with probable dementia with moderate discrimination and excellent calibration. These estimates may help guide discussions with patients and families in future care planning.
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Affiliation(s)
- W. James Deardorff
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Sun Y. Jeon
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Deborah E. Barnes
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - W. John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Kenneth M. Langa
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Kenneth E. Covinsky
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Associate Editor, JAMA Internal Medicine
| | - Susan L. Mitchell
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sei J. Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Alexander K. Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- Geriatrics, Palliative and Extended Care Service Line, San Francisco Veterans Affairs Health Care System, San Francisco, California
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Demonceau C, Buckinx F, Reginster JY, Bruyère O. Assessment of risk factors associated with long-term mortality in nursing homes: result from the SENIOR cohort. Aging Clin Exp Res 2023; 35:2997-3005. [PMID: 37917376 DOI: 10.1007/s40520-023-02579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Previous studies on risk factors for death in nursing homes have focused on short-term observation and limited number risk factors. AIMS This study aims to identify factors predictive of 8-year survival in nursing homes. METHODS The study used the baseline measurements from the SENIOR cohort collected in 2013-2014. Data included clinical assessments (i.e., body composition, nutritional status, physical performance, level of dependence and cognition, frailty phenotype) as well as demographic information, number of medications and medical history. Mortality data were collected annually for 8 years. Univariate analyses were initially performed to assess potential predictive factors, followed by a Cox regression model using stepwise selection. RESULTS Of the 662 participants enrolled in the cohort, 58 (8.8%) were not further assessed due to the withdrawal of 2 nursing homes and 71 (10.7%) had no mortality data available (i.e., relocation, refusal to continue the study). Among the 533 patients included, 111 (20.8%) were still alive in 2022. Median survival time was 4 years (1.93-6.94). Multivariate regression showed that younger age (HR = 1.04 (1.03-1.06)), higher body mass index (HR = 0.96 (0.94-0.98)), higher score on the Mini-Mental State-Examination (HR = 0.97 (0.94-0.99)) and higher score on the Short Physical Performance Battery (HR = 0.93 (0.90-0.97)) were protective factors against mortality. CONCLUSIONS This study highlights that certain modifiable factors related to physical or mental health contribute to increased survival in nursing homes. Because of its ability to improve physical performance and partly cognitive function, promoting physical activity in nursing homes appears to be a public health priority.
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Affiliation(s)
- Céline Demonceau
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium.
| | - Fanny Buckinx
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium
| | - Olivier Bruyère
- WHO Collaborating Center for Epidemiologic Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Avenue Hippocrate 13, CHU Bât B23, 4000, Liège, Belgium
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Björkstedt E, Voutilainen A, Auvinen K, Hyttinen V, Jyrkkä J, Mäntyselkä P, Lönnroos E. The role of functioning in predicting nursing home placement or death among older home care patients. Scand J Prim Health Care 2023; 41:478-485. [PMID: 37916677 PMCID: PMC11001308 DOI: 10.1080/02813432.2023.2274333] [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] [Received: 05/19/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE There have been few studies predicting institutionalization or death in home care settings. We examined risk factors for nursing home placement (NHP) and death among home care patients. DESIGN A prospective one-year follow-up study. SETTINGS AND SUBJECTS Persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293). MAIN OUTCOME MEASURES Risk factors for NHP or death were investigated using Cox proportional hazards model. Explanatory variables included demographics, health status (Charlson Comorbidity Index, CCI), physical (Timed Up and Go, TUG), and cognitive (Mini-Mental State Examination, MMSE) functioning, Basic and Instrumental Activities of Daily Living (BADL, IADL) and mood (Geriatric Depression Scale, GDS-15). RESULTS Of the 293 patients (mean age 82.6 years, 70.6% women), 27 (9.2%) moved to a nursing home and 25 (6.9%) died during the follow-up (mean 350 days). The combined outcome of NHP or death was predicted by BADL (HR 0.73, CI 95% 0.62-0.86), IADL (0.75, 0.65-0.87) MMSE (0.92, 0.87-0.96), and TUG (1.02, 1.01-1.03). NHP alone was predicted by BADL (0.62, 0.50-0.78), IADL (0.57, 0.45-0.73), and MMSE (0.88, 0.82-0.94) and mortality by TUG (1.02, 1.01-1.03). CONCLUSION Basic measures of functioning can be used to identify high-risk patients in home care. Decreasing BADL, IADL and MMSE predict NHP and longer TUG-times death within a year.
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Affiliation(s)
- Eeva Björkstedt
- Department of Primary Health Care, Wellbeing Services County of South Savo, Mikkeli, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kati Auvinen
- Department of Primary Health Care, Wellbeing Services County of South Savo, Mikkeli, Finland
| | - Virva Hyttinen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Johanna Jyrkkä
- Information and Development Services Unit, Finnish Medicines Agency FIMEA, Kuopio, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Clinical Research and Trials Centre, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Eija Lönnroos
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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28
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Mitsutake S, Yano S, Ishizaki T, Furuta K, Hatakeyama A, Sugiyama M, Awata S, Ito H, Toba K. Association of functional and cognitive impairment severity with discharge to long-term care facilities in older patients admitted to a general acute care hospital from home. Arch Gerontol Geriatr 2023; 115:105111. [PMID: 37421690 DOI: 10.1016/j.archger.2023.105111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/06/2023] [Accepted: 06/25/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND The early recognition of hospitalized patients at risk of being discharged to long-term care facilities (LTCFs) may help to identify those who require transitional care programs and interventions that support discharge to home. We examined the association of functional and cognitive impairment severity with discharge to LTCFs among older hospitalized patients. METHODS In this retrospective cohort study, we used an administrative claims database linked with geriatric assessment data from a general acute care hospital in Japan. We analyzed patients aged ≥65 years discharged between July 2016 and December 2018. The severity of functional and cognitive impairments was assessed using the Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) scale. Based on their DASC-8 scores, patients were designated as Category I (no impairment), Category Ⅱ (mild impairment), or Category III (moderate/severe impairment). We conducted logistic regression analyses to examine the association between the severity of impairments and discharge to LTCFs after adjusting for patient-level factors. RESULTS We analyzed 9,060 patients (mean age: 79.4 years). Among the 112 patients (1.2%) discharged to LTCFs, 62.3%, 18.6%, and 19.2% fell under Category I, Category Ⅱ, and Category III, respectively. Category II was not significantly associated with discharge to LTCFs. However, Category III had a significantly higher odds of discharge to LTCFs than Category I (Adjusted odds ratio: 2.812, 95% confidence interval: 1.452-5.449). CONCLUSION Patients identified as Category III by the DASC-8 on admission may benefit from enhanced transitional care and interventions that promote discharge to home.
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Affiliation(s)
- Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shohei Yano
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan; The Salvation Army Booth Memorial Hospital, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Ko Furuta
- Department of Psychiatry, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Akira Hatakeyama
- Dementia Support Center, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Mika Sugiyama
- Research Team for Promoting Independence of the Elderly, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hideki Ito
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Kenji Toba
- Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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29
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Kodera R, Fujihara K, Koyama T, Shiozaki H, Mutsuma Y, Yagyuda N, Hatta M, Tsuruoka K, Takeda Y, Araki A, Sone H. Impact of a history of cardiovascular disease and physical activity habits on the incidence of functional disability. Sci Rep 2023; 13:20793. [PMID: 38012261 PMCID: PMC10682401 DOI: 10.1038/s41598-023-47913-z] [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: 08/12/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
We examined the impact of a history of coronary artery disease (CAD) or cerebrovascular disease (CVD) and physical activity habits on functional disability among community-dwelling Japanese adults. This population-based retrospective cohort study included 10,661 people aged 39-98 years in Japan (5054, men). Median follow-up was 3.7 years. During the study period, 209 functional disabilities occurred in the overall study population. In multivariable analysis, a history of CVD (hazard ratio [HR] 1.57 [95% CI: 1.00-2.45]) and no physical activity habit (HR 1.74 [1.27-2.39]) presented increased risks for functional disability. HRs for functional disability among patients with a CVD history with and without a physical activity habit were 1.68 (0.75-3.74) and 2.65 (1.49-4.71), respectively, compared with individuals without a history of CVD with a physical activity habit. Similar results were observed for CAD. We found no significant difference in the incidence of functional disability between the group with a history of CAD or CVD and physical activity habits and the group with no history of CAD or CVD and without physical activity habits. Physical activity habits had a favorable influence on avoiding functional disability regardless of a history of CAD or CVD. Future prospective studies are needed to clarify these associations.
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Affiliation(s)
- Remi Kodera
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan.
| | - Tetsuya Koyama
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Haruka Shiozaki
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Yurie Mutsuma
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Noriko Yagyuda
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Mariko Hatta
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Kahori Tsuruoka
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Yasunada Takeda
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakaecho, Itabashi-ku, Tokyo, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, 1-757, Asahimachi, Niigata, Niigata, Japan
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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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Sabesan V, Dawoud M, Al-Mansoori A, Stephens BJ, Lavin AC, Lozano JM, Fomunung CK. Factors influencing physical therapy utilization after shoulder surgery: a retrospective review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:511-518. [PMID: 37928991 PMCID: PMC10625012 DOI: 10.1016/j.xrrt.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Postoperative physical therapy (PT) is a cornerstone to achieve optimal patient outcomes. Access to postoperative PT can be limited by insurance type, coverage, and cost. With copayments (CP) for PT as high as $75 per visit, PT can be costprohibitive for patients. The purpose of this study was to evaluate factors affecting PT utilization among patients that underwent shoulder surgery. Methods A retrospective analysis was performed of 80 shoulder surgery patients with postoperative PT sessions attended at a single institution from 2017 to 2019. Patients were divided based on insurance type: private insurance (PI), and Medicare with or without supplemental insurance (MI), and CP or no copayment. Demographics, CP, total, and postoperative number of PT sessions utilized was collected and analyzed. Results The cohort had 53 females and an average age of 62. There was no significant difference between PI and MI at baseline other than surgery performed (P = .03), older MI group (69 years vs. 56 years: P < .01), and more females in PI group (76% vs. 55%; P = .05). There was no significant difference in the number of PT sessions between groups. The PI group was more likely to have a CP (P < .01). The CP group more often had PI and significantly more total PT visits (P = .05), while the no copayment group more often had Medicare (P < .01). CP was not independently associated with a change in the number of PT visits or total PT visits. Conclusions The utilization of PT after shoulder surgery was found to not be influenced by insurance type or CP as determined by the number of PT sessions attended. Further investigations are necessary to better understand the relationship between CP and different insurance types and develop effective strategies to increase access to PT for postoperative shoulder patients.
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Affiliation(s)
- Vani Sabesan
- HCA Florida JFK Hospital, Palm Beach Shoulder Service – Atlantis Orthopaedics, Palm Beach, FL, USA
- Cleveland Clinic Florida, Levitetz Department of Orthopedic Surgery, Weston, FL, USA
| | - Mirelle Dawoud
- Cleveland Clinic Florida, Levitetz Department of Orthopedic Surgery, Weston, FL, USA
| | - Ahmed Al-Mansoori
- Cleveland Clinic Florida, Levitetz Department of Orthopedic Surgery, Weston, FL, USA
| | - B. Joshua Stephens
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, FL, USA
| | - Alessia C. Lavin
- HCA Florida JFK Hospital, Palm Beach Shoulder Service – Atlantis Orthopaedics, Palm Beach, FL, USA
| | - Juan Manuel Lozano
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Clyde K. Fomunung
- HCA Florida JFK Hospital, Palm Beach Shoulder Service – Atlantis Orthopaedics, Palm Beach, FL, USA
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Socci M, Di Rosa M, D’Amen B, Melchiorre MG. Functional and Psychosocial Profile of Older People Living in Nursing Homes: Findings from the European Survey of Health, Ageing and Retirement in Europe (SHARE). Healthcare (Basel) 2023; 11:2702. [PMID: 37830739 PMCID: PMC10572757 DOI: 10.3390/healthcare11192702] [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: 09/01/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND This paper is based on results from the Survey of Health, Ageing and Retirement in Europe (SHARE), exploring many aspects (health, economic situation and welfare) of the European population aged 50+. Differently from many other international studies, SHARE includes persons living in nursing homes or residential care facilities as part of its sample. The aim of this paper is to provide a socio-demographic, functional and psychosocial snapshot of older residents in nursing homes in Europe. METHODS This paper uses data from SHARE Wave 8/2020, carried out in 27 European countries. A quantitative/descriptive approach explores the prevalence of older people aged 65+ living in residential facilities as mapped by the SHARE survey across Europe, with regard to associated dimensions, i.e., socio-demographic, family relationship, perceived health/main diseases, functional and psychological status. RESULTS These show that older residents live mainly in Central and Northern Europe, are aged 80+, female and widowed. A small social network (SN) size is often reported. Health is perceived, above all, as being fair-poor, and the presence of long-term illness is high, with several chronic health conditions and functional limitations. The reported quality of life (QoL) is low for most respondents, with moderate-low satisfaction with life. CONCLUSION The analysis depicts a profile of seniors needing residential care in Europe, and provides useful insights for policymakers, to better sustain this frail population group, and to allow and improve access to high-quality long-term care (LTC) in Europe. Our findings could also be of help to train health professionals, and potentially drive the research towards the exploration of new housing solutions for seniors. This would in turn contribute to the effective implementation of European initiatives to strengthen LTC systems.
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Affiliation(s)
- Marco Socci
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, Via Santa Margherita 5, 60124 Ancona, Italy; (M.S.); (M.G.M.)
| | - Mirko Di Rosa
- Centre for Biostatistics and Applied Geriatric Clinical Epidemiology, IRCCS INRCA—National Institute of Health and Science on Ageing, Via Santa Margherita 5, 60124 Ancona, Italy
| | - Barbara D’Amen
- Italian National Institute of Statistics—ISTAT, Via Cesare Balbo 39, 00184 Roma, Italy;
| | - Maria Gabriella Melchiorre
- Centre for Socio-Economic Research on Ageing, IRCCS INRCA—National Institute of Health and Science on Ageing, Via Santa Margherita 5, 60124 Ancona, Italy; (M.S.); (M.G.M.)
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Redzovic S, Vereijken B, Bonsaksen T. Aging at home: factors associated with independence in activities of daily living among older adults in Norway-a HUNT study. Front Public Health 2023; 11:1215417. [PMID: 37860795 PMCID: PMC10583577 DOI: 10.3389/fpubh.2023.1215417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023] Open
Abstract
Background Maintaining independence in activities of daily living (ADL) is essential for the well-being of older adults. This study examined the relationship between demographic and living situation factors and ADL independence among community-dwelling older adults in Norway. Methods Data was collected in Norway between 2017 and 2019 as part of the fourth wave of the ongoing Trøndelag Health Study (HUNT) survey, sent to all citizens in Trøndelag county over 20 years of age, which is considered representative of the Norwegian population. Included in the current cross-sectional study were 22,504 community-living individuals aged 70 years or older who completed the survey and responded to all items constituting the ADL outcome measure. Group differences in ADL independence were examined with Chi Square tests, while crude and adjusted associations with ADL independence were examined with logistic regression analyses. Statistical significance was set at p < 0.05. Results The participants reported a high degree of independence in primary ADL and slightly lower in instrumental ADL. In the fully adjusted analyses, ADL independence was associated with lower age, female gender, higher levels of education and income, higher subjective well-being, having no chronic or disabling disease, and having someone to talk to in confidence. Surprisingly, women who were married had higher likelihood of ADL independence than unmarried women, whereas married men had lower likelihood of ADL independence than unmarried men. Conclusion In addition to known demographic and disease-related factors, the social context affects independence in ADL even in a society that offers advanced health and homecare services to all older adults equally. Furthermore, the same social setting can have differential effects on men and women. Despite the healthcare system in Norway being well-developed, it does not completely address this issue. Further improvements are necessary to address potential challenges that older adults encounter regarding their social connections and feelings of inclusion. Individuals with limited education and income are especially susceptible to ADL dependency as they age, necessitating healthcare services to specifically cater to this disadvantaged demographic.
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Affiliation(s)
- Skender Redzovic
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore Bonsaksen
- Department of Health and Nursing Science, Inland Norway University of Applied Sciences, Elverum, Norway
- Department of Health, VID Specialized University, Stavanger, Norway
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Wang J, Yang Q, Wu B. Effects of Care Arrangement on the Age of Institutionalization among Community-dwelling Chinese Older Adults. J Aging Soc Policy 2023; 35:595-610. [PMID: 32033523 DOI: 10.1080/08959420.2020.1726720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 11/26/2018] [Indexed: 01/01/2023]
Abstract
Early and unnecessary institutionalization of older adults can be a heavy burden on the country and taxpayers. It is crucial to understand factors impacting the age of institutionalization of older adults in China. This study examined care arrangements of older adults in China and the relationship between these arrangements and the age of relocation to long-term care facilities (institutionalization). Results show that care arrangements affect the age of institutionalization among community-dwelling Chinese older adults. Those who were primarily cared for by sons and daughter-in-laws tended to be institutionalized at a significantly later age compared to those who were cared for by their spouses. Those who were primarily cared for by other relatives and friends, by domestic helpers, and those with no caregivers tended to have significantly earlier institutionalization compared to those who were cared for by their spouses. However, the number of older adults living in empty nest families is increasing rapidly. Traditional family support for older adults has been shrinking due to fewer children, out-migration of adult children from rural to urban areas, and increased employment of women in China. There is an acute shortage of competent and qualified elder care workers. Most Chinese domestic helpers started their work with limited or even no training, risking the safety of themselves and their employers. In addition to increasing and optimizing the investment in the elder care industry, legal protection and policy support for the elderly and domestic helpers are urgently needed to address these key issues.
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Affiliation(s)
- Jing Wang
- Fudan University School of Nursing, Shanghai, China
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Qing Yang
- Duke University School of Nursing, Durham, North Carolina, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, New York, USA
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Pomeroy ML, Cudjoe TKM, Cuellar AE, Ihara ES, Ornstein KA, Bollens-Lund E, Kotwal AA, Gimm GW. Association of Social Isolation With Hospitalization and Nursing Home Entry Among Community-Dwelling Older Adults. JAMA Intern Med 2023; 183:955-962. [PMID: 37486647 PMCID: PMC10366946 DOI: 10.1001/jamainternmed.2023.3064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/19/2023] [Indexed: 07/25/2023]
Abstract
Importance Social isolation is associated with adverse health outcomes, yet its implications for hospitalization and nursing home entry are not well understood. Objective To evaluate whether higher levels of social isolation are associated with overnight hospitalization, skilled nursing facility stays, and nursing home placement among a nationally representative sample of community-dwelling older adults after adjusting for key health and social characteristics, including loneliness and depressive symptoms. Design, Setting, and Participants This observational cohort study included 7 waves of longitudinal panel data from the Health and Retirement Study, with community-dwelling adults aged 65 years or older interviewed between March 1, 2006, and June 30, 2018 (11 517 respondents; 21 294 person-years). Data were analyzed from May 25, 2022, to May 4, 2023. Main Outcomes and Measures Social isolation was measured with a multidomain 6-item scale (range, 0-6, in which a higher score indicates greater isolation). Multivariate logistic regressions were performed on survey-weighted data to produce national estimates for the odds of self-reported hospitalization, skilled nursing facility stays, and nursing home placement over time. Results A total of 57% of this study's 11 517 participants were female, 43% were male, 8.4% were Black, 6.7% were Hispanic or Latino, 88.1% were White, 3.5% were other ("other" includes American Indian or Alaska Native, Asian or Pacific Islander, and other race, which has no further breakdown available because this variable was obtained directly from the Health and Retirement Study), and 58.2% were aged 65 to 74 years. Approximately 15% of community-dwelling older adults in the US experienced social isolation. Higher social isolation scores were significantly associated with increased odds of nursing home placement (odds ratio, 2.01; 95% CI, 1.21-3.32) and skilled nursing facility stays (odds ratio, 1.16; 95% CI, 1.06-1.28) during 2 years. With each point increase in an individual's social isolation score, the estimated probability of nursing home placement or a skilled nursing facility stay increased by 0.5 and 0.4 percentage points, respectively, during 2 years. Higher levels of social isolation were not associated with 2-year hospitalization rates. Conclusions and Relevance This cohort study found that social isolation was a significant risk factor for nursing home use among older adults. Efforts to deter or delay nursing home entry should seek to enhance social contact at home or in community settings. The design and assessment of interventions that optimize the social connections of older adults have the potential to improve their health trajectories and outcomes.
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Affiliation(s)
- Mary Louise Pomeroy
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Thomas K. M. Cudjoe
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alison E. Cuellar
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, Virginia
| | - Emily S. Ihara
- Department of Social Work, College of Public Health, George Mason University, Fairfax, Virginia
| | - Katherine A. Ornstein
- Roger C. Lipitz Center for Integrated Health Care, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Evan Bollens-Lund
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, Mount Sinai Health System, New York, New York
| | - Ashwin A. Kotwal
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco
- Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Gilbert W. Gimm
- Department of Health Administration and Policy, College of Public Health, George Mason University, Fairfax, Virginia
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Bone JK, Fancourt D, Sonke JK, Bu F. Participatory and Receptive Arts Engagement in Older Adults: Associations with Cognition Over a Seven-Year Period. CREATIVITY RESEARCH JOURNAL 2023; 36:436-450. [PMID: 39140023 PMCID: PMC11318508 DOI: 10.1080/10400419.2023.2247241] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Indexed: 08/15/2024]
Abstract
There is growing evidence for the impact of arts engagement on later life cognition. However, confounding by socioeconomic factors may have led to an overestimation of this association. We analyzed data from 4,344 older adults in the Wisconsin Longitudinal Study. We measured participatory (e.g. painting, making music, crafts) and receptive (e.g. concert, play, museum) arts engagement separately. Participants completed six neurocognitive tests measuring two distinct domains of cognitive function (episodic/working memory and executive function/language) concurrently and seven years later. We used inverse probability of treatment weighting (IPTW) to remove confounding by a range of demographic and socioeconomic factors. Engaging in participatory or receptive arts for up to one hour per week (but not more frequently) was associated with better subsequent executive function/language. Similarly, engaging in receptive arts activities for up to three hours per week (but not more frequently) was associated with better subsequent episodic/working memory. These effects were of similar sizes to doing vigorous physical activity for up to one hour per week. However, our findings also highlight key methodological issues when exploring the relationship between arts engagement and cognition that should be considered in future studies, including measurement bias, life-course stage, length of follow-up, variation in outcomes, attrition, and missing data.
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Nicosia FM, Zamora K, Rizzo A, Spar MJ, Silvestrini M, Brown RT. Using multiple qualitative methods to inform intervention development: Improving functional status measurement for older veterans in primary care settings. PLoS One 2023; 18:e0290741. [PMID: 37616266 PMCID: PMC10449158 DOI: 10.1371/journal.pone.0290741] [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: 04/05/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
Functional status, or the ability to perform activities of daily living, is central to older adults' health and quality of life. However, health systems have been slow to incorporate routine measurement of function into patient care. We used multiple qualitative methods to develop a patient-centered, interprofessional intervention to improve measurement of functional status for older veterans in primary care settings. We conducted semi-structured interviews with patients, clinicians, and operations staff (n = 123) from 7 Veterans Health Administration (VHA) Medical Centers. Interviews focused on barriers and facilitators to measuring function. We used concepts from the Consolidated Framework for Implementation Science and sociotechnical analysis to inform rapid qualitative analyses and a hybrid deductive/inductive approach to thematic analysis. We mapped qualitative findings to intervention components. Barriers to measurement included time pressures, cumbersome electronic tools, and the perception that measurement would not be used to improve patient care. Facilitators included a strong interprofessional environment and flexible workflows. Findings informed the development of five intervention components, including (1) an interprofessional educational session; (2) routine, standardized functional status measurement among older patients; (3) annual screening by nurses using a standardized instrument and follow-up assessment by primary care providers; (4) electronic tools and templates to facilitate increased identification and improved management of functional impairment; and (5) tailored reports on functional status for clinicians and operations leaders. These findings show how qualitative methods can be used to develop interventions that are more responsive to real-world contexts, increasing the chances of successful implementation. Using a conceptually-grounded approach to intervention development has the potential to improve patient and clinician experience with measuring function in primary care.
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Affiliation(s)
- Francesca M. Nicosia
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Kara Zamora
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Anael Rizzo
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Malena J. Spar
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Molly Silvestrini
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Rebecca T. Brown
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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Wrotek M, Kalbarczyk M. Predictors of long-term care use - informal home care recipients versus private and public facilities residents in Poland. BMC Geriatr 2023; 23:512. [PMID: 37620838 PMCID: PMC10463875 DOI: 10.1186/s12877-023-04216-2] [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: 10/24/2022] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND The population aging, together with the shrinking caring potential of families, is a major challenge for social policy in the coming years. The aim of the study is to identify the factors that determine not only the use of long-term care (LTC) but also the selection of individual types of such care in Poland. METHODS Using unique data collected from inpatient LTC facilities in Poland and the Survey on Health, Ageing and Retirement in Europe (SHARE) database, we estimate logistic regressions explaining the choice of LTC solution. RESULTS Our results suggest that social inequalities play a role in choosing the type of LTC. Better educated people choose private institutions, while people without support network use more often social residential homes. The impact of multimorbidity on choosing different types of inpatient facilities is limited, thus the number of ADL limitations remains a better indicator of long term care utilization. CONCLUSIONS The study confirms that social inequalities influence decisions about the choice of LTC. However, multi-morbidity is a predictor of using LTC to a limited extent. The differences in LTC selection determinants between women and men are noticeable.
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Affiliation(s)
- Małgorzata Wrotek
- Faculty of Economic Sciences, University of Warsaw, Długa 44/50, Warsaw, 00-241, Poland.
| | - Małgorzata Kalbarczyk
- Faculty of Economic Sciences, University of Warsaw, Długa 44/50, Warsaw, 00-241, Poland
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Burrell LV, Rostad HM, Wentzel-Larsen T, Skinner MS, Sogstad MKR. The influence of individual and municipality characteristics on allocation of long-term care services: a register-based cross-sectional study. BMC Health Serv Res 2023; 23:801. [PMID: 37501173 PMCID: PMC10373409 DOI: 10.1186/s12913-023-09641-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 06/03/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Variation in service allocation between municipalities may arise as a result of prioritisation. Both individual and societal characteristics determine service allocation, but previous literature has often investigated these factors separately. The present study aims to map variation in allocation of long-term care services and investigate the extent to which service allocation is associated with characteristics related to the individual care recipient and the municipality. METHODS This cross-sectional study used register data from the Norwegian Registry for Primary Health Care on all 250 687 individuals receiving municipal health and care services in Norway on 31 December 2019. These individual level data were paired with municipal level data from the Municipality-State-Reporting register and information on the care models in Norwegian long-term care services, derived from a nationwide survey. Multilevel analyses were used to identify individual and municipal factors that were associated with allocation of home care, practical assistance and long-term stay in institutions. RESULTS In total, 164 634 people received home care services and 97 380 received practical assistance per 31 December 2019. Furthermore, 64 404 received both types of home-based services and 31 342 people had a long-term stay in an institution. Increased disability was strongly associated with being allocated more hours of home care and practical assistance, as well as allocation of a long-term institutional stay. The amount of home care and practical assistance declined with increasing age, but the odds of institutional stay increased with age. Care recipients living alone received more home-based services, and women had higher odds of a long-term institutional stay. Significant associations between the proportion of elderly in nursing homes and allocation of a long-term institutional stay and more practical assistance emerged. Other associations with municipalities' structural characteristics and care service models were weak. CONCLUSIONS The influence of individual characteristics outweighed the contribution of municipality characteristics, and the results point to a limited influence of municipality characteristics on allocation of long-term care services.
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Affiliation(s)
- Lisa Victoria Burrell
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.
| | - Hanne Marie Rostad
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Tore Wentzel-Larsen
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1‑3, Oslo, 0484, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1, Oslo, 0484, Norway
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Ryu E, Wi CI, Wheeler PH, King KS, Carlson RE, Juhn YJ, Takahashi PY. The Role of Individual-Level Socioeconomic Status on Nursing Home Placement Accounting for Neighborhood Characteristics. J Am Med Dir Assoc 2023; 24:1048-1053.e2. [PMID: 36841262 PMCID: PMC10962058 DOI: 10.1016/j.jamda.2023.01.016] [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: 10/18/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Independent living is desirable for many older adults. Although several factors such as physical and cognitive functions are important predictors for nursing home placement (NHP), it is also reported that socioeconomic status (SES) affects the risk of NHP. In this study, we aimed to examine whether an individual-level measure of SES is associated with the risk of NHP after accounting for neighborhood characteristics. DESIGN A population-based study (Olmsted County, Minnesota, USA). SETTING AND PARTICIPANTS Older adults (age 65+ years) with no prior history of NHP. METHODS Electronic health records (EHR) were used to identify individuals with any NHP between April 1, 2012 (baseline date) and April 30, 2019. Association between the (HOUsing-based index of SocioEconomic Status (HOUSES) index, an individual-level SES measure based on housing characteristics of current residence, and risk of NHP was tested using random effects Cox proportional hazard model adjusting for area deprivation index (ADI), an aggregated SES measure that captures neighborhood characteristics, and other pertinent confounders such as age and chronic disease burden. RESULTS Among 15,031 older adults, 3341 (22.2%) experienced NHP during follow-up period (median: 7.1 years). At baseline date, median age was 73 years old with 55% female persons, 91% non-Hispanic Whites, and median number of chronic conditions of 4. Accounting for pertinent confounders, the HOUSES index was strongly associated with risk of NHP (hazard ratio 1.89; 95% confidence interval 1.66‒2.15 for comparing the lowest vs highest quartiles), which was not influenced by further accounting for ADI. CONCLUSIONS AND IMPLICATIONS This study demonstrates that an individual-level SES measure capturing current individual-specific socioeconomic circumstances plays a significant role for predicting NHP independent of neighborhood characteristics where they reside. This study suggests that older adults who are at higher risk of NHP can be identified by utilizing the HOUSES index and potential individual-level intervention strategies can be applied to reduce the risk for those with higher risk.
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Affiliation(s)
- Euijung Ryu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Philip H Wheeler
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Katherine S King
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Rachel E Carlson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paul Y Takahashi
- Division of Primary Care and Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Cremer S, Vluggen S, Man-Van-Ginkel JMD, Metzelthin SF, Zwakhalen SM, Bleijlevens MHC. Effective nursing interventions in ADL care affecting independence and comfort - a systematic review. Geriatr Nurs 2023; 52:73-90. [PMID: 37269607 DOI: 10.1016/j.gerinurse.2023.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023]
Abstract
Despite its frequent provision, evidence of nursing interventions in Activities of Daily Living (ADL) remains unclear. Hence, we addressed the research question: What are the effects of ADL nursing interventions on independence and comfort in adults across all care settings? We conducted a systematic review of randomized controlled trials and quasi-experimental studies described in systematic reviews. In three databases, we searched for systematic reviews that we used as a portal to select (quasi) experimental studies. After narratively summarizing the studies on characteristics, effects, and interventions, we assessed the risk of bias. Among the 31 included studies, 14 studies evaluated independence, 14 studies measured comfort, and three studies assessed both outcomes. Seven interventions significantly improved independence and seven interventions significantly improved comfort. The studies varied highly in intervention components, outcome measures, and quality. Evidence on ADL nursing interventions affecting independence and comfort remains fragmented and inconclusive, limiting guidance for nursing professionals.
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Affiliation(s)
- S Cremer
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
| | - S Vluggen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - J M de Man-Van-Ginkel
- Department of Gerontology and Geriatrics, Nursing Science, Leiden University Medical Centre, Postzone C-07-Q, Postbus 9600, Leiden, RC 2300, The Netherlands
| | - S F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - S M Zwakhalen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - M H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
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Skolarus L, Thrash-Sall E, Hellem AK, Giacalone M, Burke J, Lin CC, Bailey S, Corches C, Dinh M, Casetti A, Mansour M, Bowie K, Roth R, Whitfield C, Sales A. Community-Led, Cross-Sector Partnership of Housing and Health Care to Promote Aging in Place (Unite Health Project): Protocol for a Prospective Observational Study. JMIR Res Protoc 2023; 12:e47855. [PMID: 37384383 PMCID: PMC10365602 DOI: 10.2196/47855] [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: 04/05/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND For many older Americans, aging in place is their preferred living arrangement. Minoritized and socioeconomically disadvantaged older adults are up to 3 times more likely to experience disability than other groups, which increases their likelihood of being unable to age in place. Bold ideas to facilitate aging in place, particularly among vulnerable populations, are needed. One such idea is the Unite care model, a community-initiated, academic-supported, cross-sector initiative that combines 2 sectors: housing and health care. The Unite care model colocates a federally qualified health center clinic on an older adult affordable housing campus in Flint, Michigan. OBJECTIVE There are two aims to this study. Aim 1 is to evaluate the implementation of the Unite care model in terms of acceptability, adoption, and penetration. Aim 2 is to determine which older adults use the care model and whether the care model promotes aging in place through risk factor reduction and improvement in the physical and social environment. METHODS We will assess the care model using a concurrent, exploratory mixed methods design. For aim 1, acceptability will be assessed through semistructured interviews with key stakeholder groups; adoption and penetration will be assessed using housing and health care records. For aim 2, residents residing in the Unite clinic building will participate in structured outcome assessments at 6 and 12 months. Risk factor reduction will be measured by change in systolic blood pressure from baseline to 12 months and change in the physical and social environment (item counts) will also be assessed from baseline to 12 months. RESULTS Data collection for aim 1 began in July 2021 and is anticipated to end in April 2023. Data collection for aim 2 began in June 2021 and concluded in November 2022. Data analysis for aim 1 is anticipated to begin in the summer of 2023 and analysis for aim 2 will begin in the spring of 2023. CONCLUSIONS If successful, the Unite care model could serve as a new care model to promote aging in place among older adults living in poverty and older Black Americans. The results of this proposal will inform whether larger scale testing of this new model of care is warranted. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47855.
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Affiliation(s)
- Lesli Skolarus
- Davee Department of Neurology, Northwestern University, Chicago, IL, United States
| | | | - Abby Katherine Hellem
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | | | - James Burke
- Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Chun Chieh Lin
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Bailey
- Bridges Into the Future, Flint, MI, United States
| | - Casey Corches
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Mackenzie Dinh
- Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Amanda Casetti
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Maria Mansour
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Kaitlyn Bowie
- Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Rylyn Roth
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Candace Whitfield
- Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Anne Sales
- Sinclair School of Nursing, University of Missouri, Columbia, MO, United States
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, United States
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Novais T, Vanhems E, Coste MH, Krolak-Salmon P. Educational care for patients with Alzheimer's disease and their caregivers in France: A mapping proposal. PATIENT EDUCATION AND COUNSELING 2023; 111:107692. [PMID: 36917885 DOI: 10.1016/j.pec.2023.107692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/08/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To formalize a proposal for educational approach for patients with Alzheimer's disease and related dementias (ADRD) and caregivers across existing diagnosis/care organizations and structures. METHODS Three steps:1/ identifying the existing organizations and structures that could be involved in educational care; 2/ identifying the main educational skills of interest for ADRD patients and caregivers; 3/ conducting a survey among these organizations and structures to achieve a mapping proposal of educational care. RESULTS Nine organizations and structures, and 29 educational skills of interest were identified for the step 3 survey. Overall, 423 organizations/structures completed the step 3 survey. Twelve of 29 educational skills were covered by 50% of organizations/structures included. The most covered skills were "Maintaining autonomy in daily living activities", "coping with cognitive disorders", and "coping with behavioral disorders". CONCLUSIONS A mapping of educational care that could be provided by the different structures and organizations involved in the ADRD care pathway was proposed regarding their missions and intervention place. PRACTICE IMPLICATIONS Policy makers and funding bodies will need to invest in the healthcare professionals' training about educational approach and ADRD in order to extend educational care throughout the patient's care pathway.
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Affiliation(s)
- Teddy Novais
- Department of Pharmacy, Charpennes Hospital, Hospices Civils de Lyon, Villeurbanne, F-69100, France; Lyon Institute for Aging, Hospices Civils de Lyon, F-69000 Lyon, France; Research on Healthcare Performance (RESHAPE), INSERM U1290, University Lyon1, F-69000 Lyon, France.
| | - Elyse Vanhems
- Lyon Institute for Aging, Hospices Civils de Lyon, F-69000 Lyon, France
| | | | - Pierre Krolak-Salmon
- Lyon Institute for Aging, Hospices Civils de Lyon, F-69000 Lyon, France; Clinical Research Centre (CRC) - VCF (Aging - Brain - Frailty), Charpennes Hospital, University Hospital of Lyon, Villeurbanne, F-69000 Lyon, France; Neuroscience Research Centre of Lyon (CRNL), F-69000 Lyon, France
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Lee J, Jang SN, Kim CS. Patterns and determinants of health and social care service needs among community-dwelling older adults. Geriatr Nurs 2023; 51:69-75. [PMID: 36921395 DOI: 10.1016/j.gerinurse.2023.02.016] [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: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
AIM Using Anderson's behavioral model, we examined the patterns and determinants associated with older adults' needs for community- and institution-based care services. METHODS Participants included 411 community-dwelling older adults from the 2020 National Survey of Older Koreans. Logistic regression analyses were performed to examine factors associated with service needs among older adults. RESULTS The need was greatest for movement support services. Enabling factors (marital status, co-residence with children, receipt of financial assistance for medical expenses, social participation, and satisfaction with healthcare facilities) were associated with service needs. Long-term care beneficiary status, activities of daily living limitations, depressive symptoms, hypertension, and vision impairment were also significant factors. CONCLUSIONS Older adults with physical disabilities, depressive symptoms, and limited resources for care require prioritization in support policies to promote aging in place. Both health and social care needs should be addressed in long-term care to enhance social participation among older adults.
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Affiliation(s)
- Jakyung Lee
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea.
| | - Soong-Nang Jang
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea; Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
| | - Cheong-Seok Kim
- Department of Sociology, Dongguk University-Seoul, Seoul, Republic of Korea
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45
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Scheckler S. Household Composition Under Strain: Regional Unemployment Rates and the Older American Housing Decision. J Aging Soc Policy 2023; 35:125-153. [PMID: 34420481 DOI: 10.1080/08959420.2021.1941703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This research explored the relationship between regional unemployment rates and the community-based housing configuration of older Americans. The analysis used the American Community Survey from 2006 to 2016 to examine regions experiencing high unemployment for differences in the likelihood of older adults to live alone, with a spouse or partner, or in a multigenerational household. Findings demonstrated that under the strain of higher regional unemployment, older adults were less likely to live alone and more likely to live in a multigenerational household. Additionally, older adults with a difficulty that could signify a need for support were less likely to live with a spouse or partner, while those without a difficulty were more likely to live with a spouse or partner. Recession-related safety-net policy should target supports to community-dwelling older adults, particularly those living alone, those with more support needs, with lower income, and older renters, because their housing arrangements may become vulnerable during regional economic contraction. Implications during COVID-19 are discussed.
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Affiliation(s)
- Samara Scheckler
- Joint Center for Housing Studies, Harvard University, Cambridge, Massachusetts, United States of America Postdoctoral Fellow
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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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Sheth S, Cogle CR. Home Modifications for Older Adults: A Systematic Review. J Appl Gerontol 2023; 42:1151-1164. [PMID: 36655622 DOI: 10.1177/07334648231151669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
While ≧10,000 Americans turn 65 years old every day, only 10% of American homes are "aging ready." Unsafe homes can exacerbate disability, lead to falls, and increase the likelihood of hospitalization. With increased investments in home and community-based services, public health stakeholders are considering home modifications to promote successful aging. While several home modification models exist, there is significant heterogeneity between models and no consensus on critical features. PubMed, EMBASE, and Web of Science were reviewed and twelve randomized controlled trials of home modifications for older adults were identified and evaluated for model structure, reported outcomes, and risk of bias. Overall, occupational therapist-driven home modifications supplemented with clinical, physical activity, and/or behavioral components saw the greatest success. This systematic review discusses the components of these models, highlights particularly effective and frequently used features, and the practice and research needed to create effective next-generation home modification models which promote healthy longevity.
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Affiliation(s)
- Sohum Sheth
- College of Medicine, 12233University of Florida, Gainesville, FL, USA
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Bailey MD, Gambert S, Gruber-Baldini A, Guralnik J, Kozar R, Qato DM, Shardell M, Albrecht JS. Traumatic Brain Injury and Risk of Long-Term Nursing Home Entry among Older Adults: An Analysis of Medicare Administrative Claims Data. J Neurotrauma 2023; 40:86-93. [PMID: 35793112 PMCID: PMC10162579 DOI: 10.1089/neu.2022.0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of injury-related disability among older adults, and there is increasing interest in post-discharge management as this population grows. We evaluated the association between TBI and long-term nursing home (NH) entry among a nationally representative sample of older adults. We identified 207,355 adults aged ≥65 years who received a diagnosis of either a TBI, non-TBI trauma, or were uninjured between January 2008 and June 2015 from a 5% sample of Medicare beneficiaries. The NH entry was operationalized as the first NH admission that resulted in a stay ≥100 days. Time to NH entry was calculated as the difference between the NH entry date and the index date (the date of TBI, non-TBI trauma, or inpatient/outpatient visit in the uninjured group). We used cause-specific Cox proportional hazards models with stabilized inverse probability of exposure weights to model time to NH entry as a function of injury in the presence of death as a competing risk and generated hazard ratios (HR) and 95% confidence intervals (CI). After excluding beneficiaries living in a NH at index, there were 60,600 TBI, 63,762 non-TBI trauma, and 69,893 uninjured beneficiaries in the sample. In weighted models, beneficiaries with TBI entered NHs at higher rates relative to the non-TBI trauma (HR 1.15; 95% CI 1.10, 1.20) and uninjured (HR 1.67; 95% CI 1.60, 1.74) groups. Future research should focus on interventions to retain older adult TBI survivors within the community.
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Affiliation(s)
- M. Doyinsola Bailey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Steven Gambert
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ann Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rosemary Kozar
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Danya M. Qato
- Department of Pharmaceutical Health Services Research, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michelle Shardell
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Patterson SE. Educational Attainment Differences in Attitudes toward Provisions of IADL Care for Older Adults in the U.S. J Aging Soc Policy 2022; 34:903-922. [PMID: 32008480 PMCID: PMC7433851 DOI: 10.1080/08959420.2020.1722898] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/10/2019] [Indexed: 01/28/2023]
Abstract
Educational attainment is increasingly associated with family inequality in the U.S., but there is little understanding about whether and how education stratifies attitudes toward eldercare. Using the General Social Survey 2012 Eldercare Module, I test the association between educational attainment and attitudes toward eldercare provisions of Instrumental Activities of Daily Living (IADL) including different combinations of help and payment for help. IADLs are the most common care received by older adults and needs are projected to grow, so understanding attitudes toward this type of care is timely and relevant. Results show that adults with a bachelor's degree or graduate/professional degree, compared to adults with less than a high school degree, are more likely to support complete family IADL eldercare, where families provide the care and any payment necessary for care, compared to complete outside IADL eldercare, where outside institutions provide both care and payment. Educational attainment is an important axis of stratification in the U.S. and may explain potentially bifurcated policy solutions desired among different groups.
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Affiliation(s)
- Sarah E. Patterson
- The University of Western Ontario, Sociology Department, Social Science
Centre, Room 5306, London, Ontario, Canada, N6A 5C2
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50
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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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