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Malhotra C, Huynh VA, Østbye T, Malhotra R. Caregivers' Absenteeism and Its Association With Health Shocks and Functional Impairment Among Persons With Severe Dementia. J Aging Soc Policy 2024; 36:603-620. [PMID: 37026473 DOI: 10.1080/08959420.2023.2196232] [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: 08/18/2022] [Accepted: 11/20/2022] [Indexed: 04/08/2023]
Abstract
Adult child caregivers of persons with severe dementia (PWSDs) experience absenteeism due to caregiving. We quantified employed adult child caregivers' absenteeism; its association with PWSDs' functional impairment and health shocks; and characteristics of caregivers not experiencing absenteeism in the presence of PWSDs' health shocks and high functional impairment. We used a prospective cohort of 111 employed adult child caregivers of community-dwelling PWSDs in Singapore surveyed every 4 months for 1 year. We calculated absenteeism days due to caregiving and the corresponding absenteeism cost. Findings showed that 43% of the caregivers experienced absenteeism due to caregiving at least once during 1 year. On average, in a month, caregivers experienced 2.3 (SD = 5.9) absenteeism days and S$758 (SD = 2120) absenteeism cost. Those caring for PWSDs with high functional impairment experienced an additional 2.5 absenteeism days and S$788 absenteeism cost versus caregivers of PWSDs with low functional impairment. Caregivers whose PWSDs experienced a health shock experienced an additional 1.8 absenteeism days and S$772 absenteeism cost versus caregivers of PWSDs without a health shock. Co-residence with PWSDs worsened the impact of PSWDs' high functional impairment on caregivers absenteeism. Caregivers not co-residing with PWSDs and not using a maladaptive coping style were less likely to experience absenteeism when caring for PWSDs with a health shock. Results suggest a need to support caregivers of PWSDs to better cope with their caregiving in order to mitigate caregivers' absenteeism.
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Affiliation(s)
- Chetna Malhotra
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Vinh Anh Huynh
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Truls Østbye
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
| | - Rahul Malhotra
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
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Yi Y, Liu J, Jiang L. Does home and community-based services use reduce hospital utilization and hospital expenditure among disabled elders? Evidence from China. Front Public Health 2023; 11:1266949. [PMID: 37965517 PMCID: PMC10642179 DOI: 10.3389/fpubh.2023.1266949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/02/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction In the background of aging in place, home and community-based services (HCBS) have been playing an increasingly important role in long-term care (LTC) security systems. However, it is still uncertain whether and how HCBS use affects hospital utilization and the corresponding expenditures. Methods Using data from the China Health and Retirement Longitudinal Survey (CHARLS) and the China City Statistical Yearbook, the instrumental variable (IV) approach is applied to identify the causal effects of HCBS use on hospital utilization and hospital expenditure among disabled elders. Results We find that HCBS use significantly reduces the probability of being hospitalized, the times of hospitalization, and the length of inpatient stay, as well as the total, out-of-pocket and reimbursement inpatient expenditures, demonstrating not only the substitution impact of HCBS for hospital care but also the effectiveness of medical expenditure control in LTC security systems. Heterogeneity analysis shows that the impacts of HCBS use on hospital utilization and hospital expenditure concentrate on disabled elders who are younger, male, living in urban areas, or from higher-income households; both healthcare and spiritual consolation services have significant negative effects, while the anticipated effects of daily care service use are not supported. The possible mechanisms are the substitution of HCBS for hospital care and the improvements in both the physical and psychological health of disabled elders. However, the mechanism of adverse events decrease is not verified, which needs to be investigated further with more proxy variables. Conclusion This study provides empirical evidence that HCBS use can not only reduce hospital utilization and hospital expenditure among disabled elders but also improve their physical and psychological health. Policy designs should emphasize the orientation of HCBS, ensure the fundamental and central position of HCBS in the formal care service system, pay more attention to the accessibility and affordability of HCBS for fragile groups, and diversify and optimize the development of the health service and the spiritual consolation service.
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Affiliation(s)
| | | | - Ling Jiang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China
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Min SH, Song J, Evans L, Bowles KH, McDonald MV, Chae S, Topaz M. Home Healthcare Patients With Distinct Psychological, Cognitive, and Behavioral Symptom Profiles and At-Risk Subgroup for Hospitalization and Emergency Department Visits Using Latent Class Analysis. Clin Nurs Res 2023; 32:1021-1030. [PMID: 37345951 PMCID: PMC11080676 DOI: 10.1177/10547738231183026] [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: 06/23/2023]
Abstract
One-third of home healthcare patients are hospitalized or visit emergency departments during a 60-day episode of care. Among all risk factors, psychological, cognitive, and behavioral symptoms often remain underdiagnosed or undertreated in older adults. Little is known on subgroups of older adults receiving home healthcare services with similar psychological, cognitive, and behavioral symptom profiles and an at-risk subgroup for future hospitalization and emergency department visits. Our cross-sectional study used data from a large, urban home healthcare organization (n = 87,943). Latent class analysis was conducted to identify meaningful subgroups of older adults based on their distinct psychological, cognitive, and behavioral symptom profiles. Adjusted multiple logistic regression was used to understand the association between the latent subgroup and future hospitalization and emergency department visits. Descriptive and inferential statistics were conducted to describe the individual characteristics and to test for significant differences. The three-class model consisted of Class 1: "Moderate psychological symptoms without behavioral issues," Class 2: "Severe psychological symptoms with behavioral issues," and Class 3: "Mild psychological symptoms without behavioral issues." Compared to Class 3, Class 1 patients had 1.14 higher odds and Class 2 patients had 1.26 higher odds of being hospitalized or visiting emergency departments. Significant differences were found in individual characteristics such as age, gender, race/ethnicity, and insurance. Home healthcare clinicians should consider the different latent subgroups of older adults based on their psychological, cognitive, and behavioral symptoms. In addition, they should provide timely assessment and intervention especially to those at-risk for hospitalization and emergency department visits.
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Affiliation(s)
- Se Hee Min
- Columbia University School of Nursing, New York, NY, USA
| | - Jiyoun Song
- Columbia University School of Nursing, New York, NY, USA
| | - Lauren Evans
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
| | - Kathryn H Bowles
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Margaret V McDonald
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
| | - Sena Chae
- University of Iowa College of Nursing, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York, NY, USA
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, USA
- Data Science Institute, Columbia University, New York, NY, USA
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Rommerskirch-Manietta M, Manietta C, Purwins D, Braunwarth JI, Quasdorf T, Roes M. Mapping implementation strategies of evidence-based interventions for three preselected phenomena in people with dementia-a scoping review. Implement Sci Commun 2023; 4:104. [PMID: 37641142 PMCID: PMC10463361 DOI: 10.1186/s43058-023-00486-4] [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: 08/04/2022] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Caring for people with dementia is complex, and there are various evidence-based interventions. However, a gap exists between the available interventions and how to implement them. The objectives of our review are to identify implementation strategies, implementation outcomes, and influencing factors for the implementation of evidence-based interventions that focus on three preselected phenomena in people with dementia: (A) behavior that challenges supporting a person with dementia in long-term care, (B) delirium in acute care, and (C) postacute care needs. METHODS We conducted a scoping review according to the description of the Joanna Briggs Institute. We searched MEDLINE, CINAHL, and PsycINFO. For the data analysis, we conducted deductive content analysis. For this analysis, we used the Expert Recommendations for Implementation Change (ERIC), implementation outcomes according to Proctor and colleagues, and the Consolidated Framework for Implementation Research (CFIR). RESULTS We identified 362 (A), 544 (B), and 714 records (C) on the three phenomena and included 7 (A), 3 (B), and 3 (C) studies. Among the studies, nine reported on the implementation strategies they used. Clusters with the most reported strategies were adapt and tailor to context and train and educate stakeholders. We identified one study that tested the effectiveness of the applied implementation strategy, while ten studies reported implementation outcomes (mostly fidelity). Regarding factors that influence implementation, all identified studies reported between 1 and 19 factors. The most reported factors were available resources and the adaptability of the intervention. To address dementia-specific influencing factors, we enhanced the CFIR construct of patient needs and resources to include family needs and resources. CONCLUSIONS We found a high degree of homogeneity across the different dementia phenomena, the evidence-based interventions, and the care settings in terms of the implementation strategies used, implementation outcomes measured, and influencing factors identified. However, it remains unclear to what extent implementation strategies themselves are evidence-based and which intervention strategy can be used by practitioners when either the implementation outcomes are not adjusted to the implementation strategy and/or the effects of implementation strategies are mostly unknown. Future research needs to focus on investigating the effectiveness of implementation strategies for evidence-based interventions for dementia care. TRIAL REGISTRATION The review protocol was prospectively published (Manietta et al., BMJ Open 11:e051611, 2021).
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Affiliation(s)
- Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany.
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Daniel Purwins
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Jana Isabelle Braunwarth
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Tina Quasdorf
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
- School of Health Science, Institute of Nursing, ZHAW Zürich University of Applied Science, Winterthur, Switzerland
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Witten, Witten, Germany
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Hirschman KB, McHugh M, Morgan B. An integrative review of measures of transitions and care coordination for persons living with dementia and their caregivers. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12391. [PMID: 37555017 PMCID: PMC10404587 DOI: 10.1002/trc2.12391] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 08/10/2023]
Abstract
Introduction High rates of hospital visits and readmissions are common among persons living with dementia, resulting in frequent transitions in care and care coordination. This paper identifies and evaluates existing measures of transitions and care coordination for persons living with dementia and their caregivers. Methods This integrative review builds off a prior review using a systematic search of online databases (PubMed, EBSCO, CINAHL, PsycInfo, and Scopus) to identify records and locate reports (or articles) that use measures of care transitions and care coordination. Identified measures were compared to the Alzheimer's Association's Dementia Care Practice Recommendations to evaluate strengths and weaknesses of the measure in this population, such as if measures were person- and family-centered. Results Seventy-one reports using measures of transitions in care and care coordination for persons living with dementia and their caregivers were identified. There were multiple measures identified in some reports. Three main areas of measures were classified into: identification of the population (3 measures, 8 reports), transitional care and care coordination delivery (14 measures, 17 reports), and transitional care and care coordination outcomes (e.g., health-care use, cost, and mortality; 17 measures, 60 reports). A strength of the three main areas of measures was that a portion of the measures were person- and family-centered. Variability in the operational definitions of some measures and time intensiveness of collecting the measure (e.g., number of items, the time it takes to complete the items) were common weaknesses. Discussion Transitions and care coordination measures are varied across studies targeted at persons living with dementia and their caregivers. Existing measures focus heavily on outcomes, specifically health-care resource use, and cost, rather than the elements of transitional care or care coordination. Future measure development focused on care transitions and service coordination is needed.
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Affiliation(s)
| | - Molly McHugh
- University of PennsylvaniaSchool of NursingPhiladelphiaPennsylvaniaUSA
| | - Brianna Morgan
- University of PennsylvaniaSchool of NursingPhiladelphiaPennsylvaniaUSA
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6
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Costa-Font J, Vilaplana-Prieto C. 'Investing' in care for old age? An examination of long-term care expenditure dynamics and its spillovers. EMPIRICAL ECONOMICS 2023; 64:1-30. [PMID: 35668842 PMCID: PMC9137442 DOI: 10.1007/s00181-022-02246-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/10/2022] [Indexed: 05/10/2023]
Abstract
UNLABELLED We study the dynamic drivers of expenditure on long-term care (LTC) programmes, and more specifically, the effects of labour market participation of traditional unpaid caregivers (women aged 40 and older) on LTC spending, alongside the spillover effects of a rise in LTC expenditure on health care expenditures (HCE) and the economy (per capita GDP). Our estimates draw from a panel of more than a decade worth of expenditure data from a sample of OECD countries. We use a panel vector auto-regressive (panel-VAR) system that considers the dynamics between the dependent variables. We find that LTC expenditure increases with the rise of the labour market participation of the traditional unpaid caregiver (women over 40 years of age), and that such expenditures rise exerts large spillover effects on health spending and the economy. We find that a 1% increase in female labour participation gives rise to a 1.48% increase in LTC expenditure and a 0.88% reduction in HCE. The effect of LTC spending over HCE is mainly driven by a reduction in inpatient and medicine expenditures, exhibiting large country heterogeneity. Finally, we document significant spillover effects of LTC expenditures on per capita GDP. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s00181-022-02246-0.
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Affiliation(s)
- Joan Costa-Font
- London School of Economics and Political Science, CESIfo & IZA Bonn, Department of Health Policy, London School of Economics, Houghton Street, London, WC2A 2AE UK
| | - Cristina Vilaplana-Prieto
- Department of Economic Analysis. Faculty of Economics and Business, University of Murcia, Murcia, Spain
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7
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O'Rourke G, Parker D, Anderson R, Morgan-Trimmer S, Allan L. Interventions to support recovery following an episode of delirium: A realist synthesis. Aging Ment Health 2021; 25:1769-1785. [PMID: 32734773 DOI: 10.1080/13607863.2020.1793902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Persistent delirium is associated with poor outcomes in older adults but little is known about how to support longer-term recovery from delirium. The aim of this review was to identify and synthesise literature to understand mechanisms of recovery from delirium as a basis for designing an intervention that enables more effective recovery. METHODS A systematic search of literature relevant to the research question was conducted in two phases. Phase one focused on studies evaluating the efficacy of interventions to support recovery from delirium, and stage two used a wider search strategy to identify other relevant literature including similar patient groups and wider methodologies. Synthesis of the literature followed realist principles. RESULTS Phase one identified four relevant studies and stage two identified a further forty-six studies. Three interdependent recovery domains and four recovery facilitators were identified. Recovery domains were 1) support for physical recovery through structured exercise programmes; 2) support for cognitive recovery through reality orientation and cognitive stimulation; 3) support for emotional recovery through talking with skilled helpers. Recovery facilitators were 1) involvement and support of carers; 2) tailoring intervention to individual needs, preferences and abilities; 3) interpersonal connectivity and continuity in relationships and; 4) facilitating positive expressions of self. CONCLUSIONS Multicomponent interventions with elements that address all recovery domains and facilitators may have the most promise. Future research should build on this review and explore patients', carers', and professionals' tacit theories about the persistence of delirium or recovery from delirium in order to inform an effective intervention.
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Affiliation(s)
- Gareth O'Rourke
- College of Medicine and Health, University of Exeter, Exeter, England
| | - Daisy Parker
- College of Medicine and Health, University of Exeter, Exeter, England
| | - Rob Anderson
- College of Medicine and Health, University of Exeter, Exeter, England
| | | | - Louise Allan
- College of Medicine and Health, University of Exeter, Exeter, England
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Ashbourne J, Boscart V, Meyer S, Tong CE, Stolee P. Health care transitions for persons living with dementia and their caregivers. BMC Geriatr 2021; 21:285. [PMID: 33926380 PMCID: PMC8086075 DOI: 10.1186/s12877-021-02235-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 04/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Persons with dementia are likely to require care from various health care providers in multiple care settings, necessitating navigation through an often-fragmented care system. This study aimed to create a better understanding of care transition experiences from the perspectives of persons living with dementia and their caregivers in Ontario, Canada, through the development of a theoretical framework. METHODS Constructivist grounded theory guided the study. Seventeen individual caregiver interviews, and 12 dyad interviews including persons with dementia and their caregivers, were recorded and transcribed verbatim. The data were coded using NVivo 10 software; analysis occurred iteratively until saturation was reached. RESULTS A theoretical framework outlining the context, processes, and influencing factors of care transitions was developed and refined. Gaining an in-depth understanding of the complex care transitions of individuals with dementia and their caregivers is an important step in improving the quality of care and life for this population. CONCLUSION The framework developed in this study provides a focal point for efforts to improve the health care transitions of persons living with dementia.
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Affiliation(s)
- Jessica Ashbourne
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Veronique Boscart
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
- School of Health and Life Sciences, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Ontario, N2G 4M4, Canada
| | - Samantha Meyer
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Catherine E Tong
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
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Effects of a Person Centered Dementia Training Program in Greek Hospital Staff-Implementation and Evaluation. Brain Sci 2020; 10:brainsci10120976. [PMID: 33322754 PMCID: PMC7763588 DOI: 10.3390/brainsci10120976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 02/07/2023] Open
Abstract
People with Dementia (PwD) are frequently admitted in general hospitals. However, health care professionals have lack of dementia knowledge, negative attitudes toward dementia, and lack of confidence in caring those patients. The aim of this study is to develop, implement and evaluate a dementia staff training program in Greek general hospitals. It was a repeated-measures research design. Fourteen (14) two-day workshops were conducted, consisting of six targeted and interactive modules. Staff members (N = 242) attended the program and were assessed according to (1) individual performance: questionnaires about attitudes towards dementia, confidence in care, knowledge about dementia and anxiety before, immediately after the training and three months later, (2) an overall training evaluation immediately after the training and (3) an evaluation of training implementation three months later. Positive attitudes towards dementia, improvement of confidence in care and decrease of feeling of anxiety as a trait, were sustained over time. Knowledge about dementia also increased after the training and sustained, with, however, a slight decrease over time. A well applied training program seems to provide the basis of a better care in PwD during hospitalization. However, changes in the organizational level and a transformation of care culture are necessary for training sustainability over time.
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10
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Novak P, Chu J, Ali MM, Chen J. Racial and Ethnic Disparities in Serious Psychological Distress Among Those With Alzheimer's Disease and Related Dementias. Am J Geriatr Psychiatry 2020; 28:478-490. [PMID: 31500897 PMCID: PMC7021571 DOI: 10.1016/j.jagp.2019.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Alzheimer's disease and related dementias (ADRD) is a growing public health challenge. Prior research suggests that non-Hispanic whites (whites), non-Hispanic African Americans (African Americans), and Hispanics have differing risks for ADRD. OBJECTIVE To examine the existence of serious psychological distress (SPD) among whites, African Americans, and Hispanics; to calculate the predicted probability of ADRD in whites, African Americans, and Hispanics, and to decompose the differences among ADRD populations, quantifying the burden of higher SPD among African Americans and Hispanics, compared to whites. DATA AND METHOD The authors use nationally representative data from the Medical Expenditure Panel Survey (2007-2015) to estimate the association between ADRD and race, ethnicity, and SPD. Using Blinder-Oaxaca decomposition analysis, the authors estimate to what extent higher SPD among Hispanics and African Americans was associated with higher ADRD rates compared to whites. RESULTS After controlling for individuals' demographic and socioeconomic characteristics and co-existing medical conditions, the presence of SPD was still significantly associated with a higher likelihood of having ADRD. The model predicted significantly higher likelihood of having ADRD among African Americans (7.1%) and Hispanics (5.7%) compared to whites (4.5%). Higher rates of having SPD among African Americans explained 15% of white-black difference and 40% of the white-Hispanic difference in ADRD rates, respectively. DISCUSSION AND CONCLUSION Our findings suggest a significant relationship between SPD and ADRD and that the burden of SPD was greater among African Americans and Hispanics with ADRD. Efficient screening using self-reported SPD, compared to simply using diagnoses codes of mental illness, may be more helpful to reduce racial and ethnic disparities in ADRD.
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Affiliation(s)
- Priscilla Novak
- Department of Health Policy and Management (PN), University of Maryland College Park, School of Public Health, College Park, MD.
| | - Jun Chu
- University of Maryland College Park
| | - Mir M. Ali
- University of Maryland College Park, AND U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation
| | - Jie Chen
- University of Maryland College Park
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Abstract
Associated with substantial morbidity and mortality, delirium is a syndrome commonly experienced by hospitalized adults. This article presents a case study highlighting how delirium may go unrecognized by the healthcare team and provides 10 suggestions for improving delirium assessment, prevention, and management in the acute care setting.
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Affiliation(s)
- Elizabeth Cullen
- Michele Balas is an associate professor at the Ohio State University College of Nursing, Center of Excellence in Critical and Complex Care, Columbus, Ohio. Elizabeth Cullen is a clinical instructor at the Ohio State University College of Nursing, Columbus, Ohio
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Prusaczyk B, Olsen MA, Carpenter CR, Proctor E. Differences in Transitional Care Provided to Patients With and Without Dementia. J Gerontol Nurs 2019; 45:15-22. [PMID: 31211400 DOI: 10.3928/00989134-20190530-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 03/28/2019] [Indexed: 11/20/2022]
Abstract
Older adults with dementia experience more care transitions than those without dementia yet are routinely excluded from transitional care studies. The purpose of the current study was to understand the transitional care delivered to older adults with dementia compared to those without dementia. The medical charts of 210 patients (126 with dementia, 84 without dementia) 70 years and older hospitalized at a single hospital were reviewed for evidence of transitional care, including discharge planning, patient education, and follow-up appointments. Patients with dementia were significantly less likely to receive education related to their follow-up needs, whom to contact after discharge, medication regimens after discharge, and symptoms after discharge than patients without dementia. Caregivers to patients with dementia have previously reported a desire for more education and information from hospital providers so they can advocate for patients in aftercare; therefore, nurses and social workers should consider providing education regardless of a patient's dementia diagnosis. [Journal of Gerontological Nursing, 45(8), 15-22.].
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Koren D, Laidsaar-Powell R, Tilden W, Latt M, Butow P. Health care providers' perceptions of family caregivers' involvement in consultations within a geriatric hospital setting. Geriatr Nurs 2018; 39:419-427. [DOI: 10.1016/j.gerinurse.2017.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/11/2017] [Accepted: 12/18/2017] [Indexed: 11/25/2022]
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Costa-Font J, Jimenez-Martin S, Vilaplana C. Does long-term care subsidization reduce hospital admissions and utilization? JOURNAL OF HEALTH ECONOMICS 2018; 58:43-66. [PMID: 29408154 DOI: 10.1016/j.jhealeco.2018.01.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 10/19/2017] [Accepted: 01/13/2018] [Indexed: 05/25/2023]
Abstract
We use quasi-experimental evidence on the expansion of the public subsidization of long-term care to examine the causal effect of a change in caregiving affordability on the delivery of hospital care. More specifically, we examine a reform that both introduced a new caregiving allowance and expanded the availability of publicly funded home care services, on both hospital admissions (both on the internal and external margin) and length of stay. We find robust evidence of a reduction in both hospital admissions and utilization among both those receiving a caregiving allowance and, albeit less intensely, among beneficiaries of publicly funded home care, which amounts to 11% of total healthcare costs. These effects were stronger when regions had an operative regional health and social care coordination plan in place. Consistently, a subsequent reduction in the subsidy, five years after its implementation, is found to significantly attenuate such effects. We investigate a number of potential mechanisms, and show a number of falsification and robustness checks.
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Affiliation(s)
- Joan Costa-Font
- London School of Economics and Political Science (LSE) & CESifo & IZA, United Kingdom.
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Shippee T, Shippee N, Fernstrom K, Mobley P, Frazer M, Jou J, Britt H. Quality of Life for Late Life Patients: Mixed-Methods Evaluation of a Whole-Person Approach for Patients With Chronic Illnesses. J Appl Gerontol 2017; 38:910-930. [PMID: 29164987 DOI: 10.1177/0733464817732511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Quality of life (QOL) for patients with serious illness in late life is important for patients and policy makers and has implications for improved care delivery. This mixed-methods evaluation examined the effectiveness of a new whole-person approach to late life care-the LifeCourse-which provides patients with ongoing, across-setting assistance from lay health care workers, supported by a clinical team. We investigated whether participation in LifeCourse improves QOL for intervention patients, compared with usual care controls. QOL was assessed using baseline and 6 months Functional Assessment of Chronic Illness Therapy-Palliative version tool ( n = 181 patients and 126 controls). LifeCourse had a significant positive effect on overall QOL for patients when compared with controls. Interview data revealed that participants adjusted expectations when assessing QOL and actively sought out ways to maintain QOL with meaningful activities and needed services. LifeCourse offers a promising model for improving QOL for late life patients.
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Affiliation(s)
| | | | | | | | | | - Judy Jou
- 1 University of Minnesota, Minneapolis, USA
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Prusaczyk B, Cherney SM, Carpenter CR, DuBois JM. Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities. Clin Gerontol 2017; 40:63-73. [PMID: 28452628 PMCID: PMC5911394 DOI: 10.1080/07317115.2016.1201714] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Due to issues related to informed research consent, older adults with cognitive impairments are often excluded from high-quality studies that are not directly related to cognitive impairment, which has led to a dearth of evidence for this population. The challenges to including cognitively impaired older adults in research and the implications of their exclusion are a transdisciplinary issue. The ethical challenges and logistical barriers to conducting research with cognitively impaired older adults are addressed from the perspectives of three different fields-social work, emergency medicine, and orthopaedic surgery. Issues related to funding, study design, intervention components, and outcomes are discussed through the unique experiences of three different providers. A fourth perspective-medical research ethics-provides alternatives to exclusion when conducting research with cognitively impaired older adults such as timing, corrective feedback and plain language, and capacity assessment and proxy appointments. Given the increasing aging population and the lack of evidence on cognitively impaired older adults, it is critical that researchers, funders, and institutional review boards not be dissuaded from including this population in research studies.
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Affiliation(s)
- Beth Prusaczyk
- a Washington University School of Medicine , St. Louis , Missouri , USA
| | - Steven M Cherney
- a Washington University School of Medicine , St. Louis , Missouri , USA
| | | | - James M DuBois
- a Washington University School of Medicine , St. Louis , Missouri , USA
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Naylor MD, Hirschman KB, Hanlon AL, Abbott KM, Bowles KH, Foust J, Shah S, Zubritsky C. Factors Associated With Changes in Perceived Quality of Life Among Elderly Recipients of Long-Term Services and Supports. J Am Med Dir Assoc 2015; 17:44-52. [PMID: 26412018 DOI: 10.1016/j.jamda.2015.07.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/29/2015] [Accepted: 07/31/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Advance knowledge about changes in multiple dimensions of health related quality of life (HRQoL) among older adults receiving long-term services and supports (LTSS) over time and across settings. DESIGN A prospective, observational, longitudinal cohort design. SETTING Nursing homes (NHs), assisted living facilities (ALFs), community. PARTICIPANTS A total of 470 older adults who were first-time recipients of LTSS. MEASUREMENT Single-item quality-of-life measure assessed every 3 months over 2 years. HRQoL domains of emotional status, functional status, and social support were measured using standardized instruments. RESULTS Multivariable mixed effects model with time varying covariates revealed that quality-of-life ratings decreased over time (P < .001). Quality-of-life ratings were higher among enrollees with fewer depressive symptoms (P < .001), higher general physical function (P < .001), enhanced emotional well-being (P < .001), and greater social support (P = .004). Ratings also were higher among those with increased deficits in activities of daily living (P = .02). Ratings were highest among enrollees who received LTSS from ALFs, followed by NHs, then home and community-based services (H&CBS), but only findings between ALFs and H&CBS were statistically significant (P < .001). Finally, ratings tended to decrease over time among enrollees with greater cognitive impairment and increase over time among enrollees with less cognitive impairment (P < .001). CONCLUSIONS Findings advance knowledge regarding what is arguably the most important outcome of elderly LTSS recipients: quality of life. Understanding associations between multiple HRQoL domains and quality of life over time and directly from LTSS recipients represents a critical step in enhancing care processes and outcomes of this vulnerable population.
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Affiliation(s)
- Mary D Naylor
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
| | - Karen B Hirschman
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Alexandra L Hanlon
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Katherine M Abbott
- Miami University, Department of Sociology and Gerontology, Scripps Research Center, Oxford, OH
| | - Kathryn H Bowles
- NewCourtland Center for Transitions and Health; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Janice Foust
- College of Nursing and Health Sciences, University of Massachusetts - Boston, Boston, MA
| | - Shivani Shah
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY
| | - Cynthia Zubritsky
- University of Pennsylvania School of Medicine, Department of Psychiatry, Philadelphia, PA
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Callahan KE, Lovato JF, Miller ME, Easterling D, Snitz B, Williamson JD. Associations Between Mild Cognitive Impairment and Hospitalization and Readmission. J Am Geriatr Soc 2015; 63:1880-5. [PMID: 26313420 DOI: 10.1111/jgs.13593] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether older adults with mild cognitive impairment (MCI), a condition not previously explored as a risk factor, have more hospitalizations and 30-day readmissions than those with normal cognition. DESIGN Post hoc analysis of prospectively gathered data on incident hospitalization and readmission from the Ginkgo Evaluation of Memory Study (GEMS), a randomized, double-blind, placebo-controlled trial designed to assess the effect of Ginkgo biloba on incidence of dementia. SETTING GEMS was conducted in five academic medical centers in the United States. PARTICIPANTS Community-dwelling adults aged 75 and older with normal cognition (n = 2,314) or MCI (n = 428) at baseline cognitive testing (N = 2,742). MEASUREMENTS Index hospitalization and 30-day hospital readmission, adjusted for age, sex, race, education, clinic site, trial assignment status, comorbidities, number of prescription medications, and living with an identified proxy. RESULTS MCI was associated with a 17% greater risk of index hospitalization than normal cognition (adjusted hazard ratio (aHR) = 1.17, 95% confidence interval (CI) = 1.02-1.34)). In participants who lived with a proxy, MCI was associated with a 39% greater risk of index hospitalization (aHR = 1.39, 95% CI = 1.17-1.66). Baseline MCI was not associated with greater odds of 30-day hospital readmission (adjusted odds ratio = 0.90, 95% CI = 0.60-1.36). CONCLUSION MCI may represent a target condition for healthcare providers to coordinate support services in an effort to reduce hospitalization and subsequent disability.
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Affiliation(s)
- Kathryn E Callahan
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina.,Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - James F Lovato
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Michael E Miller
- Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Doug Easterling
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Beth Snitz
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeff D Williamson
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University, Winston-Salem, North Carolina.,Sticht Center on Aging, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
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Ray CA, Ingram V, Cohen-Mansfield J. Systematic review of planned care transitions for persons with dementia. Neurodegener Dis Manag 2015; 5:317-31. [PMID: 26295723 DOI: 10.2217/nmt.15.23] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A systematic review was conducted to identify, categorize and summarize available research on planned care transitions or relocations for persons with dementia (PWD) in order to help guide best practice. Articles were identified by keyword searches of electronic databases, and a soft search of references of relevant articles. The review found that planned care transitions in PWD are associated with an increase in undesirable outcomes, particularly immediately post-transition, and that caregivers are often underutilized in care planning and underprepared for care transitions. It is recommended that transitional care interventions for PWD make explicit efforts to enhance caregiver involvement, provide social and pragmatic support for PWD and their caregivers and offer assistance in managing behavioral and psychological symptoms of dementia.
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20
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Mockford C. A review of family carers' experiences of hospital discharge for people with dementia, and the rationale for involving service users in health research. J Healthc Leadersh 2015; 7:21-28. [PMID: 29355178 PMCID: PMC5740992 DOI: 10.2147/jhl.s70020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In the UK, service user involvement is an important factor in health policy, and obtaining research funding. It may be helpful in expanding our knowledge in areas where research evidence is poor such as experiences of hospital discharge planning for the family carers of people with dementia.
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Affiliation(s)
- Carole Mockford
- Division of Health Sciences, Royal College of Nursing Research Institute, University of Warwick, Coventry, UK
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21
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Balogun SA, Rose K, Thomas S, Owen J, Brashers V. Innovative interprofessional geriatric education for medical and nursing students: focus on transitions in care. QJM 2015; 108:465-71. [PMID: 25362097 DOI: 10.1093/qjmed/hcu226] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Interprofessional education (IPE) is crucial in fostering effective collaboration and optimal team-based patient care, all of which improve patient care and outcomes. Appropriate interprofessional communication is especially important in geriatrics where patients are vulnerable to adverse effects across the care continuum. Transitions in geriatric care are complex, involving several disciplines and requiring careful coordination. As part of the University of Virginia's initiative on IPE, we developed and implemented an interprofessional geriatric education workshop for nursing and medical students with a focus on transitions in care. METHODS A total of 254 students (144 medical students, 107 nursing students and 3 unknown) participated in a 90-min interactive, case-based workshop. Nursing and medical faculty facilitated the monthly workshops with small groups of medical and nursing students over 1 year. Self-perceived competencies in IPE skills and attitudes toward interprofessional teamwork were measured through post-workshop surveys. Data were analyzed using descriptive and nonparametric statistics, excluding the three unknown students. RESULTS Over 90% of students were better able to describe the necessary interprofessional communication needed to develop a patient-centered care plan in transitioning patients between clinical sites. Four out of five students reported an enhanced appreciation of interprofessional teamwork. They were also able to identify legal, financial and social implications in transitions of care (75%). Nursing students consistently rated the workshop more highly than medical students across most domains (P < 0.05). CONCLUSIONS Students improved and demonstrated their knowledge of interprofessional communication and teamwork skills required in transitions of geriatric care. Introducing these concepts in medical and nursing training may help in fostering effective interprofessional communication and collaboration.
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Affiliation(s)
- S A Balogun
- From the Division of General Medicine, Geriatrics/Palliative Care, University of Virginia Health System, P.O. Box 800901, School of Nursing, University of Virginia Health System, P.O. Box 800782, University of Virginia, McLeod Hall 2013A, School of Nursing, University of Virginia, P.O. Box 800711 and School of Nursing, University of Virginia, P.O. Box 800826, Charlottesville, VA 22908, USA
| | - K Rose
- From the Division of General Medicine, Geriatrics/Palliative Care, University of Virginia Health System, P.O. Box 800901, School of Nursing, University of Virginia Health System, P.O. Box 800782, University of Virginia, McLeod Hall 2013A, School of Nursing, University of Virginia, P.O. Box 800711 and School of Nursing, University of Virginia, P.O. Box 800826, Charlottesville, VA 22908, USA
| | - S Thomas
- From the Division of General Medicine, Geriatrics/Palliative Care, University of Virginia Health System, P.O. Box 800901, School of Nursing, University of Virginia Health System, P.O. Box 800782, University of Virginia, McLeod Hall 2013A, School of Nursing, University of Virginia, P.O. Box 800711 and School of Nursing, University of Virginia, P.O. Box 800826, Charlottesville, VA 22908, USA
| | - J Owen
- From the Division of General Medicine, Geriatrics/Palliative Care, University of Virginia Health System, P.O. Box 800901, School of Nursing, University of Virginia Health System, P.O. Box 800782, University of Virginia, McLeod Hall 2013A, School of Nursing, University of Virginia, P.O. Box 800711 and School of Nursing, University of Virginia, P.O. Box 800826, Charlottesville, VA 22908, USA
| | - V Brashers
- From the Division of General Medicine, Geriatrics/Palliative Care, University of Virginia Health System, P.O. Box 800901, School of Nursing, University of Virginia Health System, P.O. Box 800782, University of Virginia, McLeod Hall 2013A, School of Nursing, University of Virginia, P.O. Box 800711 and School of Nursing, University of Virginia, P.O. Box 800826, Charlottesville, VA 22908, USA
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"Dementia-friendly hospitals: care not crisis": an educational program designed to improve the care of the hospitalized patient with dementia. Alzheimer Dis Assoc Disord 2015; 24:372-9. [PMID: 20625267 DOI: 10.1097/wad.0b013e3181e9f829] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 3.2 million hospital stays annually involve a person with dementia, leading to higher costs, longer lengths of stay, and poorer outcomes. Older adults with dementia are vulnerable when hospitals are unable to meet their special needs. METHODS We developed, implemented, and evaluated a training program for 540 individuals at 4 community hospitals. Pretest, posttest, and a 120-day delayed posttest were performed to assess knowledge, confidence, and practice parameters. RESULTS The mean age of the sample was 46 years; 83% were White, 90% were female, and 60% were nurses. Upon completion, there were significant gains (P's <0.001) in knowledge and confidence in recognizing, assessing, and managing dementia. Attendees reported gains in communication skills and strategies to improve the hospital environment, patient safety, and behavioral management. At 120 days, 3 of 4 hospitals demonstrated maintenance of confidence. In the hospital that demonstrated lower knowledge and confidence scores, the sample was older and had more nurses and more years in practice. CONCLUSIONS We demonstrate the feasibility of training hospital staff about dementia and its impact on patient outcomes. At baseline, there was low knowledge and confidence in the ability to care for dementia patients. Training had an immediate impact on knowledge, confidence, and attitudes with lasting impact in 3 of 4 hospitals. We identified targets for intervention and the need for ongoing training and administrative reinforcement to sustain behavioral change. Community resources, such as local chapters of the Alzheimer Association, may be key community partners in improving care outcomes for hospitalized persons with dementia.
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POROCK DAVINA, CLISSETT PHILIP, HARWOOD ROWANH, GLADMAN JOHNR. Disruption, control and coping: responses of and to the person with dementia in hospital. AGEING & SOCIETY 2015; 35:37-63. [PMID: 25878366 PMCID: PMC4301214 DOI: 10.1017/s0144686x13000561] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 11/07/2022]
Abstract
This qualitative study aimed to gain insight into the experience of hospitalisation from the perspectives of the older person with dementia, their family care-giver and other patients sharing the ward (co-patients). Non-participant observation of care on 11 acute hospital wards was supplemented by 39 semi-structured interviews with 35 family care-givers and four co-patients following discharge. Constant comparative analysis produced the core problem facing all those involved: disruption from normal routine meaning that the experience of hospitalisation was disrupted by the presence and behaviour of the person with dementia. Disruption adversely affected the person with dementia, triggering constructive, disengaged, distressed and neutral behaviours. Using Kitwood's model of person-centred care, these behaviours were interpreted as attempts by the person with dementia at gaining a sense of control over the unfamiliar environment and experience. Family care-givers' lives and experiences both inside and outside the hospital were disrupted by the hospitalisation. They too attempted to gain a sense of control over the experience and to give a sense of control to the patient, co-patients and staff. Co-patients experienced disruption from sharing space with the person with dementia and were left feeling vulnerable and sometimes afraid. They too attempted to gain a sense of control over their situation and give some control by helping the person with dementia, the family care-giver and the staff.
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Affiliation(s)
- DAVINA POROCK
- Institute for Person-Centered Care, State University of New York at Buffalo, USA
- School of Nursing, Midwifery and Physiotherapy, University of Nottingham, UK
| | - PHILIP CLISSETT
- School of Nursing, Midwifery and Physiotherapy, University of Nottingham, UK
| | - ROWAN H. HARWOOD
- Health Care for Older People, Nottingham University Hospitals NHS Trust, UK
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Feasibility of "Standardized Clinician" Methodology for Patient Training on Hospital-to-Home Transitions. Simul Healthc 2014; 10:4-13. [PMID: 25514585 DOI: 10.1097/sih.0000000000000053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Patient engagement in health care is increasingly recognized as essential for promoting the health of individuals and populations. This study pilot tested the standardized clinician (SC) methodology, a novel adaptation of standardized patient methodology, for teaching patient engagement skills for the complex health care situation of transitioning from a hospital back to home. METHODS Sixty-seven participants at heightened risk for hospitalization were randomly assigned to either simulation exposure-only or full-intervention group. Both groups participated in simulation scenarios with "standardized clinicians" around tasks related to hospital discharge and follow-up. The full-intervention group was also debriefed after scenario sets and learned about tools for actively participating in hospital-to-home transitions. Measures included changes in observed behaviors at baseline and follow-up and an overall program evaluation. RESULTS The full-intervention group showed increases in observed tool possession (P = 0.014) and expression of their preferences and values (P = 0.043). The simulation exposure-only group showed improvement in worksheet scores (P = 0.002) and fewer engagement skills (P = 0.021). Both groups showed a decrease in telling an SC about their hospital admission (P < 0.05). Open-ended comments from the program evaluation were largely positive. CONCLUSIONS Both groups benefited from exposure to the SC intervention. Program evaluation data suggest that simulation training is feasible and may provide a useful methodology for teaching patient skills for active engagement in health care. Future studies are warranted to determine if this methodology can be used to assess overall patient engagement and whether new patient learning transfers to health care encounters.
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25
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Griffiths P, Bridges J, Sheldon H, Thompson R. The role of the dementia specialist nurse in acute care: a scoping review. J Clin Nurs 2014; 24:1394-405. [DOI: 10.1111/jocn.12717] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Griffiths
- Faculty of Health Sciences; University of Southampton; Southampton and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex); UK
| | - Jackie Bridges
- Faculty of Health Sciences; University of Southampton; Southampton and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex); UK
| | | | - Rachel Thompson
- Royal College of Nursing and Admiral Nurse; Dementia UK
- Royal College of Nursing; London UK
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Abstract
OVERVIEW Although it increases the risk of poor outcomes and raises the costs of care, cognitive impairment in hospitalized older adults is often neither accurately identified nor well managed. In conducting a two-phase, comparative-effectiveness clinical trial of the effects of three nursing interventions-augmented standard care, resource nurse care, and the transitional care model-on hospitalized older adults with cognitive deficits, a team of researchers encountered several challenges. For example, in assessing potential subjects for the study, they found that nearly half of those assessed had cognitive impairment, yet many family caregivers could not be identified or had no interest in participating in the study. One lesson the researchers learned was that research involving cognitively impaired older adults must actively engage clinicians, patients, and family caregivers, as well as address the complex process of managing postdischarge care.
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Hanrahan NP, Solomon P, Hurford MO. A pilot randomized control trial: testing a transitional care model for acute psychiatric conditions. J Am Psychiatr Nurses Assoc 2014; 20:315-27. [PMID: 25288600 DOI: 10.1177/1078390314552190] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE People with multiple and persistent mental and physical health problems have high rates of transition failures when transferring from a hospital level of care to home. The transitional care model (TCM) is evidence-based and demonstrated to improve posthospital outcomes for elderly with physical health conditions, but it has not been studied in the population with serious mental illness. METHOD Using a randomized controlled design, 40 inpatients from two general hospital psychiatric units were recruited and randomly assigned to an intervention group (n = 20) that received the TCM intervention that was delivered by a psychiatric nurse practitioner for 90 days posthospitalization, or a control group (n = 20) that received usual care. Outcomes were as follows: service utilization, health-related quality of life, and continuity of care. RESULTS The intervention group showed higher medical and psychiatric rehospitalization than the control group (p = .054). Emergency room use was lower for intervention group but not statistically significant. Continuity of care with primary care appointments were significantly higher for the intervention group (p = .023). The intervention group's general health improved but was not statistically significant compared with controls. CONCLUSIONS A transitional care intervention is recommended; however, the model needs to be modified from a single nurse to a multidisciplinary team with expertise from a psychiatric nurse practitioner, a social worker, and a peer support specialist. A team approach can best manage the complex physical/mental health conditions and complicated social needs of the population with serious mental illness.
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Affiliation(s)
- Nancy P Hanrahan
- Nancy P. Hanrahan, PhD, RN, FAAN, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Phyllis Solomon
- Phyllis Solomon, PhD, University of Pennsylvania School of Social Policy & Practice, Philadelphia, PA, USA
| | - Matthew O Hurford
- Matthew O. Hurford, MD, Philadelphia Department of Behavioral Health and Intellectual Disability Services, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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LaMantia MA, Boustani MA, Jhanji S, Maina M, Nazir A, Messina FC, Frame A, Alder C, Chodosh J. Redesigning acute care for cognitively impaired older adults: Optimizing health care services. DEMENTIA 2014; 15:913-30. [PMID: 25128821 DOI: 10.1177/1471301214547089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE OF THE STUDY Cognitive impairment (CI) is one of several factors known to influence hospitalization, hospital length of stay, and rehospitalization among older adults. Redesigning care delivery systems sensitive to the influence of CI may reduce acute care utilization while improving care quality. To develop a foundation of fundamental needs for health care redesign, we conducted focus groups with inpatient and outpatient providers to identify barriers, facilitators, and suggestions for improvements in care delivery for patients with CI. DESIGN AND METHODS Focus group sessions were conducted with providers to identify their approach to caring for cognitively impaired hospitalized adults; obstacles and facilitators to providing this care; and suggestions for improving the care process. Using a thematic analysis, two reviewers analyzed these transcripts to develop codes and themes. RESULTS Seven themes emerged from the focus group transcripts. These were: (1) reflections on serving the cognitively impaired population; (2) descriptions of perceived barriers to care; (3) strategies that improve or facilitate caring for hospitalized older adults; (4) the importance of fostering a hospital friendly to the needs of older adults; (5) the need for educating staff, patients, and caregivers; (6) the central role of good communication; and (7) steps needed to provide more effective care. IMPLICATIONS Providing effective acute care services to older adults with CI is an important challenge in health care reform. An understanding derived from the perspective of multiple professional disciplines is an important first step. Future research will build on this preliminary study in developing new acute care models for patients with CI.
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Affiliation(s)
- Michael A LaMantia
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Malaz A Boustani
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shola Jhanji
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Mungai Maina
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Arif Nazir
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Frank C Messina
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Amie Frame
- Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | | - Joshua Chodosh
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Lee JH, Kim SJ, Lam J, Kim S, Nakagawa S, Yoo JW. The effects of shared situational awareness on functional and hospital outcomes of hospitalized older adults with heart failure. J Multidiscip Healthc 2014; 7:259-65. [PMID: 25061316 PMCID: PMC4085298 DOI: 10.2147/jmdh.s62269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Functional decline of hospitalized older adults is common and triggers health care expenditures. Physical therapy can retard the functional decline that occurs during hospitalization. This study aims to examine whether shared situational awareness (SSA) intervention may enhance the benefits of physical therapy for hospitalized older persons with a common diagnosis, heart failure. METHOD An SSA intervention that involved daily multidisciplinary meetings was applied to the care of functionally declining older adults admitted to the medicine floor for heart failure. Covariates were matched between the intervention group (n=473) and control group (n=475). Both intervention and control groups received physical therapy for ≥0.5 hours per day. The following three outcomes were compared between groups: 1) disability, 2) transition to skilled nursing facility (SNF, post-acute care setting), and 3) 30-day readmission rate. RESULTS Disability was lower in the intervention group (28%) than in the control group (37%) (relative risk [RR] =0.74; 95% confidence interval [CI], 0.35-0.97; P=0.026), and transition to SNF was lower in the intervention group (22%) than in the control group (30%) (RR =0.77; 95% CI, 0.39-0.98; P=0.032). The 30-day readmission rate did not significantly differ between the two groups. CONCLUSION SSA intervention enhanced the benefits of physical therapy for functionally declining older adults. When applied to older adults with heart failure in the form of daily multidisciplinary meetings, SSA intervention improved functional outcomes and reduced transfer to SNFs after hospitalization.
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Affiliation(s)
- Joo H Lee
- Department of Media and Communication, Hanyang University College of Social Sciences, Seoul, Korea
| | - Sun J Kim
- Department of Public Health, Yonsei University College of Medicine, Seoul, Korea ; Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
| | - Julia Lam
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sulgi Kim
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Shunichi Nakagawa
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ji W Yoo
- Center for Senior Health and Longevity, Aurora Health Care, Milwaukee, WI, USA ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
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Dementia considered? Safety-relevant communication between health care settings: a systematic review. J Public Health (Oxf) 2014. [DOI: 10.1007/s10389-014-0630-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Martins S, Conceição F, Paiva JA, Simões MR, Fernandes L. Delirium recognition by family: European Portuguese validation study of the family confusion assessment method. J Am Geriatr Soc 2014; 62:1748-52. [PMID: 25039562 DOI: 10.1111/jgs.12973] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To present the validation study of the European Portuguese version of the Family Confusion Assessment Method (FAM-CAM) and to assess the level of psychological distress in families and caregivers of elderly hospitalized adults with delirium. DESIGN Validation study. SETTING Intermediate care unit of the Intensive Medicine Service of the São João Hospital Center, Porto, Portugal. PARTICIPANTS Families and caregivers of elderly hospitalized adults (≥48 hours). Inclusion criteria were sufficient knowledge about the individual to enable reporting on his or her mental and physical abilities and staying at the individual's bedside daily during hospitalization. Families and caregivers younger than 18 and those who did not speak Portuguese were excluded. MEASUREMENTS A trained researcher translated the FAM-CAM according to International Society For Pharmacoeconomics and Outcomes Research guidelines. All individuals were assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) (reference standard) and the Confusion Assessment Method (CAM). A trained researcher administered the FAM-CAM to families and caregivers. The level of family-perceived distress was evaluated on a numerical rating scale from 0 to 4. RESULTS The sample included 40 families and caregivers (58% adult children). According to the DSM-IV-TR, 20% of individuals had delirium. The FAM-CAM had moderate sensitivity (75%) and good specificity (91%) when assessed against the DSM-IV-TR and better sensitivity (86%) and specificity (91%) than the CAM. Fifty-seven percent of families and caregivers classified delirium as an extremely distressing experience. CONCLUSION These preliminary results suggest that FAM-CAM is a sensitive screening tool for family detection of delirium in elderly hospitalized adults. The high level of psychological distress found corroborated previous studies. Future studies with larger samples will be needed for further validation and to allow the analysis of other psychometric properties.
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Affiliation(s)
- Sónia Martins
- Research and Education Unit on Aging, University of Porto, Porto, Portugal
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Hill NL, Yevchak A, Gilmore-Bykovskyi A, Kolanowski AM. The Model of Care Partner Engagement: Use in delirium management. Geriatr Nurs 2014; 35:272-8. [DOI: 10.1016/j.gerinurse.2014.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 02/20/2014] [Accepted: 02/22/2014] [Indexed: 01/26/2023]
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Bull MJ, Boaz L, Sjostedt JM. Family Caregivers' Knowledge of Delirium and Preferred Modalities for Receipt of Information. J Appl Gerontol 2014; 35:744-58. [PMID: 24942969 DOI: 10.1177/0733464814535484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 04/21/2014] [Indexed: 11/16/2022] Open
Abstract
Delirium is a life-threatening, frequently reversible condition that is often a sign of an underlying health problem. In-hospital mortality alone for older adults with delirium ranges from 25% to 33%. Early recognition of delirium is critical because prolonged duration poses a greater risk of poor functional outcomes for older adults. Family caregivers, who are familiar with the older adult's usual behaviors, are most likely to recognize delirium symptoms but might dismiss them as due to aging. It is important to learn what family caregivers know about delirium to ascertain their need for education. The aims of this study were to describe family caregivers' knowledge of delirium and preferred modalities for receipt of information about delirium. A cross-sectional design was used for this study and a survey distributed to family caregivers for older adults. Analysis of 134 usable surveys indicated that family caregivers need and want information about delirium. The preferred modalities for receipt of information included Internet, in-person classes, and newsletters.
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Carbone MK, Gugliucci MR. Delirium and the Family Caregiver: The Need for Evidence-based Education Interventions. THE GERONTOLOGIST 2014; 55:345-52. [PMID: 24847844 DOI: 10.1093/geront/gnu035] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/25/2014] [Indexed: 11/14/2022] Open
Abstract
Delirium, an acute confusional state, is experienced by many older adults. Although there is substantial research on risk factors and etiology, we hypothesized that there is a dearth of information on educating the family caregivers of delirious older patients. A date-specific (2000-2013) literature review of articles, written in English, was conducted in several major databases using keyword searches. This systematic review focused on 2 objectives: (1) investigate published studies on the impact of delirium on the family regarding caring for a loved one; and (2) determine if there are interventions that have provided family caregivers with education and/or coping skills to recognize and/or manage delirium. A systematic elimination provided outcomes that met both objectives. Thirty articles addressed impact on family caregivers (objective 1); only 7 addressed caregiver education regarding the delirious state of a loved one (objective 2). Few studies consider the impact of delirium on family caregivers and even fewer studies focus on how to manage delirium in loved ones. With increased risks to older adult patients, high cost of care, and the preventable nature of delirium, family caregiver education may be an important tactic to improve outcomes for both patient and caregiver.
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Affiliation(s)
- Meredith K Carbone
- Geriatrics Education and Research & Professor, University of New England College of Osteopathic Medicine, Biddeford, Maine
| | - Marilyn R Gugliucci
- Geriatrics Education and Research & Professor, University of New England College of Osteopathic Medicine, Biddeford, Maine.
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Naylor MD, Hirschman KB, Hanlon AL, Bowles KH, Bradway C, McCauley KM, Pauly MV. Comparison of evidence-based interventions on outcomes of hospitalized, cognitively impaired older adults. J Comp Eff Res 2014; 3:245-57. [PMID: 24969152 PMCID: PMC4171127 DOI: 10.2217/cer.14.14] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIM This article reports the effects of three evidence-based interventions of varying intensity, each designed to improve outcomes of hospitalized cognitively impaired older adults. MATERIALS & METHODS In this comparative effectiveness study, 202 older adults with cognitive impairment (assessed within 24 h of index hospitalization) were enrolled at one of three hospitals within an academic health system. Each hospital was randomly assigned one of the following interventions: Augmented Standard Care (ASC; lower dose: n = 65), Resource Nurse Care (RNC; medium dose: n = 71) or the Transitional Care Model (TCM; higher dose: n = 66). Since randomization at the patient level was not feasible due to potential contamination, generalized boosted modeling that estimated multigroup propensity score weights was used to balance baseline patient characteristics between groups. Analyses compared the three groups on time with first rehospitalization or death, the number and days of all-cause rehospitalizations per patient and functional status through 6-month postindex hospitalization. RESULTS In total, 25% of the ASC group were rehospitalized or died by day 33 compared with day 58 for the RNC group versus day 83 for the TCM group. The largest differences between the three groups on time to rehospitalization or death were observed early in the Kaplan-Meier curve (at 30 days: ASC = 22% vs RNC = 19% vs TCM = 9%). The TCM group also demonstrated lower mean rehospitalization rates per patient compared with the RNC (p < 0.001) and ASC groups (p = 0.06) at 30 days. At 90-day postindex hospitalization, the TCM group continued to demonstrate lower mean rehospitalization rates per patient only when compared with the ASC group (p = 0.02). No significant group differences in functional status were observed. CONCLUSION Findings suggest that the TCM intervention, compared with interventions of lower intensity, has the potential to decrease costly resource use outcomes in the immediate postindex hospitalization period among cognitively impaired older adults.
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Affiliation(s)
- Mary D Naylor
- NewCourtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Karen B Hirschman
- NewCourtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Alexandra L Hanlon
- NewCourtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Kathryn H Bowles
- Center for Integrative Science in Aging (CISA), University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Christine Bradway
- Center for Integrative Science in Aging (CISA), University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Kathleen M McCauley
- NewCourtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Mark V Pauly
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, PA, USA
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Shankar KN, Hirschman KB, Hanlon AL, Naylor MD. Burden in caregivers of cognitively impaired elderly adults at time of hospitalization: a cross-sectional analysis. J Am Geriatr Soc 2014; 62:276-84. [PMID: 24502827 DOI: 10.1111/jgs.12657] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To describe the factors associated with burden that caregivers of cognitively impaired older adults (dementia, delirium, or both) at the time of hospitalization experienced. DESIGN Cross-sectional data analyses. SETTING Three hospitals-one academic tertiary hospital and two associated community hospitals. PARTICIPANTS Caregivers (N = 495) of cognitively impaired older adults at the time of hospital admission. MEASUREMENTS Multivariable linear regression was performed to analyze the effect of the independent variables (caregiver: demographic characteristics, depressive symptoms, self-efficacy; older adult: neuropsychiatric symptoms, delirium, functional deficits) on caregiver burden. RESULTS Higher burden was associated with younger caregiver age (P = .02), being a spouse (P = .03), depressive symptoms (P < .001), caregivers' lower perceived self-efficacy in managing care recipient symptoms (P = .002), and limited finances at the end of the month (P = .01). Caregiver burden was also strongly associated with the care recipient factors distressing neuropsychiatric symptoms (P = .001), delirium (P = .001), and greater functional deficits in basic activities of daily living (P = .001). CONCLUSION These findings suggest that caregivers of older adults who were cognitively impaired at hospital admission experience burden. Understanding the factors that contribute to burden at the time of hospitalization for caregivers of persons with cognitive impairment can inform the development of interventions targeted throughout the hospitalization that have the potential to decrease burden.
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Affiliation(s)
- Kalpana N Shankar
- Boston Medical Center, Boston, Massachusetts; School of Medicine, Boston University, Boston, Massachusetts
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Zega M, D'Agostino F, Bowles KH, De Marinis MG, Rocco G, Vellone E, Alvaro R. Development and Validation of a Computerized Assessment Form to Support Nursing Diagnosis. Int J Nurs Knowl 2013; 25:22-9. [DOI: 10.1111/2047-3095.12008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maurizio Zega
- School of Nursing; University Tor Vergata; Rome Italy
| | | | | | | | - Gennaro Rocco
- Center of Excellence for Nursing Scholarship; Rome Italy
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Felix HC, Thostenson JD, Bursac Z, Bradway C. Effect of weight on indwelling catheter use among long-term care facility residents. UROLOGIC NURSING 2013; 33:194-200. [PMID: 24079118 PMCID: PMC5360177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study examined the effect of obesity on the use of indwelling urinary catheters among long-term care facility residents and found initial increases in usage by weight category, which declined during the next 12 months.
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Affiliation(s)
- Holly C Felix
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Yoo JW, Seol H, Kim SJ, Yang JM, Ryu WS, Min TD, Choi JB, Kwon M, Kim S. Effects of hospitalist-directed interdisciplinary medicine floor service on hospital outcomes for seniors with acute medical illness. Geriatr Gerontol Int 2013; 14:71-7. [DOI: 10.1111/ggi.12056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Ji Won Yoo
- Department of Internal Medicine and Institute of Gerontology; University of Michigan Medical School; Ann Arbor Michigan USA
- Department of Internal Medicine; Korea University College of Medicine; Seoul Korea
| | - Haesun Seol
- Federally Qualified Health Center; VNA Health Center; Bensenville Illinois USA
| | - Sun Jung Kim
- School of Public Health; Yonsei University; Seoul Korea
| | - Janet Miyoung Yang
- Department of Internal Medicine; Saint Joseph Mercy Hospital; Ann Arbor Michigan USA
| | - Woo Sang Ryu
- Center of Clinical Research; Korea University College of Medicine; Seoul Korea
| | - Too Dae Min
- Center of Clinical Research; Korea University College of Medicine; Seoul Korea
| | - Jong Bum Choi
- Center for Clinical Research; Yonsei University College of Medicine; Seoul Korea
| | - Minkyung Kwon
- Center for Clinical Research; Yonsei University College of Medicine; Seoul Korea
| | - Sulgi Kim
- Department of Epidemiology; School of Public Health; University of Washington; Seattle Washington USA
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Trojanowski JQ, Arnold SE, Karlawish JH, Naylor M, Brunden KR, Lee VMY. A model for improving the treatment and care of Alzheimer's disease patients through interdisciplinary research. Alzheimers Dement 2012; 8:564-73. [PMID: 23102127 PMCID: PMC3643202 DOI: 10.1016/j.jalz.2011.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 12/31/2022]
Abstract
The emerging global epidemic of Alzheimer's disease (AD) demands novel paradigms to address the two unmet needs of the field: (a) cost-effective health care delivery programs/services, and (b) clinical and basic research to accelerate therapy discovery/development. This report outlines a model demonstration project, the Marian S. Ware Alzheimer Program at the University of Pennsylvania, which was designed to achieve four specific aims: (1) improve the integration and continuity of AD care; (2) identify biomarkers that detect the earliest presence of AD and related neurodegenerative cognitive disorders; (3) enhance both the design and conduct of clinical trials as well as review their results to more effectively test new AD therapies and translate valuable therapies into clinical practice; and (4) discover and develop novel disease-modifying small molecule treatments for AD. The "Ware-UPenn" program has been presented in this report as a useful prototype for partnerships between private philanthropy and academia in planning and developing programs to address a major national public health problem.
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Steis MR, Evans L, Hirschman KB, Hanlon A, Fick DM, Flanagan N, Inouye SK. Screening for delirium using family caregivers: convergent validity of the Family Confusion Assessment Method and interviewer-rated Confusion Assessment Method. J Am Geriatr Soc 2012; 60:2121-6. [PMID: 23039310 PMCID: PMC3498543 DOI: 10.1111/j.1532-5415.2012.04200.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To explore agreement between the Family Confusion Assessment Method (FAM-CAM) for delirium identification and interviewer-rated CAM delirium ratings. DESIGN Exploratory analysis of agreement. SETTING Community. PARTICIPANTS Fifty-two family caregivers and 52 elderly adults with preexisting impairment according to standardized cognitive testing. MEASUREMENTS The interviewer-rating for delirium was determined by fulfillment of the CAM algorithm RESULTS The total sample included 52 paired CAM:FAM-CAM assessments completed across 52 dyads of elderly adults with preexisting cognitive impairment and family caregivers. The point prevalence of delirium was 13% (7/52). Characteristics did not differ significantly between the groups with and without delirium. The FAM-CAM questions that mapped directly to the original four-item CAM algorithm had the best overall agreement with the interviewer-rated CAM (kappa = 0.85, 95% confidence interval (CI) = 0.65-1.0), sensitivity of 88% (95% CI = 47-99%), and specificity of 98% (95% CI = 86-100%). CONCLUSION The FAM-CAM is a sensitive screening tool for detection of delirium in elderly adults with cognitive impairment using family caregivers, with relevance for research and clinical practice.
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Affiliation(s)
| | - Lois Evans
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
| | - Karen B. Hirschman
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
| | - Alexandra Hanlon
- University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
| | - Donna M. Fick
- School of Nursing, The Pennsylvania State University, University Park, Pennsylvania
| | - Nina Flanagan
- Decker School of Nursing, Binghamton University, Binghamton, New York
| | - Sharon K. Inouye
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School and the Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, Boston, MA
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Parke B, Hunter KF, Bostrom AM, Chambers T, Manraj C. Identifying modifiable factors to improve quality for older adults in hospital: a scoping review. Int J Older People Nurs 2012; 9:8-24. [PMID: 23067226 DOI: 10.1111/opn.12007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 07/26/2012] [Indexed: 01/20/2023]
Abstract
BACKGROUND Traditional ways of viewing hospitalisation do not always recognise how elements within the hospital environment contribute to disability. Four theoretical dimensions of older adult-hospital environment fit have been proposed in previous research on elder-friendly hospitals: social climate, physical design, care systems and processes, policies and procedures; however, modifiable factors for each dimension are not yet identified. DESIGN Exploratory iterative design guided by Arksey and O'Malley (2005, International Journal of Social Research Methodology 8, 19) scoping review methodology. METHOD We undertook a scoping review of primary research related to hospitalised community-dwelling older adults. Keys search terms and criteria were used to identify relevant articles with modifiable factors extracted from articles meeting study criteria. RESULTS A total of 66 studies were included and evaluated for modifiable factor mapping. We were able to map all 66 studies to the four dimensions. The majority of included studies described care systems and processes, with little relating to social climate, physical design and policies and procedures. Thirty-nine potentially modifiable factors were identified and mapped to the theoretical dimensions according to four overarching themes: models of care; assessment of potential geriatric issues; targeting care to a specific clinical issue and supporting transitions home themes. CONCLUSION The dimensions of older adult-hospital fit help us to organise key features of an elder-friendly hospital and identify potentially modifiable factors. Although it makes intuitive sense to cluster and organise according to the dimensions to help with understanding, this tells us little about the synergy of interactions and hierarchical relationships. Our results highlight the importance of competent gerontological nursing in care for hospitalised older adults and the need for further understanding of the older adult and family as a unit of care. IMPLICATIONS FOR PRACTICE Registered nurses have a leadership role to ensure safe quality care for older people in hospital. This leadership role can be framed in interventions that focus on fixing the fit between what older people need and what the hospital environment provides. Modifiable factors for improvement are within the scope and competency of the registered nurse.
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Affiliation(s)
- Belinda Parke
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Toles MP, Abbott KM, Hirschman KB, Naylor MD. Transitions in care among older adults receiving long-term services and supports. J Gerontol Nurs 2012; 38:40-7. [PMID: 23066681 DOI: 10.3928/00989134-20121003-04] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 04/03/2012] [Indexed: 11/20/2022]
Abstract
Recipients of long-term services and supports (LTSS) frequently transition between LTSS settings (e.g., assisted living facilities, nursing homes) and hospitals for acute changes in health. In this qualitative study, we analyzed findings from interviews with 57 recently hospitalized LTSS recipients and their family caregivers and described barriers and facilitators to high-quality care to support older adults through these care transitions. The themes that emerged strongly suggest that LTSS recipients and family caregivers do not receive needed information about the reasons for their transfers to hospitals, medical diagnoses, and planned treatments to address acute changes in health. Our findings indicate an urgent need for nurses and other health care team members to talk with LTSS recipients (and family caregivers) and ensure they are engaged and informed participants in care. We also found the need for research to test evidence-based transitional care for high-risk LTSS recipients and their family caregivers.
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Affiliation(s)
- Mark P Toles
- Duke University School of Nursing, durham, NC, USA.
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Differences in depression severity in family caregivers of hospitalized individuals with dementia and family caregivers of outpatients with dementia. Am J Geriatr Psychiatry 2012; 20:815-9. [PMID: 21997604 PMCID: PMC3487168 DOI: 10.1097/jgp.0b013e318235b62f] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine if family caregivers of hospitalized individuals with dementia exhibit greater depression severity than caregivers of outpatients. METHODS Caregivers were recruited during care recipient treatment. Measures assessed depression, stress, burden, and grief. RESULTS Forty-one caregivers of a hospitalized patient and 44 caregivers of an outpatient (total N = 85) were recruited. The groups did not differ except caregivers of hospitalized patients were younger and less likely to reside with the care recipient. Regarding depression, 63.4% of caregivers of a hospitalized patient and 43.2% of caregivers of an outpatient scored within the clinical depressive symptoms range. Independent sample t-tests showed that caregivers of a hospitalized patient had greater severity of depression, burden, and grief. Caregiving for a hospitalized person remained a significant predictor of greater depression severity in regression models. CONCLUSIONS Family caregiving for a person hospitalized for psychiatric treatment of dementia is a risk factor for depression.
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Geary CR, Schumacher KL. Care transitions: integrating transition theory and complexity science concepts. ANS Adv Nurs Sci 2012; 35:236-48. [PMID: 22869210 DOI: 10.1097/ans.0b013e31826260a5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Care transitions, defined as hospital discharge or movement from one health care setting to another, are currently a major concern of health care providers and policy makers. Extensive empirical research has been conducted on care transitions, but the theoretical foundations are rarely made explicit. We propose that integrating concepts on complex adaptive systems from complexity science with classic theory on transitions in nursing provides a powerful new lens through which to study care transitions and improve transition outcomes. We summarize concepts from both theoretical approaches, propose an expanded model of transitions, and apply the model to the transition from hospital to home.
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Abstract
Addressing the health care needs of older adults coping with multiple conditions and their family caregivers in a person- and family-centered, safe, effective, efficient, equitable, and timely manner will be a major issue confronting America's health care system for the foreseeable future. This article describes the efforts of a multidisciplinary team to create a path from system fragmentation to integration for this vulnerable population through the design, testing, and translation of the Transitional Care Model (TCM). The TCM is a nurse-led, team-based care delivery system innovation that is designed to increase alignment of the care system with the preferences, needs, and values of high-risk individuals and their family caregivers and achieve higher-quality outcomes while reducing health care costs. A rigorous body of evidence reinforces a tremendous opportunity to address the urgent need for higher-value health care, through widespread implementation of the TCM for chronically ill older adults. Capitalizing on this opportunity will require the investment, commitment, and support of nursing and its leadership.
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Bradway C, Trotta R, Bixby MB, McPartland E, Wollman MC, Kapustka H, McCauley K, Naylor MD. A qualitative analysis of an advanced practice nurse-directed transitional care model intervention. THE GERONTOLOGIST 2012; 52:394-407. [PMID: 21908805 PMCID: PMC3342512 DOI: 10.1093/geront/gnr078] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 07/08/2011] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The purpose of this study was to describe barriers and facilitators to implementing a transitional care intervention for cognitively impaired older adults and their caregivers lead by advanced practice nurses (APNs). DESIGN AND METHODS APNs implemented an evidence-based protocol to optimize transitions from hospital to home. An exploratory, qualitative directed content analysis examined 15 narrative case summaries written by APNs and fieldnotes from biweekly case conferences. RESULTS Three central themes emerged: patients and caregivers having the necessary information and knowledge, care coordination, and the caregiver experience. An additional category was also identified, APNs going above and beyond. IMPLICATIONS APNs implemented individualized approaches and provided care that exceeds the type of care typically staffed and reimbursed in the American health care system by applying a Transitional Care Model, advanced clinical judgment, and doing whatever was necessary to prevent negative outcomes. Reimbursement reform as well as more formalized support systems and resources are necessary for APNs to consistently provide such care to patients and their caregivers during this vulnerable time of transition.
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NILSSON ANITA, LINDKVIST MARIE, RASMUSSEN BIRGITH, EDVARDSSON DAVID. Staff attitudes towards older patients with cognitive impairment: need for improvements in acute care. J Nurs Manag 2012; 20:640-7. [DOI: 10.1111/j.1365-2834.2012.01406.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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O’Connor M. Hospitalization Among Medicare-Reimbursed Skilled Home Health Recipients. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2012; 24:27-37. [PMID: 26709341 PMCID: PMC4690459 DOI: 10.1177/1084822311419498] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article presents a summary and critique of the published empirical evidence between the years 2002 and 2011 regarding rehospitalization among Medicare-reimbursed, skilled home health recipients. The knowledge gained will be applied to a discussion regarding ACH among geriatric home health recipients and areas for future research. The referenced literature in MEDLINE, PubMed and Cochrane databases was searched using combinations of the following search terms: home care and home health and Medicare combined with acute care hospitalization, rehospitalization, hospitalization, and adverse events and limited to studies conducted in the United States. Twenty-five research studies published in the last eight years investigated hospitalization among patients receiving Medicare-reimbursed, skilled home health. Empirical findings indicate telehomecare can reduce hospitalizations and emergency room use. The identification of risk factors for hospitalization relate to an elder's sociodemographic, clinical and functional status that can be identified upon admission and interventions taken in order to reduce hospitalizations. Disease management, frontloading nurse visits, the structure of home health services and OBQI are also among the interventions identified to reduce hospitalizations. However, the body of evidence is limited by a paucity of research and the over reliance on small sample sizes. Few published studies have explored methods that effectively reduce hospitalization among Medicare-reimbursed skilled home health recipients. Further research is needed to clarify the most effective ways to structure home health services to maximize benefits and reduce hospitalization among this chronically ill geriatric population.
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Affiliation(s)
- Melissa O’Connor
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Byrne K, Orange JB, Ward-Griffin C. Care transition experiences of spousal caregivers: from a geriatric rehabilitation unit to home. QUALITATIVE HEALTH RESEARCH 2011; 21:1371-1387. [PMID: 21525238 DOI: 10.1177/1049732311407078] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of this study was to develop a theoretical framework about caregivers' experiences and the processes in which they engaged during their spouses' transition from a geriatric rehabilitation unit to home. We used a constructivist grounded theory methodology approach. Forty-five interviews were conducted across three points in time with 18 older adult spousal caregivers. A theoretical framework was developed within which reconciling in response to fluctuating needs emerged as the basic social process. Reconciling included three subprocesses (i.e., navigating, safekeeping, and repositioning), and highlighted how caregivers responded to the fluctuating needs of their spouse, to their own needs, and to those of the marital dyad. Reconciling was situated within a context shaped by a trajectory of prior care transitions and intertwined life events experienced by caregivers. Findings serve as a resource for scientists, rehabilitation clinicians, educators, and decision makers toward improving transitional care for spousal caregivers.
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Affiliation(s)
- Kerry Byrne
- University of British Columbia, Department of Sociology, Vancouver, British Columbia, Canada.
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