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Bynum JPW, Benloucif S, Martindale J, O'Malley AJ, Davis MA. Regional variation in diagnostic intensity of dementia among older U.S. adults: An observational study. Alzheimers Dement 2024. [PMID: 39149970 DOI: 10.1002/alz.14092] [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: 12/04/2023] [Revised: 05/01/2024] [Accepted: 06/03/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Geographic variation in diagnosed cases of Alzheimer's disease and related dementias (ADRD) could be due to underlying population risk or differences in intensity of new case identification. Areas with low ADRD diagnostic intensity could be targeted for additional surveillance efforts. METHODS Medicare claims were used for a cohort of older adults across hospital referral regions (HRRs). ADRD-specific regional diagnosis intensity was measured as the ratio of expected new ADRD cases (estimated using population demographics, risk factors, and practice intensity) compared to observed ADRD-diagnosed cases. RESULTS Crude new ADRD diagnosis rate ranged from 1.7 to 5.4 per 100 across HRRs. ADRD-specific diagnosis intensity ranged from 0.69 to 1.47 and varied most for Black, Hispanic, and the youngest (66-74) subgroups. Across all subgroups, ADRD diagnosis intensity was associated with 2-fold difference in receiving an ADRD diagnosis. DISCUSSION Where one resides influences the likelihood of receiving an ADRD diagnosis, particularly among those 66-74 years of age and minoritized groups. HIGHLIGHTS Rate of new Alzheimer's disease and related dementias (ADRD) case identification varies geographically across the United States. Variation in case identification is greatest in Black, Hispanic, and young-old groups. Intensity of diagnosis (ie, case identification) unrelated to population risk differs across place. Likelihood of receiving an ADRD diagnosis varies 2-fold based on place of residence.
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Affiliation(s)
- Julie P W Bynum
- Department of Internal Medicine, 1500 East Medical Center Dr Ann Arbor, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, Michigan, USA
- Geisel School of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Dr Lebanon, Hanover, New Hampshire, USA
| | - Slim Benloucif
- Department of Internal Medicine, 1500 East Medical Center Dr Ann Arbor, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jonathan Martindale
- Department of Internal Medicine, 1500 East Medical Center Dr Ann Arbor, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - A James O'Malley
- Geisel School of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, 1 Medical Center Dr Lebanon, Hanover, New Hampshire, USA
- Department of Biomedical Data Science, 1 Rope Ferry Rd, Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Matthew A Davis
- Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, Michigan, USA
- University of Michigan School of Nursing, Department of Systems, Populations, and Leadership, 400 North Ingalls Building, Ann Arbor, Michigan, USA
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Risvoll H, Risør T, Halvorsen KH, Waaseth M, Stub T, Giverhaug T, Musial F. General practitioners' role in safeguarding patients with dementia in their use of dietary supplements. A qualitative study. Scand J Prim Health Care 2024; 42:16-28. [PMID: 37982720 PMCID: PMC10851825 DOI: 10.1080/02813432.2023.2283182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/08/2023] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVE The use of dietary supplements (DS) may cause harm through direct and indirect effects. Patients with dementia may be particularly vulnerable. This study aims to explore general practitioners' (GPs') experiences with DS use by these patients, the GPs perceived responsibilities, obstacles in taking on this responsibility, their attitudes toward DS, and suggestions for improvements to safeguard the use of DS in this patient group. DESIGN Qualitative individual interview study conducted February - December 2019. Data were analysed using systematic text condensation. SETTING Primary healthcare clinics in Norway. SUBJECTS Fourteen Norwegian GPs. FINDINGS None of the informants were dismissive of patients using DS. They were aware of the possible direct risks and had observed them in patients. Most GPs showed little awareness of potential indirect risks to patients with dementia who use DS. They acknowledged the need for caretaking of these patients. Although there were differences in practice styles, most of the GPs wished to help their patients safeguarding DS use but found it difficult due to the lack of quality assurance of product information. Furthermore, there were no effective ways for the GPs to document DS use in the patients' records. Several suggestions for improvement were given by the GPs, such as increased attention from GPs, inclusion of DS in the prescription software, and stricter regulatory systems for DS from the authorities. CONCLUSION The GPs had initially little awareness of this safety risk, but there were differences in practice style and attitudes towards DS. The GPs did not perceive themselves as main responsible for safe use of DS in patient with dementia. The most important reason to disclaim responsibility was lack of information about the products. One suggestion for improvement was better integration of DS in patients' medical record.
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Affiliation(s)
- Hilde Risvoll
- NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- NLSH Vesterålen, Department of Neurology, Stokmarknes, Norway
- Valnesfjord Helsesportsenter, Valnesfjord, Norway
| | - Torsten Risør
- Section for General Practice, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- Section for General Practice & Research Unit for General Practice, Department of Public Health, University of Copenhagen, København K, Denmark
| | - Kjell H. Halvorsen
- IPSUM research group, Department of Pharmacy, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Marit Waaseth
- IPSUM research group, Department of Pharmacy, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Trine Stub
- NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Trude Giverhaug
- Center for Profession and Quality, University Hospital of North Norway, Tromsø, Norway
| | - Frauke Musial
- NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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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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Limpawattana P, Manjavong M. The Mini-Cog, Clock Drawing Test, and Three-Item Recall Test: Rapid Cognitive Screening Tools with Comparable Performance in Detecting Mild NCD in Older Patients. Geriatrics (Basel) 2021; 6:91. [PMID: 34562992 PMCID: PMC8482262 DOI: 10.3390/geriatrics6030091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early mild neurocognitive disorder (mild NCD) detection can allow for appropriate planning and delay disease progression. There have been few studies examining validated mild NCD detection tools. One such tool that may be of use is the Mini-Cog, which consists of the clock drawing test (CDT) and three-item recall. METHODS This study aimed to compare the diagnostic properties of the Mini-Cog, the CDT alone, and the three-item recall test alone in mild NCD detection according to DSM-5 criteria. The participants were older patients attending the medicine outpatient clinic. Area under receiver operating characteristic (ROC) curve (AUC) analysis was used to compare the tools' accuracy. RESULTS A total of 150 patients were enrolled, 42 of whom were diagnosed as having mild NCD. The AUCs of ROC curves of the three-item recall, CDT, Mini-Cog1, and Mini-Cog2 were 0.71, 0.67, 0.73, and 0.71, respectively (p = 0.36). The sensitivity of the tools was 85.7%, 66.7%, 57.4%, and 69% respectively. The tests performed similarly in participants with ≤6 years of education (p = 0.27) and those with >6 years of education (p = 0.49). CONCLUSIONS All tools exhibited similar acceptable performance in detecting mild NCD and were not affected by education. These convenient tools might be suitable for use in clinical practice.
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Affiliation(s)
| | - Manchumad Manjavong
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
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Multispecialty Interprofessional Team Memory Clinics: Enhancing Collaborative Practice and Health Care Providers' Experience of Dementia Care. Can J Aging 2021; 41:96-109. [PMID: 33926598 DOI: 10.1017/s0714980821000052] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This study explored whether working within Multispecialty INterprofessional Team (MINT) memory clinics has an impact on health care professionals' perceptions of the challenges, attitudes, and level of collaboration associated with providing dementia care. Surveys were completed by MINT memory clinic members pre- and 6-months post-clinic launch. A total of 228 pre-and-post-training surveys were matched for analysis. After working in the MINT memory clinics for 6 months, there were significant reductions in mean ratings of the level of challenge associated with various aspects of dementia care, and significant increases in the frequency with which respondents experienced enthusiasm, inspiration, and pride in their work in dementia care and in ratings of the extent of collaboration for dementia care. This study provides some insights into the effect of collaborative, interprofessional approaches on health care professionals' perceptions of the challenges and attitudes associated with providing dementia care and level of collaboration with other health professionals.
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Can Continuity of Care Reduce Hospitalization Among Community-dwelling Older Adult Veterans Living With Dementia? Med Care 2020; 58:988-995. [PMID: 32925470 DOI: 10.1097/mlr.0000000000001386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hospitalization is a difficult experience, especially for patients with dementia. Understanding whether better continuity of care (COC) reduces hospitalizations can indicate interventions that might help curb hospitalizations. OBJECTIVE To estimate the causal impact of COC on hospitalizations and different reasons for hospitalization among community-dwelling older veterans with dementia. RESEARCH DESIGN Population-based observational study using nationwide Veterans Health Administration data linked to Medicare claims in Fiscal Years (FYs) 2014-2015. To account for unobserved confounders we used an instrumental variable for COC-whether veteran changed residence by more than 10 miles. SUBJECTS Community-dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (n=105,528). MEASURES Bice-Boxerman Continuity of Care (BBC) index (0-worst to 1-best COC); binary indicators of any hospitalization for all causes, for ambulatory care sensitive conditions (ACSCs) and for reasons grouped by major diagnostic category. RESULTS The mean BBC in FY 2014 was 0.32 (SD, 0.23). In FY 2015 43.3% of the cohort veterans were hospitalized. A 0.1 higher BBC resulted in 2.4% (95% confidence interval, 0.5%-4.4%) lower probability of hospitalization for all causes. BBC was not associated with hospitalization for ACSCs. Grouped by major diagnostic category, a 0.1 higher BBC resulted in 3.8% (95% confidence interval, 2.1%-5.4%) lower probability of hospitalization for neuropsychiatric diseases/disorders, with no impact on hospitalizations for circulatory, respiratory, infectious, kidney and urinary, digestive, musculoskeletal, and endocrine-metabolic diseases/disorders. CONCLUSIONS Among community-dwelling older veterans with dementia, better COC resulted in less hospitalizations, and this effect was primarily due to less hospitalization for neuropsychiatric diseases/disorders but not hospitalization for ACSCs, or other hospitalization reasons.
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Lei L, Intrator O, Conwell Y, Fortinsky RH, Cai S. Continuity of care and health care cost among community-dwelling older adult veterans living with dementia. Health Serv Res 2020; 56:378-388. [PMID: 32812658 DOI: 10.1111/1475-6773.13541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To estimate the causal impact of continuity of care (COC) on total, institutional, and noninstitutional cost among community-dwelling older veterans with dementia. DATA SOURCES Combined Veterans Health Administration (VHA) and Medicare data in Fiscal Years (FYs) 2014-2015. STUDY DESIGN FY 2014 COC was measured by the Bice-Boxerman Continuity of Care (BBC) index on a 0-1 scale. FY 2015 total combined VHA and Medicare cost, institutional cost of acute inpatient, emergency department [ED], long-/short-stay nursing home, and noninstitutional long-term care (LTC) cost for medical (like skilled-) and social (like unskilled-) services were assessed controlling for covariates. An instrumental variable for COC (change of residence by more than 10 miles) was used to account for unobserved health confounders. DATA COLLECTION Community-dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (N = 102 073). PRINCIPAL FINDINGS Mean BBC in FY 2014 was 0.32; mean total cost in FY 2015 was $35 425. A 0.1 higher BBC resulted in (a) $4045 lower total cost; (b) $1597 lower acute inpatient cost, $119 lower ED cost, $4368 lower long-stay nursing home cost; (c) $402 higher noninstitutional medical LTC and $764 higher noninstitutional social LTC cost. BBC had no impact on short-stay nursing home cost. CONCLUSIONS COC is an effective approach to reducing total health care cost by supporting noninstitutional care and reducing institutional care.
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Affiliation(s)
- Lianlian Lei
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, New York
| | - Orna Intrator
- Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, New York.,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Richard H Fortinsky
- Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Shubing Cai
- Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, New York.,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Bhardwaj N, Cecchetti AA, Murughiyan U, Neitch S. Analysis of Benzodiazepine Prescription Practices in Elderly Appalachians with Dementia via the Appalachian Informatics Platform: Longitudinal Study. JMIR Med Inform 2020; 8:e18389. [PMID: 32749226 PMCID: PMC7435704 DOI: 10.2196/18389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Caring for the growing dementia population with complex health care needs in West Virginia has been challenging due to its large, sizably rural-dwelling geriatric population and limited resource availability. OBJECTIVE This paper aims to illustrate the application of an informatics platform to drive dementia research and quality care through a preliminary study of benzodiazepine (BZD) prescription patterns and its effects on health care use by geriatric patients. METHODS The Maier Institute Data Mart, which contains clinical and billing data on patients aged 65 years and older (N=98,970) seen within our clinics and hospital, was created. Relevant variables were analyzed to identify BZD prescription patterns and calculate related charges and emergency department (ED) use. RESULTS Nearly one-third (4346/13,910, 31.24%) of patients with dementia received at least one BZD prescription, 20% more than those without dementia. More women than men received at least one BZD prescription. On average, patients with dementia and at least one BZD prescription sustained higher charges and visited the ED more often than those without one. CONCLUSIONS The Appalachian Informatics Platform has the potential to enhance dementia care and research through a deeper understanding of dementia, data enrichment, risk identification, and care gap analysis.
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Affiliation(s)
- Niharika Bhardwaj
- Department of Clinical and Translational Science, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Alfred A Cecchetti
- Department of Clinical and Translational Science, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Usha Murughiyan
- Department of Clinical and Translational Science, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Shirley Neitch
- Department of Internal Medicine, Joan C Edwards School of Medicine, Marshall University, Huntington, WV, United States
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Morrison RA, Jesdale BM, Dubé CE, Nunes AP, Bova CA, Liu SH, Lapane KL. Differences in Staff-Assessed Pain Behaviors among Newly Admitted Nursing Home Residents by Level of Cognitive Impairment. Dement Geriatr Cogn Disord 2020; 49:243-251. [PMID: 32610321 PMCID: PMC7704920 DOI: 10.1159/000508096] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/22/2020] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Pain is common among nursing home residents with cognitive impairment and dementia. Pain is often underdiagnosed and undertreated, which may lead to adverse health outcomes. Nonverbal behaviors are valid indicators of pain, but the extent to which these behavioral expressions vary across levels of cognitive impairment is unknown. This study sought to examine differences in the prevalence of pain behaviors among nursing home residents with varying levels of cognitive impairment. METHODS The Minimum Data Set, version 3.0, was used to identify newly admitted nursing home residents with staff-assessed pain (2010-2016, n = 1,036,806). Staff-assessed pain behaviors included nonverbal sounds, vocal complaints, facial expressions, and protective body movements or postures over a 5-day look-back period for residents unable or unwilling to self-report pain. The Cognitive Function Scale was used to categorize residents as having no/mild, moderate, or severe cognitive impairment. Modified Poisson models provided adjusted prevalence ratios (aPR) and 95% CIs. RESULTS Compared to residents with no/mild cognitive impairments (any pain: 48.1%), residents with moderate cognitive impairment (any pain: 42.4%; aPR: 0.94 [95% CI 0.93-0.95]) and severe cognitive impairment (any pain: 38.4%; aPR: 0.86 [95% CI 0.85-0.88]) were less likely to have any pain behavior documented. Vocal pain behaviors were common (43.5% in residents with no/mild cognitive impairment), but less so in those with severe cognitive impairment (20.1%). Documentation of facial expressions and nonverbal pain behaviors was more frequent for residents with moderate and severe cognitive impairment than those with no/mild cognitive impairment. CONCLUSIONS The prevalence of behaviors indicative of pain differs by level of cognitive impairment. Pain evaluation and management plays an important role in treatment and care outcomes. Future work should examine how practitioners' perceptions of pain behaviors influence their ratings of pain intensity and treatment choices.
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Affiliation(s)
- Reynolds A Morrison
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bill M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Catherine E Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Anthony P Nunes
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Carol A Bova
- School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Shao-Hsien Liu
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA,
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Heintz H, Monette P, Epstein-Lubow G, Smith L, Rowlett S, Forester BP. Emerging Collaborative Care Models for Dementia Care in the Primary Care Setting: A Narrative Review. Am J Geriatr Psychiatry 2020; 28:320-330. [PMID: 31466897 DOI: 10.1016/j.jagp.2019.07.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/23/2019] [Accepted: 07/28/2019] [Indexed: 01/17/2023]
Abstract
The rapidly increasing population living with dementia presents a unique economic and public health challenge. However, primary care physicians, despite their position as first-line providers, often lack the time, support, and training to systematically screen for, diagnose, and treat dementia, as well as provide adequate psychosocial support to unpaid caregivers. Models of collaborative care, which have found success in reducing symptom severity and increasing quality of life for other chronic illnesses, have been studied for feasibility, efficacy, and cost effectiveness in treating individuals with dementia and supporting caregivers. A review of initial data from several models suggests that enrollment in a collaborative care program for dementia is associated with benefits such as reduction in behavioral symptoms of dementia, improved functioning and quality of life, less frequent utilization of acute medical services, and decrease in caregiver burden. These evidence-based models, if implemented widely, stand to facilitate delivery of highly effective dementia care while reducing associated total medical expense. In this narrative review, we examine the key components of collaborative care teams, summarize outcomes of prior studies and discuss barriers and opportunities for wider dissemination of collaborative care models that are partnered with and/or based within primary care settings.
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Affiliation(s)
- Hannah Heintz
- Division of Geriatric Psychiatry, Geriatric Psychiatry Research Program, McLean Hospital (HH, PM, BPF), Belmont, MA
| | - Patrick Monette
- Division of Geriatric Psychiatry, Geriatric Psychiatry Research Program, McLean Hospital (HH, PM, BPF), Belmont, MA
| | - Gary Epstein-Lubow
- Hebrew SeniorLife (GE-L), Roslindale, MA; Department of Psychiatry, Harvard Medical School (GE-L, BPF), Boston, MA
| | - Lorie Smith
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital (LS, SR), Boston, MA
| | - Susan Rowlett
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital (LS, SR), Boston, MA
| | - Brent P Forester
- Division of Geriatric Psychiatry, Geriatric Psychiatry Research Program, McLean Hospital (HH, PM, BPF), Belmont, MA; Department of Psychiatry, Harvard Medical School (GE-L, BPF), Boston, MA; Partners Population Health, Partners Healthcare (BPF), Somerville, MA.
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Azar J, Kelley K, Dunscomb J, Perkins A, Wang Y, Beeler C, Dbeibo L, Webb D, Stevens L, Luektemeyer M, Kara A, Nagy R, Solid CA, Boustani M. Using the agile implementation model to reduce central line-associated bloodstream infections. Am J Infect Control 2019; 47:33-37. [PMID: 30201414 DOI: 10.1016/j.ajic.2018.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/06/2018] [Accepted: 07/08/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Central line-associated bloodstream infections (CLABSIs) are among the most common hospital-acquired infections and can lead to increased patient morbidity and mortality rates. Implementation of practice guidelines and recommended prevention bundles has historically been suboptimal, suggesting that improvements in implementation methods could further reductions in CLABSI rates. In this article, we describe the agile implementation methodology and present details of how it was successfully used to reduce CLABSI. METHODS We conducted an observational study of patients with central line catheters at 2 adult tertiary care hospitals in Indianapolis from January 2015 to June 2017. RESULTS The intervention successfully reduced the CLABSI rate from 1.76 infections per 1,000 central line days to 1.24 (rate ratio = 0.70; P = .011). We also observed reductions in the rates of Clostridium difficile and surgical site infections, whereas catheter-associated urinary tract infections remained stable. CONCLUSIONS Using the AI model, we were able to successfully implement evidence-based practices to reduce the rate of CLABSIs at our facility.
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Clevenger CK, Cellar J, Kovaleva M, Medders L, Hepburn K. Integrated Memory Care Clinic: Design, Implementation, and Initial Results. J Am Geriatr Soc 2018; 66:2401-2407. [DOI: 10.1111/jgs.15528] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 06/05/2018] [Accepted: 10/10/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Carolyn K. Clevenger
- Nell Hodgson Woodruff School of NursingEmory University Atlanta Georgia
- Integrated Memory Care Clinic, Emory Healthcare Atlanta Georgia
| | - Janet Cellar
- Integrated Memory Care Clinic, Emory Healthcare Atlanta Georgia
- Department of NeurologyEmory University Atlanta Georgia
- Alzheimer's Disease Research CenterEmory University Atlanta Georgia
| | - Mariya Kovaleva
- Nell Hodgson Woodruff School of NursingEmory University Atlanta Georgia
| | - Laura Medders
- Integrated Memory Care Clinic, Emory Healthcare Atlanta Georgia
| | - Kenneth Hepburn
- Nell Hodgson Woodruff School of NursingEmory University Atlanta Georgia
- Alzheimer's Disease Research CenterEmory University Atlanta Georgia
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13
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Boustani M, Alder CA, Solid CA. Agile Implementation: A Blueprint for Implementing Evidence‐Based Healthcare Solutions. J Am Geriatr Soc 2018. [DOI: 10.1111/jgs.15283] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Malaz Boustani
- Center for Health Innovation and Implementation Science, Indiana Clinical Translational Science InstituteIndiana UniversityIndianapolis Indiana
- Sandra Eskenazi Center for Brain Care InnovationEskenazi HealthIndianapolis Indiana
- Center for Aging Research, Regenstrief Institute, Inc.Indiana UniversityIndianapolis Indiana
| | - Catherine A. Alder
- Sandra Eskenazi Center for Brain Care InnovationEskenazi HealthIndianapolis Indiana
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Xu D, Anderson HD, Tao A, Hannah KL, Linnebur SA, Valuck RJ, Culbertson VL. Assessing and predicting drug-induced anticholinergic risks: an integrated computational approach. Ther Adv Drug Saf 2017; 8:361-370. [PMID: 29090085 PMCID: PMC5638173 DOI: 10.1177/2042098617725267] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/19/2017] [Indexed: 11/17/2022] Open
Abstract
Background: Anticholinergic (AC) adverse drug events (ADEs) are caused by inhibition of muscarinic receptors as a result of designated or off-target drug–receptor interactions. In practice, AC toxicity is assessed primarily based on clinician experience. The goal of this study was to evaluate a novel concept of integrating big pharmacological and healthcare data to assess clinical AC toxicity risks. Methods: AC toxicity scores (ATSs) were computed using drug–receptor inhibitions identified through pharmacological data screening. A longitudinal retrospective cohort study using medical claims data was performed to quantify AC clinical risks. ATS was compared with two previously reported toxicity measures. A quantitative structure–activity relationship (QSAR) model was established for rapid assessment and prediction of AC clinical risks. Results: A total of 25 common medications, and 575,228 exposed and unexposed patients were analyzed. Our data indicated that ATS is more consistent with the trend of AC outcomes than other toxicity methods. Incorporating drug pharmacokinetic parameters to ATS yielded a QSAR model with excellent correlation to AC incident rate (R2 = 0.83) and predictive performance (cross validation Q2 = 0.64). Good correlation and predictive performance (R2 = 0.68/Q2 = 0.29) were also obtained for an M2 receptor-specific QSAR model and tachycardia, an M2 receptor-specific ADE. Conclusions: Albeit using a small medication sample size, our pilot data demonstrated the potential and feasibility of a new computational AC toxicity scoring approach driven by underlying pharmacology and big data analytics. Follow-up work is under way to further develop the ATS scoring approach and clinical toxicity predictive model using a large number of medications and clinical parameters.
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Affiliation(s)
- Dong Xu
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Idaho State University, 1311 East Central Drive, Meridian, ID 83642, USA
| | - Heather D Anderson
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Aoxiang Tao
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, Idaho State University, Meridian, ID, USA
| | - Katia L Hannah
- School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sunny A Linnebur
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Robert J Valuck
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Vaughn L Culbertson
- Department of Pharmacy Practice and Administrative Sciences, College of Pharmacy, Idaho State University, 1311 East Central Drive, Meridian, ID 83642, USA
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15
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Kunschmann R, Busse S, Frodl T, Busse M. Psychotic Symptoms Associated with Poor Renal Function in Mild Cognitive Impairment and Dementias. J Alzheimers Dis 2017; 58:243-252. [DOI: 10.3233/jad-161306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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16
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Snowden MB, Steinman LE, Bryant LL, Cherrier MM, Greenlund KJ, Leith KH, Levy C, Logsdon RG, Copeland C, Vogel M, Anderson LA, Atkins DC, Bell JF, Fitzpatrick AL. Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence? Int J Geriatr Psychiatry 2017; 32:357-371. [PMID: 28146334 PMCID: PMC5962963 DOI: 10.1002/gps.4652] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 11/30/2016] [Accepted: 12/02/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The challenges posed by people living with multiple chronic conditions are unique for people with dementia and other significant cognitive impairment. There have been recent calls to action to review the existing literature on co-occurring chronic conditions and dementia in order to better understand the effect of cognitive impairment on disease management, mobility, and mortality. METHODS This systematic literature review searched PubMed databases through 2011 (updated in 2016) using key constructs of older adults, moderate-to-severe cognitive impairment (both diagnosed and undiagnosed dementia), and chronic conditions. Reviewers assessed papers for eligibility and extracted key data from each included manuscript. An independent expert panel rated the strength and quality of evidence and prioritized gaps for future study. RESULTS Four thousand thirty-three articles were identified, of which 147 met criteria for review. We found that moderate-to-severe cognitive impairment increased risks of mortality, was associated with prolonged institutional stays, and decreased function in persons with multiple chronic conditions. There was no relationship between significant cognitive impairment and use of cardiovascular or hypertensive medications for persons with these comorbidities. Prioritized areas for future research include hospitalizations, disease-specific outcomes, diabetes, chronic pain, cardiovascular disease, depression, falls, stroke, and multiple chronic conditions. CONCLUSIONS This review summarizes that living with significant cognitive impairment or dementia negatively impacts mortality, institutionalization, and functional outcomes for people living with multiple chronic conditions. Our findings suggest that chronic-disease management interventions will need to address co-occurring cognitive impairment. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Lesley E. Steinman
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Lucinda L. Bryant
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Monique M. Cherrier
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Kurt J. Greenlund
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katherine H. Leith
- College of Social Work, Hamilton College, University of South Carolina, Columbia, SC, USA
| | - Cari Levy
- Division of Health Care Policy and Research, School of Medicine, University of Colorado and the Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - Rebecca G. Logsdon
- UW School of Nursing, Northwest Research Group on Aging, Seattle, WA, USA
| | - Catherine Copeland
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Mia Vogel
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Lynda A. Anderson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David C. Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Janice F. Bell
- Betty Irene Moore School of Nursing, University of California, Davis, CA, USA
| | - Annette L. Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global Health, School of Medicine and School of Public Health, University of Washington, Seattle, WA, USA
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Morgan DG, Kosteniuk JG, Stewart NJ, O'Connell ME, Kirk A, Crossley M, Dal Bello-Haas V, Forbes D, Innes A. Availability and Primary Health Care Orientation of Dementia-Related Services in Rural Saskatchewan, Canada. Home Health Care Serv Q 2017; 34:137-58. [PMID: 26496646 PMCID: PMC4706021 DOI: 10.1080/01621424.2015.1092907] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Community-based services are important for improving outcomes for individuals with dementia and their caregivers. This study examined: (a) availability of rural dementia-related services in the Canadian province of Saskatchewan, and (b) orientation of services toward six key attributes of primary health care (i.e., information/education, accessibility, population orientation, coordinated care, comprehensiveness, quality of care). Data were collected from 71 rural Home Care Assessors via cross-sectional survey. Basic health services were available in most communities (e.g., pharmacists, family physicians, palliative care, adult day programs, home care, long-term care facilities). Dementia-specific services typically were unavailable (e.g., health promotion, counseling, caregiver support groups, transportation, week-end/night respite). Mean scores on the primary health care orientation scales were low (range 12.4 to 17.5/25). Specific services to address needs of rural individuals with dementia and their caregivers are limited in availability and fit with primary health care attributes.
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Affiliation(s)
- Debra G Morgan
- a Canadian Centre for Health and Safety in Agriculture , University of Saskatchewan , Saskatoon , Saskatchewan , Canada
| | - Julie G Kosteniuk
- a Canadian Centre for Health and Safety in Agriculture , University of Saskatchewan , Saskatoon , Saskatchewan , Canada
| | - Norma J Stewart
- b College of Nursing , University of Saskatchewan , Saskatoon , Saskatchewan , Canada
| | - Megan E O'Connell
- c Department of Psychology , University of Saskatchewan , Saskatoon , Saskatchewan , Canada
| | - Andrew Kirk
- d Division of Neurology, College of Medicine , University of Saskatchewan , Saskatoon , Saskatchewan , Canada
| | - Margaret Crossley
- e Department of Psychology (Professor Emerita) , University of Saskatchewan , Saskatoon , Saskatchewan , Canada
| | - Vanina Dal Bello-Haas
- f School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada
| | - Dorothy Forbes
- g Faculty of Nursing , University of Alberta , Edmonton , Alberta , Canada
| | - Anthea Innes
- h University of the West of Scotland , Hamilton , Scotland
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Notarnicola I, Petrucci C, De Jesus Barbosa MR, Giorgi F, Stievano A, Rocco G, Lancia L. Complex adaptive systems and their relevance for nursing: An evolutionary concept analysis. Int J Nurs Pract 2017; 23. [DOI: 10.1111/ijn.12522] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 11/15/2016] [Accepted: 12/03/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Ippolito Notarnicola
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
- Nursing Science Doctorate School; University of L'Aquila; L'Aquila Italy
| | - Cristina Petrucci
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
| | - Maria Rosimar De Jesus Barbosa
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
- Nursing Science Doctorate School; University of L'Aquila; L'Aquila Italy
| | - Fabio Giorgi
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
- Nursing Science Doctorate School; University of L'Aquila; L'Aquila Italy
| | - Alessandro Stievano
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
- Centre of Excellence for Nursing Scholarship; L'Aquila Italy
| | - Gennaro Rocco
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
- Centre of Excellence for Nursing Scholarship; L'Aquila Italy
| | - Loreto Lancia
- Department of Health, Life and Environmental Sciences; University of L'Aquila; L'Aquila Italy
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Chen Z, Yang X, Song Y, Song B, Zhang Y, Liu J, Wang Q, Yu J. Challenges of Dementia Care in China. Geriatrics (Basel) 2017; 2:geriatrics2010007. [PMID: 31011017 PMCID: PMC6371088 DOI: 10.3390/geriatrics2010007] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/03/2017] [Accepted: 01/13/2017] [Indexed: 11/16/2022] Open
Abstract
Dementia results in brain dysfunction, disability and dependency among affected people, causing an overwhelming burden for caregivers. China has the largest number of people with dementia worldwide and is facing severe challenges with respect to dementia care, including poor awareness of dementia in the public, inadequate knowledge of dementia for medical professionals and caregivers, an underdeveloped dementia service system, and high costs of dementia care. To address these challenges, China is taking action to increase dementia awareness and education among the public and care providers, and develop policies, services and resources for dementia care.
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Affiliation(s)
- Zheng Chen
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Xuan Yang
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Yuetao Song
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Binbin Song
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Yi Zhang
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Jiawen Liu
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Qing Wang
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
| | - Jia Yu
- Institute for Geriatrics and Rehabilitation, Beijing Geriatric Hospital, Beijing University of Chinese Medicine, 118 Wenquan Road, Haidian District, 100095 Beijing, China.
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Amjad H, Carmichael D, Austin AM, Chang CH, Bynum JPW. Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare. JAMA Intern Med 2016; 176:1371-8. [PMID: 27454945 PMCID: PMC5061498 DOI: 10.1001/jamainternmed.2016.3553] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
IMPORTANCE Poor continuity of care may contribute to high health care spending and adverse patient outcomes in dementia. OBJECTIVE To examine the association between medical clinician continuity and health care utilization, testing, and spending in older adults with dementia. DESIGN, SETTING, AND PARTICIPANTS This was a study of an observational retrospective cohort from the 2012 national sample in fee-for-service Medicare, conducted from July to December 2015, using inverse probability weighted analysis. A total of 1 416 369 continuously enrolled, community-dwelling, fee-for-service Medicare beneficiaries 65 years or older with a claims-based dementia diagnosis and at least 4 ambulatory visits in 2012 were included. EXPOSURES Continuity of care score measured on patient visits across physicians over 12 months. A higher continuity score is assigned to visit patterns in which a larger share of the patient's total visits are with fewer clinicians. Score range from 0 to 1 was examined in low-, medium-, and high-continuity tertiles. MAIN OUTCOMES AND MEASURES Outcomes include all-cause hospitalization, ambulatory care sensitive condition hospitalization, emergency department visit, imaging, and laboratory testing (computed tomographic [CT] scan of the head, chest radiography, urinalysis, and urine culture), and health care spending (overall, hospital and skilled nursing facility, and physician). RESULTS Beneficiaries with dementia who had lower levels of continuity of care were younger, had a higher income, and had more comorbid medical conditions. Almost 50% of patients had at least 1 hospitalization and emergency department visit during the year. Utilization was lower with increasing level of continuity. Specifically comparing the highest- vs lowest-continuity groups, annual rates per beneficiary of hospitalization (0.83 vs 0.88), emergency department visits (0.84 vs 0.99), CT scan of the head (0.71 vs 0.83), urinalysis (0.72 vs 1.09), and health care spending (total spending, $22 004 vs $24 371) were higher with lower continuity even after accounting for sociodemographic factors and comorbidity burden (P < .001 for all comparisons). The rate of ambulatory care sensitive condition hospitalization was similar across continuity groups. CONCLUSIONS AND RELEVANCE Among older fee-for-service Medicare beneficiaries with a dementia diagnosis, lower continuity of care is associated with higher rates of hospitalization, emergency department visits, testing, and health care spending. Further research into these relationships, including potentially relevant clinical, clinician, and systems factors, can inform whether improving continuity of care in this population may benefit patients and the wider health system.
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Affiliation(s)
- Halima Amjad
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Donald Carmichael
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Andrea M Austin
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Chiang-Hua Chang
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Julie P W Bynum
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire3Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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21
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Sivananthan SN, McGrail KM. Diagnosis and Disruption: Population-Level Analysis Identifying Points of Care at Which Transitions Are Highest for People with Dementia and Factors That Contribute to Them. J Am Geriatr Soc 2016; 64:569-77. [PMID: 27000330 DOI: 10.1111/jgs.14033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine transitions that individuals with dementia experience longitudinally and to identify points of care when transitions are highest and the factors that contribute to those transitions. DESIGN Population-based 10-year retrospective cohort study from 2000 to 2011. SETTING General community. PARTICIPANTS All individuals aged 65 and older newly diagnosed with dementia in British Columbia, Canada. MEASUREMENTS The frequency and timing of transitions over 10 years, participant characteristics associated with greater number of transitions, and the influence of recommended dementia care and high-quality primary care on number of transitions. RESULTS Individuals experience a spike in transitions during the year of diagnosis, driven primarily by hospitalizations, despite accounting for end of life or newly moving to a long-term care facility (LTCF). This occurs regardless of survival time or care location. Regardless of survival time, individuals not in LTCFs experience a marked increase in hospitalizations in the year before and the year of death, often exceeding hospitalizations in the year of diagnosis. Receipt of recommended dementia care and receipt of high-quality primary care were independently associated with fewer transitions across care settings. CONCLUSION The spike in transitions in the year of diagnosis highlights a distressing period for individuals with dementia during which unwanted or unnecessary transitions might occur and suggests a useful target for interventions. There is an association between recommended dementia care and outcomes and evidence of the continued value of high-quality primary care in a complex population at a critical point when gaps in continuity are especially likely.
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Affiliation(s)
- Saskia N Sivananthan
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn M McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
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Koller D, Hua T, Bynum JPW. Treatment Patterns with Antidementia Drugs in the United States: Medicare Cohort Study. J Am Geriatr Soc 2016; 64:1540-8. [PMID: 27341454 DOI: 10.1111/jgs.14226] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To evaluate frequency of use of two anti-dementia drug classes approved for treatment of symptoms, whether populations most likely to benefit are treated, and correlates of treatment initiation. DESIGN Nationally representative cohort study. SETTING Fee-for-service Medicare. PARTICIPANTS Elderly adults with dementia enrolled in Medicare Parts A, B, and D in 2009 (N = 433,559) and a subset with incident dementia (n = 185,449). MEASUREMENTS Main outcome was any prescription fill for antidementia drugs (cholinesterase inhibitors (ChEIs) or memantine) within 1 year. RESULTS Treatment with antidementia drugs occurred in 55.8% of all participants with dementia and 49.3% of those with incident dementia. There was no difference between ChEIs and memantine use according to dementia severity (measured as death within first year or living in residential care vs in a community setting) even though memantine is not indicated in mild disease. In incident cases, initiation of treatment was lower in residential care (relative risk (RR) = 0.82, 95% confidence interval (CI) = 0.81-0.83) and with more comorbidities (RR = 0.96, 95% CI = 0.96-0.96). Sixty percent of participants were managed in primary care alone. Seeing a neurologist (RR = 1.07, 95% CI = 1.06-1.09) or psychiatrist (RR = 1.17, 95% CI = 1.16-1.19) was associated with higher likelihood of treatment than seeing a primary care provider alone, and seeing geriatrician was associated with with lower likelihood (RR = 0.96, 95% CI = 0.93-0.99). Across the United States, the proportion of newly diagnosed individuals started on antidementia treatment varied from 32% to 66% across hospital referral regions. CONCLUSION Antidementia drugs are used less often in people with late disease, but there is no differentiation in medication choice. Although primary care providers most often prescribe antidementia medication without specialty support, differences in practice between specialties are evident.
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Affiliation(s)
- Daniela Koller
- Department of Health Services Management, Munich School of Management, Ludwig Maximilian University of Munich, Munich, Germany
| | - Tammy Hua
- Dartmouth College, Hanover, New Hampshire
| | - Julie P W Bynum
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
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23
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Examination and Estimation of Anticholinergic Burden: Current Trends and Implications for Future Research. Drugs Aging 2016; 33:305-13. [DOI: 10.1007/s40266-016-0362-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Dixon BE, Whipple EC, Lajiness JM, Murray MD. Utilizing an integrated infrastructure for outcomes research: a systematic review. Health Info Libr J 2015; 33:7-32. [PMID: 26639793 DOI: 10.1111/hir.12127] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 10/16/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To explore the ability of an integrated health information infrastructure to support outcomes research. METHODS A systematic review of articles published from 1983 to 2012 by Regenstrief Institute investigators using data from an integrated electronic health record infrastructure involving multiple provider organisations was performed. Articles were independently assessed and classified by study design, disease and other metadata including bibliometrics. RESULTS A total of 190 articles were identified. Diseases included cognitive, (16) cardiovascular, (16) infectious, (15) chronic illness (14) and cancer (12). Publications grew steadily (26 in the first decade vs. 100 in the last) as did the number of investigators (from 15 in 1983 to 62 in 2012). The proportion of articles involving non-Regenstrief authors also expanded from 54% in the first decade to 72% in the last decade. During this period, the infrastructure grew from a single health system into a health information exchange network covering more than 6 million patients. Analysis of journal and article metrics reveals high impact for clinical trials and comparative effectiveness research studies that utilised data available in the integrated infrastructure. DISCUSSION Integrated information infrastructures support growth in high quality observational studies and diverse collaboration consistent with the goals for the learning health system. More recent publications demonstrate growing external collaborations facilitated by greater access to the infrastructure and improved opportunities to study broader disease and health outcomes. CONCLUSIONS Integrated information infrastructures can stimulate learning from electronic data captured during routine clinical care but require time and collaboration to reach full potential.
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Affiliation(s)
- Brian E Dixon
- Richard M. Fairbanks School of Public Health at IUPUI, Indianapolis, IN, USA.,Regenstrief Institute, Inc., Indianapolis, IN, USA.,Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Elizabeth C Whipple
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Michael D Murray
- Regenstrief Institute and Purdue University, Indianapolis, IN, USA
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Nieuwenhuijze M, Downe S, Gottfreðsdóttir H, Rijnders M, du Preez A, Vaz Rebelo P. Taxonomy for complexity theory in the context of maternity care. Midwifery 2015; 31:834-43. [PMID: 26092306 DOI: 10.1016/j.midw.2015.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 05/05/2015] [Accepted: 05/25/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The linear focus of 'normal science' is unable to adequately take account of the complex interactions that direct health care systems. There is a turn towards complexity theory as a more appropriate framework for understanding system behaviour. However, a comprehensive taxonomy for complexity theory in the context of health care is lacking. OBJECTIVE This paper aims to build a taxonomy based on the key complexity theory components that have been used in publications on complexity theory and health care, and to explore their explanatory power for health care system behaviour, specifically for maternity care. METHOD A search strategy was devised in PubMed and 31 papers were identified as relevant for the taxonomy. FINDINGS The final taxonomy for complexity theory included and defined 11 components. The use of waterbirth and the impact of the Term Breech trial showed that each of the components of our taxonomy has utility in helping to understand how these techniques became widely adopted. It is not just the components themselves that characterise a complex system but also the dynamics between them.
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Affiliation(s)
- Marianne Nieuwenhuijze
- Research Centre for Midwifery Science Maastricht, Zuyd University, P.O. Box 1256, 6201 BG Maastricht, The Netherlands.
| | - Soo Downe
- University of Central Lancashire, Brook Building BB223, Preston PR1 2HE, United Kingdom.
| | - Helga Gottfreðsdóttir
- Department of Midwifery, Faculty of Nursing, University of Iceland, Eirberg, Eiríksgata 34, 101 Reykjavík, Iceland.
| | | | - Antoinette du Preez
- School of Nursing Science, North West University, Private Bag X6001, Potchefstroom 2522, South Africa.
| | - Piedade Vaz Rebelo
- DMUC - Department of Mathematics of the University of Coimbra, Apartado 3008, EC Santa Cruz, 3001 501 Coimbra, Portugal.
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Salahudeen MS, Duffull SB, Nishtala PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr 2015; 15:31. [PMID: 25879993 PMCID: PMC4377853 DOI: 10.1186/s12877-015-0029-9] [Citation(s) in RCA: 307] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 03/06/2015] [Indexed: 11/26/2022] Open
Abstract
Background The cumulative effect of taking multiple medicines with anticholinergic properties termed as anticholinergic burden can adversely impact cognition, physical function and increase the risk of mortality. Expert opinion derived risk scales are routinely used in research and clinical practice to quantify anticholinergic burden. These scales rank the anticholinergic activity of medicines into four categories, ranging from no anticholinergic activity (= 0) to definite/high anticholinergic activity (= 3). The aim of this systematic review was to compare anticholinergic burden quantified by the anticholinergic risk scales and evaluate associations with adverse outcomes in older people. Methods We conducted a literature search in Ovid MEDLINE, EMBASE and PsycINFO from 1984-2014 to identify expert opinion derived anticholinergic risk scales. In addition to this, a citation analysis was performed in Web of Science and Google Scholar to track prospective citing of references of selected articles for assessment of individual scales for adverse anticholinergic outcomes. The primary outcomes of interest were functional and cognitive outcomes associated with anticholinergic burden in older people. The critical appraisals of the included studies were performed by two independent reviewers and the data were extracted onto standardised forms. Results The primary electronic literature search identified a total of 1250 records in the 3 different databases. On the basis of full-text analysis, we identified 7 expert-based anticholinergic rating scales that met the inclusion criteria. The rating of anticholinergic activity for medicines among these rating scales was inconsistent. For example, quetiapine was rated as having high anticholinergic activity in one scale (n = 1), moderate in another scale (n = 1) and low in two other scales (n = 2). Citation analysis of the individual scales showed that the Anticholinergic Cognitive Burden (ACB) scale was the most frequently validated expert based anticholinergic scale for adverse outcomes (N = 13). Conclusions In conclusion, there is not one standardised tool for measuring anticholinergic burden. Cohort studies have shown that higher anticholinergic burden is associated with negative brain effects, poorer cognitive and functional outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12877-015-0029-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Stephen B Duffull
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Prasad S Nishtala
- School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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Dreier A, Hoffmann W. [Dementia Care Manager for patients with dementia. Determination of the requirements and qualifications contents for nurses in the DelpHi-MV study]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 56:1398-409. [PMID: 23978981 DOI: 10.1007/s00103-013-1796-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dementia is one of the most prevalent chronic progressive diseases in older age. The progression of dementia is associated with an increasing demand for patient care. Thus, the nursing profession fulfills important tasks in the supply of care in dementia. Care of dementia patients requires nurses with more specialized professional knowledge. Consequently, the development of new qualification concepts in dementia is needed. Therefore, the German Center for Neurodegenerative Diseases, Rostock/Greifswald, has developed a qualification according to the Dementia Care Management concept. A prospective cross-sectional study identified the tasks and qualifications of nurses as Dementia Care Managers. Overall, 27 tasks and 28 qualification items were identified for a nurse to qualify as a Dementia Care Manager. In the next step, the first version of the Dementia Care Management Curriculum was developed.
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Affiliation(s)
- A Dreier
- Institut für Community Medicine, Abt. Versorgungsepidemiologie und Community Health, Universitätsmedizin Greifswald, Ellernholzstr. 1-2, 17487, Greifswald, Deutschland,
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Sivananthan SN, Puyat JH, McGrail KM. Variations in self-reported practice of physicians providing clinical care to individuals with dementia: a systematic review. J Am Geriatr Soc 2013; 61:1277-85. [PMID: 23889524 DOI: 10.1111/jgs.12368] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine to what extent actual practice as reported in the literature is consistent with clinical guidelines for dementia care. DESIGN A systematic review of empirical studies of clinical services provided by physicians to older adults with a diagnosis of dementia. SETTING All settings involving primary care physicians in which a diagnosis of dementia is provided. PARTICIPANTS Physicians providing care to individuals aged 60 and older with a primary or secondary diagnosis of dementia. INTERVENTION Seven dementia care processes recommended by guidelines: formal memory testing, imaging, laboratory testing, interventions, counseling, community service, and specialist referrals. MEASUREMENTS Web of Knowledge, PubMed, Science Direct, MedLine, PsychINFO, EMBASE, and Google Scholar databases were searched for articles in English published before March 1, 2012. RESULTS Twelve studies met the final inclusion criteria, all of which were self-reported cross-sectional surveys. There was broad variation in the proportion of physicians who reported conducting each dementia care process, with the widest variation in formal memory testing (4-96%). Recently published studies reflected a shift in scope of care, reporting that high proportions of physicians provided interventions, counseling, and referrals to specialist. CONCLUSION Despite the availability and dissemination of established best practice guidelines, there is still wide variation in physician practice patterns in dementia care. The quality of currently available studies limits the ability to draw strong conclusions. Better information on practice patterns and their relationship to outcomes for individuals with dementia and their caregivers using more-robust study designs is needed to address the needs of the increasing number of individuals who will require dementia care.
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Affiliation(s)
- Saskia N Sivananthan
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.
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Hodgson N, Gitlin LN, Winter L, Czekanski K. Undiagnosed illness and neuropsychiatric behaviors in community residing older adults with dementia. Alzheimer Dis Assoc Disord 2011; 25:109-15. [PMID: 20921879 PMCID: PMC3035741 DOI: 10.1097/wad.0b013e3181f8520a] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this retrospective analysis was to examine prevalence of undiagnosed acute illness and characteristics including neuropsychiatric symptoms associated with illness in community residing older adults with Alzheimer disease or related disorders. Subjects included 265 community residing older adults with dementia who participated in 1 of 2 interventions being tested in randomized clinical trials. Measures included a brief nursing assessment and laboratory evaluations including complete blood count, blood chemistry (Chem 7), and thyroid function tests of serum samples and culture and sensitivity tests of urine samples. Undiagnosed illness was identified according to currently published criteria. Neuropsychiatric behaviors were assessed using 21 behaviors derived from standard measures. Thirty-six percent (N=96) of patients had clinical findings indicative of undetected illness. Conditions most prevalent were bacteriuria (15%), followed by hyperglycemia (6%) and anemia (5%). The behavior most often demonstrated among those with detected illness was resisting or refusing care (66% vs. 47% for those without detected illness). Individuals with detected illness had significantly lower functional status scores [3.8 vs. 4.4, t(275)=7.01, P=0.01], lower cognitive status scores [10.5 vs. 14.4, t(275)=12.1, P<0.01], and were more likely to be prescribed psychotropic medications for behavior (41% vs. 26%, χ=3.67, P<0.05) than those without illness. Findings suggest that challenges of diagnosing acute illness with atypical presentation must be addressed to promote quality of care and the specialized needs for this vulnerable population.
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Affiliation(s)
- Nancy Hodgson
- Corresponding Author; Research Scientist, Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 Street, Suite 500, Philadelphia, PA, 19130; voice -215-955-2163; fax- 215-923-2475;
| | - Laura N. Gitlin
- Director, Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 Street, Suite 513, Philadelphia, PA, 19130
| | - Laraine Winter
- Assistant Director, Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 Street, Suite 500, Philadelphia, PA, 19130; voice - 215-503-4715; fax- 215-923-2475
| | - Kathleen Czekanski
- Nurse Interventionist, Jefferson Center for Applied Research on Aging and Health, Thomas Jefferson University, 130 S. 9 Street, Suite 500, Philadelphia, PA, 19130; voice - 215-951-1322
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Boustani MA, Sachs GA, Alder CA, Munger S, Schubert CC, Guerriero Austrom M, Hake A, Unverzagt FW, Farlow M, Matthews BR, Perkins AJ, Beck RA, Callahan CM. Implementing innovative models of dementia care: The Healthy Aging Brain Center. Aging Ment Health 2011; 15:13-22. [PMID: 21271387 PMCID: PMC3077086 DOI: 10.1080/13607863.2010.496445] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recent randomized controlled trials have demonstrated the effectiveness of the collaborative dementia care model targeting both the patients suffering from dementia and their informal caregivers. OBJECTIVE To implement a sustainable collaborative dementia care program in a public health care system in Indianapolis. METHODS We used the framework of Complex Adaptive System and the tool of the Reflective Adaptive Process to translate the results of the dementia care trial into the Healthy Aging Brain Center (HABC). RESULTS Within its first year of operation, the HABC delivered 528 visits to serve 208 patients and 176 informal caregivers. The mean age of HABC patients was 73.8 (standard deviation, SD 9.5), 40% were African-Americans, 42% had less than high school education, 14% had normal cognitive status, 39% received a diagnosis of mild cognitive impairment, and 46% were diagnosed with dementia. Within 12 months of the initial HABC visit, 28% of patients had at least one visit to an emergency room (ER) and 14% were hospitalized with a mean length of stay of five days. The rate of a one-week ER revisit was 14% and the 30-day rehospitalization rate was 11%. Only 5% of HABC patients received an order for neuroleptics and only 16% had simultaneous orders for both definite anticholinergic and anti-dementia drugs. CONCLUSION The tools of 'implementation science' can be utilized to translate a health care delivery model developed in the research laboratory to a practical, operational, health care delivery program.
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Affiliation(s)
- Malaz A. Boustani
- Indiana University Center for Aging Research, Indianapolis, IN,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN,Regenstrief Institute, Inc., Indianapolis, IN,Indiana Alzheimer Disease Center, Indianapolis, IN, USA
| | - Greg A. Sachs
- Indiana University Center for Aging Research, Indianapolis, IN,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN,Regenstrief Institute, Inc., Indianapolis, IN,Indiana Alzheimer Disease Center, Indianapolis, IN, USA
| | - Catherine A. Alder
- Indiana University Center for Aging Research, Indianapolis, IN,Regenstrief Institute, Inc., Indianapolis, IN,Wishard Health Services, Indianapolis, IN
| | - Stephanie Munger
- Indiana University Center for Aging Research, Indianapolis, IN,Regenstrief Institute, Inc., Indianapolis, IN
| | - Cathy C. Schubert
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Mary Guerriero Austrom
- Department of Psychiatry; Indiana University School of Medicine, Indianapolis, IN,Indiana Alzheimer Disease Center, Indianapolis, IN, USA
| | - Ann Hake
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN,Indiana Alzheimer Disease Center, Indianapolis, IN, USA
| | - Frederick W. Unverzagt
- Department of Psychiatry; Indiana University School of Medicine, Indianapolis, IN,Indiana Alzheimer Disease Center, Indianapolis, IN, USA
| | - Martin Farlow
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN,Indiana Alzheimer Disease Center, Indianapolis, IN, USA
| | - Brandy R. Matthews
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN,Indiana Alzheimer Disease Center, Indianapolis, IN, USA
| | - Anthony J. Perkins
- Indiana University Center for Aging Research, Indianapolis, IN,Regenstrief Institute, Inc., Indianapolis, IN
| | - Robin A. Beck
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Christopher M. Callahan
- Indiana University Center for Aging Research, Indianapolis, IN,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN,Regenstrief Institute, Inc., Indianapolis, IN
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Boustani MA, Munger S, Gulati R, Vogel M, Beck RA, Callahan CM. Selecting a change and evaluating its impact on the performance of a complex adaptive health care delivery system. Clin Interv Aging 2010; 5:141-8. [PMID: 20517483 PMCID: PMC2877524 DOI: 10.2147/cia.s9922] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Indexed: 11/23/2022] Open
Abstract
Complexity science suggests that our current health care delivery system acts as a complex adaptive system (CAS). Such systems represent a dynamic and flexible network of individuals who can coevolve with their ever changing environment. The CAS performance fluctuates and its members' interactions continuously change over time in response to the stress generated by its surrounding environment. This paper will review the challenges of intervening and introducing a planned change into a complex adaptive health care delivery system. We explore the role of the "reflective adaptive process" in developing delivery interventions and suggest different evaluation methodologies to study the impact of such interventions on the performance of the entire system. We finally describe the implementation of a new program, the Aging Brain Care Medical Home as a case study of our proposed evaluation process.
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Affiliation(s)
- Malaz A Boustani
- Indiana University Center for Aging Research, Department of Medicine, Division of General Internal Medicineand Geriatrics, Indiana University Medical Group-Primary Care, Indianapolis, IN, USA
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Affiliation(s)
- Christopher M. Callahan
- Indiana University Center for Aging Research, Indianapolis, IN USA
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA
- Regenstrief Institute, Inc., Indianapolis, IN USA
| | - Malaz A. Boustani
- Indiana University Center for Aging Research, Indianapolis, IN USA
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA
- Regenstrief Institute, Inc., Indianapolis, IN USA
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Boustani M, Campbell N, Munger S, Maidment I, Fox C. Impact of anticholinergics on the aging brain: a review and practical application. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/1745509x.4.3.311] [Citation(s) in RCA: 418] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: in an effort to enhance medication prescribing for older adults and reduce the burden of cognitive impairment, this paper reviews the literature regarding the negative impact of anticholinergics on cognitive function and provides clinicians with a practical guidance for anticholinergic use in older adults. Methods: a Medline search identified studies evaluating the use of anticholinergics and the relationship between anticholinergics and cognitive impairment. Results: prescribing anticholinergics for older adults leads to acute cognitive impairment and, possibly, chronic cognitive deficits. Assessing anticholinergic burden with a simple scale may represent a useful noninvasive tool to optimize geriatric pharmacotherapy. Conclusion: more studies are needed to validate the Anticholinergic Cognitive Burden scale and establish therapeutic guidelines in the presence of cognitive anticholinergic adverse effects.
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Affiliation(s)
- Malaz Boustani
- Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, IN 46202, USA and, Indiana University Center for Aging Research, 410 West 10th Street, Suite 2000IN 46202-3012, USA
| | - Noll Campbell
- Wishard Health Services, 1001 West 10th Street, IN 46202, USA
| | - Stephanie Munger
- Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, IN 46202, USA and, Indiana University Center for Aging Research, 410 West 10th Street, Suite 2000IN 46202-3012, USA
- Indiana University Center for Aging Research, 410 West 10th Street, Suite 2000IN 46202-3012, USA
| | - Ian Maidment
- Eastern & Area Coastal Office, St Martin’s Hospital, Littlebourne Road, Canterbury, Kent, CT1 1AZ, UK
| | - Chris Fox
- Shepway Caste Department of Old Age Psychiatry, Fokestone Health Centre,15–25 Dover Road, Folkestone, Kent, CT2 1JY, UK
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