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Glasier W, Arbeau K, Launeanu M, Kwee J. The social process of involuntary separation and the search for connection. Health Psychol Open 2024; 11:20551029231224368. [PMID: 38420186 PMCID: PMC10898822 DOI: 10.1177/20551029231224368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
Placing a loved one in care does not relieve informal caregivers' physical and emotional stresses. This study identified the unique psycho-social-spiritual processes of involuntary separation among spouses following long-term care admission. Participants were 17 spouse-caregivers (12 women and 5 men) with a mean age of 84 years who had been involuntarily separated for an average of 20 months. The basic psycho-social-spiritual process of spouse-caregiver involuntary separation was connecting in disconnection, which had three distinct stages: (1) Initial coping, (2) Adjusting to the new situation, and (3) Moving forward. Movement through the three stages was influenced by individuals' capacity and willingness to reach out for connection and by the abilities of others to extend accurate empathy and practical help. The implications of this study highlight spouse-caregivers' needs for connection and support not only during the crisis of separation, but in the months and years that follow.
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Cesana BM, Bergh S, Ciccone A, Cognat E, Fabbo A, Fascendini S, Frisoni GB, Froelich L, Handels R, Jori MC, Mecocci P, Merlo P, Peters O, Tsolaki M, Defanti CA. Predictors of Nursing Home Placement in a Cohort of European People with Alzheimer's Disease and Other Dementia Cases Enrolled in SCU-B or Non SCU-B Centers: The RECage Study. J Alzheimers Dis 2024; 98:1043-1052. [PMID: 38489173 DOI: 10.3233/jad-230878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
Background Nursing home placement (NHP) can be the final step of patients with Alzheimer's disease. Objective We aimed to identify NHP predictors among 508 people with dementia with a 3-year follow-up. Methods We analyzed data from the international observational RECage study, involving 508 people with especially Alzheimer's disease and comparing a cohort enrolled by five centers with a Special Care Unit for BPSD (behavioral and psychological symptoms of dementia) and another one enrolled by six centers lacking this facility. The tertiary objective of the study was to assess the possible role of the SCU-B in delaying NHP. We assessed the relationship of the baseline characteristics with NHP by means of univariate analysis followed by Cox's multivariate model. Results Patients' mean age was 78.1 years, 54.9% were women. Diagnosis mean age was 75.4 (±8.32) years; the main diagnosis was Alzheimer's disease (296; 58.4%). During follow-up, 96 (18.9%) patients died and 153 (30.1%) were institutionalized without a statistically significant difference between the two cohorts (p = 0.9626). The mean NHP time was 902 (95% CI: 870-934). The multivariable analysis without death as a competing risk retained four independent predictors of NHP: age increase (hazard ratio (HR) = 1.023, 95% CI: 1.000-1.046), patient education level increase (HR = 1.062, 95% CI: 1.024-1.101), Neuropsychiatric Inventory total increase (HR = 1.018; 95% CI: 1.011-1.026), and total Mini-Mental State Examination as a favorable factor (HR = 0.948, 95% CI: 0.925-0.971). Gender (females versus males: HR = 1.265, 95% CI: 0.899-1.781) was included in the final Cox's model for adjusting the estimates for. Conclusions Our data partially agree with the predictors of NHP in literature including the effect of high education level. No caregivers' factors were statistically significant. Clinical trial registration NCT03507504.
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Affiliation(s)
- Bruno Mario Cesana
- Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro" Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Sverre Bergh
- Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway (SCU-B)
| | - Alfonso Ciccone
- Department of Neurology with Neurosurgical Activity "Carlo Poma" Hospital, ASST di Mantova, Mantua, Italy (non-SCU-B)
| | - Emmanuel Cognat
- Cognitive Neurology Centre, Lariboisière-Fernand Widal Hospital GHU AP-HP Nord, Université Paris-Diderot, Paris, France (non-SCU-B)
| | - Andrea Fabbo
- Department of Primary Care, Geriatric Service-Cognitive Disorders and Dementia, Local Health Authority of Modena (AUSL), Modena, Italy (SCU-B)
| | | | - Giovanni B Frisoni
- Division of Geriatrics and Rehabilitation, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland (SCU-B)
| | - Lutz Froelich
- Department of Geriatric Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany (SCU-B)
| | - Ron Handels
- Department of Psychiatry and Neuropsychology, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Patrizia Mecocci
- Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
- NVS Department, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden (non-SCU-B)
| | - Paola Merlo
- Neurological Unit (PM), U.V.A. Centre, Humanitas Gavazzeni, Bergamo, Italy (non-SCUB)
| | - Oliver Peters
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Berlin, Germany (non SCU-B)
| | - Magda Tsolaki
- Greek Association of Alzheimer's Disease and Related Disorders (GAADRD), Thessaloniki, Greece
- First Department of Neurology, School of Medicine, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
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Björkstedt E, Voutilainen A, Auvinen K, Hyttinen V, Jyrkkä J, Mäntyselkä P, Lönnroos E. The role of functioning in predicting nursing home placement or death among older home care patients. Scand J Prim Health Care 2023; 41:478-485. [PMID: 37916677 PMCID: PMC11001308 DOI: 10.1080/02813432.2023.2274333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE There have been few studies predicting institutionalization or death in home care settings. We examined risk factors for nursing home placement (NHP) and death among home care patients. DESIGN A prospective one-year follow-up study. SETTINGS AND SUBJECTS Persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293). MAIN OUTCOME MEASURES Risk factors for NHP or death were investigated using Cox proportional hazards model. Explanatory variables included demographics, health status (Charlson Comorbidity Index, CCI), physical (Timed Up and Go, TUG), and cognitive (Mini-Mental State Examination, MMSE) functioning, Basic and Instrumental Activities of Daily Living (BADL, IADL) and mood (Geriatric Depression Scale, GDS-15). RESULTS Of the 293 patients (mean age 82.6 years, 70.6% women), 27 (9.2%) moved to a nursing home and 25 (6.9%) died during the follow-up (mean 350 days). The combined outcome of NHP or death was predicted by BADL (HR 0.73, CI 95% 0.62-0.86), IADL (0.75, 0.65-0.87) MMSE (0.92, 0.87-0.96), and TUG (1.02, 1.01-1.03). NHP alone was predicted by BADL (0.62, 0.50-0.78), IADL (0.57, 0.45-0.73), and MMSE (0.88, 0.82-0.94) and mortality by TUG (1.02, 1.01-1.03). CONCLUSION Basic measures of functioning can be used to identify high-risk patients in home care. Decreasing BADL, IADL and MMSE predict NHP and longer TUG-times death within a year.
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Affiliation(s)
- Eeva Björkstedt
- Department of Primary Health Care, Wellbeing Services County of South Savo, Mikkeli, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kati Auvinen
- Department of Primary Health Care, Wellbeing Services County of South Savo, Mikkeli, Finland
| | - Virva Hyttinen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Johanna Jyrkkä
- Information and Development Services Unit, Finnish Medicines Agency FIMEA, Kuopio, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Clinical Research and Trials Centre, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Eija Lönnroos
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Tolentino AP, Gaus KS, Gao Y, Chronowski KJ, Brice JH, Quackenbush EB. Transition of care from the emergency department to skilled nursing facility: Retrospective case-control study. J Am Coll Emerg Physicians Open 2023; 4:e13022. [PMID: 37662441 PMCID: PMC10472214 DOI: 10.1002/emp2.13022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 09/05/2023] Open
Abstract
Objective The primary objective of this study is to describe associations between emergency department (ED)-to-skilled nursing facility (SNF) transition and ED length-of-stay (LOS). The secondary objective is to explore how social determinants of health (SDOH) influence ED-to-SNF transition visit parameters. In 2020, The Centers for Medicare & Medicaid Services issued the "COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers" eliminating the requirement of a 3-day qualifying hospital stay before SNF placement. The waiver allowed ED patients to be transitioned directly to an SNF from the ED. Methods We conducted a descriptive retrospective case-control study of adult patients who sought care in the University of North Carolina Hospitals (UNCH) ED between March 1, 2020, and March 1, 2022, lived in a non-SNF residence before their ED visit, and were transitioned directly to an SNF from the ED (n 1 = 27), compared with a group seen in the ED and admitted to hospital for SNF placement (n 2 = 54). Results The ED-to-SNF group experienced a significantly longer ED LOS compared to the ED-to-Inpatient-to-SNF group: 72.8 hours (95% confidence interval [CI], 59.2-86.4) compared to 14.5 hours (95% CI, 12.1-16.9). We found no significant differences in SDOH between the ED-to-SNF group and the ED-to-Inpatient-to-SNF group. Conclusion Patients who transition from the ED to an SNF experience long ED stays that may adversely affect health and well-being. Transitioning directly from the ED to an SNF may contribute to ED boarding and overcrowding.
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Affiliation(s)
- Alec P. Tolentino
- Department of Emergency MedicineSchool of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Kelli S. Gaus
- Department of EpidemiologyGillings School of Global Public HealthUniversity of North Carolina Chapel HillChapel HillNorth CarolinaUSA
| | - Yingqiu Gao
- School of NursingUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Kevin J Chronowski
- Department of Emergency MedicineSchool of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Jane Helen Brice
- Department of Emergency MedicineSchool of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Eugenia B. Quackenbush
- Department of Emergency MedicineSchool of MedicineUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Mahlknecht P, Eisner W, Poewe W. Disability Milestones and Death in Parkinson's Disease under Subthalamic Neurostimulation. Mov Disord Clin Pract 2023; 10:1436-1437. [PMID: 37772309 PMCID: PMC10525054 DOI: 10.1002/mdc3.13841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/08/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
| | - Wilhelm Eisner
- Department of NeurosurgeryInnsbruck Medical UniversityInnsbruckAustria
| | - Werner Poewe
- Department of NeurologyInnsbruck Medical UniversityInnsbruckAustria
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Cummings J, Hahn-Pedersen JH, Eichinger CS, Freeman C, Clark A, Tarazona LRS, Lanctôt K. Exploring the relationship between patient-relevant outcomes and Alzheimer's disease progression assessed using the clinical dementia rating scale: a systematic literature review. Front Neurol 2023; 14:1208802. [PMID: 37669257 PMCID: PMC10470645 DOI: 10.3389/fneur.2023.1208802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/21/2023] [Indexed: 09/07/2023] Open
Abstract
Background People with Alzheimer's disease (AD) have difficulties in performing activities of daily living (ADLs) as the disease progresses, commonly experience neuropsychiatric symptoms (NPS), and often have comorbidities such as cardiovascular disease. These factors all contribute to a requirement for care and considerable healthcare costs in AD. The Clinical Dementia Rating (CDR) scale is a widely used measure of dementia staging, but the correlations between scores on this scale and patient-/care partner-relevant outcomes have not been characterized fully. We conducted a systematic literature review to address this evidence gap. Methods Embase, MEDLINE, and the Cochrane Library were searched September 13, 2022, to identify published studies (no restriction by date or country) in populations with mild cognitive impairment due to AD or AD dementia. Studies of interest reported data on the relationships between CDR Global or CDR-Sum of Boxes (CDR-SB) scores and outcomes including NPS, comorbidities, ADLs, nursing home placement, healthcare costs, and resource use. Results Overall, 58 studies met the inclusion criteria (42 focusing on comorbidities, 14 on ADLs or dependence, five on nursing home placement, and six on economic outcomes). CDR/CDR-SB scores were correlated with the frequency of multiple NPS and with total scores on the Neuropsychiatric Inventory. For cardiovascular comorbidities, no single risk factor was consistently linked to AD progression. Increasing CDR/CDR-SB scores were correlated with decline in multiple different measures of ADLs and were also associated with nursing home placement and increasing costs of care. Conclusion NPS, ADLs, and costs of care are clearly linked to AD progression, as measured using CDR Global or CDR-SB scores, from the earliest stages of disease. This indicates that scores derived from the CDR are a meaningful way to describe the severity and burden of AD for patients and care partners across disease stages.
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Affiliation(s)
- Jeffrey Cummings
- Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, United States
| | | | | | | | | | | | - Krista Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Ryu E, Wi CI, Wheeler PH, King KS, Carlson RE, Juhn YJ, Takahashi PY. The Role of Individual-Level Socioeconomic Status on Nursing Home Placement Accounting for Neighborhood Characteristics. J Am Med Dir Assoc 2023; 24:1048-1053.e2. [PMID: 36841262 PMCID: PMC10962058 DOI: 10.1016/j.jamda.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE Independent living is desirable for many older adults. Although several factors such as physical and cognitive functions are important predictors for nursing home placement (NHP), it is also reported that socioeconomic status (SES) affects the risk of NHP. In this study, we aimed to examine whether an individual-level measure of SES is associated with the risk of NHP after accounting for neighborhood characteristics. DESIGN A population-based study (Olmsted County, Minnesota, USA). SETTING AND PARTICIPANTS Older adults (age 65+ years) with no prior history of NHP. METHODS Electronic health records (EHR) were used to identify individuals with any NHP between April 1, 2012 (baseline date) and April 30, 2019. Association between the (HOUsing-based index of SocioEconomic Status (HOUSES) index, an individual-level SES measure based on housing characteristics of current residence, and risk of NHP was tested using random effects Cox proportional hazard model adjusting for area deprivation index (ADI), an aggregated SES measure that captures neighborhood characteristics, and other pertinent confounders such as age and chronic disease burden. RESULTS Among 15,031 older adults, 3341 (22.2%) experienced NHP during follow-up period (median: 7.1 years). At baseline date, median age was 73 years old with 55% female persons, 91% non-Hispanic Whites, and median number of chronic conditions of 4. Accounting for pertinent confounders, the HOUSES index was strongly associated with risk of NHP (hazard ratio 1.89; 95% confidence interval 1.66‒2.15 for comparing the lowest vs highest quartiles), which was not influenced by further accounting for ADI. CONCLUSIONS AND IMPLICATIONS This study demonstrates that an individual-level SES measure capturing current individual-specific socioeconomic circumstances plays a significant role for predicting NHP independent of neighborhood characteristics where they reside. This study suggests that older adults who are at higher risk of NHP can be identified by utilizing the HOUSES index and potential individual-level intervention strategies can be applied to reduce the risk for those with higher risk.
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Affiliation(s)
- Euijung Ryu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Philip H Wheeler
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Katherine S King
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Rachel E Carlson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Paul Y Takahashi
- Division of Primary Care and Internal Medicine, Mayo Clinic, Rochester, MN, USA
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De Vincenzo C, Marian I, Piol S, Keisari S, Testoni I. Self-Help Groups within Nursing Homes: The Experiences of Family Caregivers in Northeastern Italy. Behav Sci (Basel) 2023; 13:485. [PMID: 37366737 DOI: 10.3390/bs13060485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
Older adults and their family caregivers experience nursing home placement as a particularly critical time of life. The present study explored the experiences of family caregivers of nursing home residents taking part in a self-help group for caregivers. The sample was composed of six caregivers of older adults residing in a nursing home in the northeast of Italy. The respondents, aged 57 to 71, were part of a self-help group set up by the facility between 2017 and 2019. In this qualitative methodological design, we applied the principles of interpretative phenomenological analysis. Two main themes emerged from the interviews: (a) challenges in constructing experience as caregivers; and (b) shared experiences as stabilizing tools. The findings highlight the importance of self-help groups in fostering the well-being of caregivers of older adults living in nursing homes. The self-help group enabled caregivers to deal with nursing home placement and the sense of guilt deriving from it; understand and accept the disabilities affecting their loved one; comprehend the experience of ambiguous loss; and learn to listen to their own needs, thus avoiding physical and emotional exhaustion.
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Affiliation(s)
- Ciro De Vincenzo
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy
| | - Ilenia Marian
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy
| | - Silvia Piol
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy
- School of Creative Arts Therapies, University of Haifa, Haifa 3498838, Israel
| | - Shoshi Keisari
- School of Creative Arts Therapies, University of Haifa, Haifa 3498838, Israel
- Emil Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
| | - Ines Testoni
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology (FISPPA), University of Padova, 35131 Padova, Italy
- Emil Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
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Bailey MD, Gambert S, Gruber-Baldini A, Guralnik J, Kozar R, Qato DM, Shardell M, Albrecht JS. Traumatic Brain Injury and Risk of Long-Term Nursing Home Entry among Older Adults: An Analysis of Medicare Administrative Claims Data. J Neurotrauma 2023; 40:86-93. [PMID: 35793112 PMCID: PMC10162579 DOI: 10.1089/neu.2022.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Traumatic brain injury (TBI) is a leading cause of injury-related disability among older adults, and there is increasing interest in post-discharge management as this population grows. We evaluated the association between TBI and long-term nursing home (NH) entry among a nationally representative sample of older adults. We identified 207,355 adults aged ≥65 years who received a diagnosis of either a TBI, non-TBI trauma, or were uninjured between January 2008 and June 2015 from a 5% sample of Medicare beneficiaries. The NH entry was operationalized as the first NH admission that resulted in a stay ≥100 days. Time to NH entry was calculated as the difference between the NH entry date and the index date (the date of TBI, non-TBI trauma, or inpatient/outpatient visit in the uninjured group). We used cause-specific Cox proportional hazards models with stabilized inverse probability of exposure weights to model time to NH entry as a function of injury in the presence of death as a competing risk and generated hazard ratios (HR) and 95% confidence intervals (CI). After excluding beneficiaries living in a NH at index, there were 60,600 TBI, 63,762 non-TBI trauma, and 69,893 uninjured beneficiaries in the sample. In weighted models, beneficiaries with TBI entered NHs at higher rates relative to the non-TBI trauma (HR 1.15; 95% CI 1.10, 1.20) and uninjured (HR 1.67; 95% CI 1.60, 1.74) groups. Future research should focus on interventions to retain older adult TBI survivors within the community.
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Affiliation(s)
- M. Doyinsola Bailey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Steven Gambert
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ann Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Rosemary Kozar
- R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Danya M. Qato
- Department of Pharmaceutical Health Services Research, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michelle Shardell
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jennifer S. Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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10
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Mahlknecht P, Foltynie T, Limousin P, Poewe W. How Does Deep Brain Stimulation Change the Course of Parkinson's Disease? Mov Disord 2022; 37:1581-1592. [PMID: 35560443 PMCID: PMC9545904 DOI: 10.1002/mds.29052] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/07/2022] [Accepted: 04/18/2022] [Indexed: 12/14/2022] Open
Abstract
A robust body of evidence from randomized controlled trials has established the efficacy of deep brain stimulation (DBS) in reducing off time and dyskinesias in levodopa‐treated patients with Parkinson's disease (PD). These effects go along with improvements in on period motor function, activities of daily living, and quality of life. In addition, subthalamic DBS is effective in controlling drug‐refractory PD tremor. Here, we review the available data from long‐term observational and controlled follow‐up studies in DBS‐treated patients to re‐examine the persistence of motor and quality of life benefits and evaluate the effects on disease progression, major disability milestones, and survival. Although there is consistent evidence from observational follow‐up studies in DBS‐treated patients over 5–10 years and beyond showing sustained improvement of motor control, the long‐term impact of DBS on overall progression of disability in PD is less clear. Whether DBS reduces or delays the development of later motor and non‐motor disability milestones in comparison to best medical management strategies is difficult to answer by uncontrolled observational follow‐up, but there are signals from controlled long‐term observational studies suggesting that subthalamic DBS may delay some of the late‐stage disability milestones including psychosis, falls, and institutionalization, and also slightly prolongs survival compared with matched medically managed patients. These observations could be attributable to the sustained improvements in motor function and reduction in medication‐induced side effects, whereas there is no clinical evidence of direct effects of DBS on the underlying disease progression. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
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Affiliation(s)
- Philipp Mahlknecht
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, UCL Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
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Yan D, Wang S, Temkin-Greener H, Cai S. HCBS Service Spending and Nursing Home Placement for Patients With Alzheimer's Disease and Related Dementias: Does Race Matter? J Appl Gerontol 2021; 41:638-649. [PMID: 34615409 DOI: 10.1177/07334648211048187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We examined the extent to which home and community-based services (HCBS) spending affected the likelihood of nursing home (NH) placement among black and white HCBS users with Alzheimer's disease and related dementias (ADRD). METHODS The study population included new HCBS users with ADRD between 2010 and 2013 (N = 1,046,200). RESULTS We found that a one hundred dollar increase in monthly HCBS spending was associated with a 0.3 percentage points decrease in the NH placement rate among Whites, but a 0.3 percentage points increase in the NH placement rate among Blacks. The overall NH placement rate was 68.2% and 56.7% for Whites and Blacks, respectively. DISCUSSION A higher HCBS spending was associated with a decreased likelihood of NH placements for Whites but not for Blacks. It is important to understand how states' HCBS expansion efforts influence Blacks and Whites with ADRD so that resources can be tailored to communities with different race-mix.
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Affiliation(s)
- Di Yan
- Department of Public Health Sciences, 6923University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Sijiu Wang
- Department of Public Health Sciences, 123964University of Chicago, Chicago, IL, USA
| | - Helena Temkin-Greener
- Department of Public Health Sciences, 6923University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Shubing Cai
- Department of Public Health Sciences, 6923University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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12
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Hosking A, Hommel AALJ, Lorenzl S, Coelho M, Ferreira JJ, Meissner WG, Odin P, Bloem BR, Dodel R, Schrag A. Characteristics of Patients with Late-Stage Parkinsonism Who are Nursing Home Residents Compared with those Living at Home. J Am Med Dir Assoc 2020; 22:440-445.e2. [PMID: 32723531 DOI: 10.1016/j.jamda.2020.06.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine clinical characteristics and treatment complications of patients with late-stage Parkinsonism living in nursing homes compared with those living at home. DESIGN Cross-sectional analysis. SETTING AND PARTICIPANTS This study is an analysis of 692 patients with late stage Parkinsonism recruited to an in-depth international study, Care of Late-Stage Parkinsonism (CLaSP). MEASURES Sociodemographic characteristics were compared between patients who were living in a nursing home (n = 194) and those living at home (n = 498). Clinical assessments included the Unified Parkinson's Disease Rating Scale (UPDRS), the nonmotor symptom scale, the neuropsychiatric inventory, and a structured interview of patients and carers. Predictors of nursing home status were determined in a multivariate analysis. RESULTS Nursing home placement was strongly associated with more severe cognitive impairment, worse UPDRS motor scores and disability, and with being unmarried and older. Although nursing home residents had significantly higher axial scores, falls were less common. Despite similar levodopa equivalence doses, they had less dyskinesia. Nonmotor symptom burden, particularly delusion, hallucination, and depression scores were higher in nursing home residents, and they were more frequently on psychotropic medication. They had lower rates of dopamine agonist use and lower rates of impulse control disorders. In multivariate analysis, being unmarried, presence of cognitive impairment, worse disease severity as assessed on the UPDRS parts II and III, severity of delusions, and lower rate of dyskinesia were associated with nursing home placement. CONCLUSIONS AND IMPLICATIONS These clinical characteristics suggest that in patients with Parkinsonsim who are nursing home residents, presence of cognitive impairment and delusions particularly add to the higher overall symptom burden, and more often require specific treatments, including clozapine. Despite similar levodopa equivalent daily dose, motor severity is higher, and dyskinesias, indicative of a response to levodopa, are less common. Falls, however, also occur less commonly, and dopamine agonists are less frequently used, with lower rates of impulse control disorder.
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Affiliation(s)
- Alice Hosking
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Adrianus A L J Hommel
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands; Department of Medicine, University of Otago, Christchurch, New Zealand and New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Stefan Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria; Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München, Klinikum Großhadern, Munich, Germany; Department of Neurology, Agatharied Hospital, Hausham, Germany
| | - Miguel Coelho
- Interdisziplinäres Zentrum für Palliativmedizin und Klinik für Neurologie Universität München, Klinikum Großhadern, Munich, Germany
| | - Joaquim J Ferreira
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Wassilios G Meissner
- Department of Medicine, University of Otago, Christchurch, New Zealand and New Zealand Brain Research Institute, Christchurch, New Zealand; Service de Neurologie, CHU de Bordeaux, Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - Per Odin
- Department of Neurology, Lund University Hospital, Lund, Sweden
| | - Bas R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behavior, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Nijmegen, the Netherlands; Groenhuysen Organisation, Roosendaal, the Netherlands
| | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, Essen, Germany
| | - Anette Schrag
- UCL Queen Square Institute of Neurology, University College London, London, UK.
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13
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Sun C, Zhou R, Cui Y, Ding Y, Li X, Li X, Zhang Y, Chen S, Xing Y. The Adaptation of Older Adults' Transition to Nursing Homes in Mainland China: A Qualitative Study. J Transcult Nurs 2020; 32:318-325. [PMID: 32449461 DOI: 10.1177/1043659620923387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: An increasing number of older adults have moved to nursing homes in China. This study was to explore the adaptation of older adults' transition to nursing homes in mainland China. Method: A qualitative study was conducted in two nursing homes in Nanjing, China. Data were collected from 11 residents and 5 staff members through purposeful sampling with semistructured interviews, and content analysis was performed. Results: Three themes were identified: Chinese culture, policy, and adaptation (staying modest and prudent, feeling shy to speak with males, familism suppressing the inner voice, and the new policy "combination of medical service and care" bringing benefits); the adaptation to nursing homes (poor quality of sleep and catering, relationship development, and emotional reactions); and needs of residents (emotional support, more interactions, and self-realization). Discussion: Health care providers consider cultural assessments. Further work is expected to develop programs that help older adults adjust to nursing homes.
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Affiliation(s)
- Changxian Sun
- Nanjing Medical University, Nanjing, Jiangsu, China.,Jiangsu Vocational Institute of Commerce, Nanjing, Jiangsu, China
| | - Rong Zhou
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yan Cui
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yaping Ding
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xuxu Li
- Landsea Lvy Elder Care Service, Nanjing, Jiangsu, China
| | - Xianwen Li
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yangyang Zhang
- Jiangsu Vocational Institute of Commerce, Nanjing, Jiangsu, China
| | - Shen Chen
- Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ying Xing
- Nanjing Medical University, Nanjing, Jiangsu, China
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14
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Cottrell L, Duggleby W, Ploeg J, McAiney C, Peacock S, Ghosh S, Holroyd-Leduc JM, Nekolaichuk C, Forbes D, Paragg J, Swindle J. Using focus groups to explore caregiver transitions and needs after placement of family members living with dementia in 24-hour care homes. Aging Ment Health 2020; 24:227-232. [PMID: 30588823 DOI: 10.1080/13607863.2018.1531369] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Family caregivers (defined broadly as family and friends) of persons with dementia are challenged to cope with myriad stressors and changes that occur along the dementia trajectory. The purpose of this study was to explore the transitions experienced by caregivers of persons with dementia after their relative relocated to a 24-hour care home.Method: Qualitative thematic and conversational analysis were used: themes were co-created and modes of speech and syntactical patterns analysed to expose discourses related to caregiving after placement in 24-hour care homes.Results: Four main themes were co-constructed from the data analysis: living with loss, relinquishing, redefining the caregiving role, and rediscovering and recreating a new self.Discussion: Caregiving continues after placement of family members with dementia in 24-hour care homes. Caregivers are at-risk group and require ongoing support throughout the caregiving journey. Study participants reported that navigation skills such as relationship building, communication, and advocacy were particularly salient to the post-placement period, when navigating the complex health care environment was a significant obstacle. Ultimately, findings from these focus groups will be used to inform an online intervention to support caregivers of a family member with dementia residing in a 24-hour care home.
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Affiliation(s)
- L Cottrell
- Faculty of Nursing, The University of Alberta, Edmonton, Canada
| | - W Duggleby
- Faculty of Nursing, The University of Alberta, Edmonton, Canada
| | - J Ploeg
- School of Nursing, McMaster University, Hamilton, Canada
| | - C McAiney
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - S Peacock
- College of Nursing, University of Saskatchewan, Saskatchewan, Canada
| | - S Ghosh
- Department of Medical Oncology/Department of Mathematical & Statistical Sciences, The University of Alberta, Edmonton, Canada
| | - J M Holroyd-Leduc
- Department of Medicine & Community Health Sciences, University of Calgary, Alberta, Canada
| | - C Nekolaichuk
- Faculty of Medicine & Dentistry, The University of Alberta, Edmonton, Canada
| | - D Forbes
- Faculty of Nursing, The University of Alberta, Edmonton, Canada
| | - J Paragg
- Faculty of Nursing, The University of Alberta, Edmonton, Canada
| | - J Swindle
- Faculty of Nursing, The University of Alberta, Edmonton, Canada
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15
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Wang J, Caprio TV, Simning A, Shang J, Conwell Y, Yu F, Li Y. Association Between Home Health Services and Facility Admission in Older Adults With and Without Alzheimer's Disease. J Am Med Dir Assoc 2019; 21:627-633.e9. [PMID: 31879184 DOI: 10.1016/j.jamda.2019.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/24/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the association between home health (HH) services, including skilled nursing (SN), physical therapy (PT), occupational therapy, social work (SW), and homemaking aide assistance with the hazard of unplanned facility admissions among Medicare patients with and without Alzheimer's disease and related dementias (ADRD). DESIGN Analysis of the Outcome and Assessment Information Set and billing records. SETTING A not-for-profit HH agency serving multiple counties in New York State. PARTICIPANTS Adults ≥65 years old who received HH from January 1, 2017 to December 31, 2017. MEASURES Outcome was time from HH start of care to an unplanned facility admission of any type, including the hospital, nursing home, and rehabilitation facility. Independent variables included weekly intensity (visits/week, hours/week) of SN, PT, occupational therapy, SW, and, homemaking aide assistance separately. ADRD was identified by diagnosis (International Classification of Diseases, Tenth Revision codes in billing records) and cognitive impairment assessment (Outcome and Assessment Information Set). RESULTS Of the sample (N = 6153), 14.9% had an unplanned facility admission. In multivariable Cox proportional hazard models that adjusted for time-varying effects of HH intensity and covariates, receiving the highest intensity of SN (3.3 visits of 2.78 hours per week) and PT (2.5 visits of 2 hours per week) was related to up to a 54% and 86% decrease, respectively, in the hazard of unplanned facility admission among patients with ADRD (n = 1525), and decreases of 56% and 90%, respectively, among patients without ADRD (n = 4628). Receiving any SW was related to 40% decreased in the hazard of facility admission in patients without ADRD only. Other HH services were not consistently related to the risk of facility admission. CONCLUSIONS AND IMPLICATIONS Receiving a higher intensity of SN and PT was associated with reduced hazards of unplanned facility admission among HH patients with and without ADRD. Policies should ensure that patients with ADRD receive a sufficient amount and appropriate mix of HH services.
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Affiliation(s)
- Jinjiao Wang
- School of Nursing, University of Rochester, Rochester, NY.
| | - Thomas V Caprio
- Department of Medicine, University of Rochester Medical Center, Rochester, NY; University of Rochester Medical Home Care, Rochester, NY; Finger Lakes Geriatric Education Center, NY
| | - Adam Simning
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | | | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Fang Yu
- School of Nursing, University of Minnesota, Minneapolis, MN
| | - Yue Li
- Department of Public Health Sciences, University of Rochester, Rochester, NY
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16
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Hong HG, An HS, Sarzynski E, Oberst K. New Composite Measure for ADL Limitations: Application to Predicting Nursing Home Placement for Michigan MI Choice Clients. Med Care Res Rev 2019; 78:413-422. [PMID: 31702435 DOI: 10.1177/1077558719886735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Functional status measured by activities of daily living (ADL) may be used to predict nursing home placement. Scoring of ADL measures is summarized for convenience, yet this is accompanied by losing detail regarding deficits. We sought to determine whether a revised composite measure tailored to Michigan Medicaid beneficiaries would better identify those at risk for nursing home admission. We compared composite ADL measures created by exploratory factor analysis and additive modeling to Medicaid Enrollment, MI Choice Waiver program, and Nursing Facility claims data from 2013 to 2017. There were moderate to high levels of correlation between ADLs (.4-.82). Exploratory factor analysis extracted two factors, corresponding to domains of mobility or self-care tasks. Application of the self-care-based ADL limitations composite measure provided prediction power equivalent to an additive measure incorporating all ADL limitations for nursing home admission. This approach demonstrated improved interpretability with the need for just five measures.
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Affiliation(s)
| | - Hong-Su An
- Michigan State University, East Lansing, MI, USA
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17
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Ota K, Arikawa M, Ohashi S, Azekawa T, Matsumoto T. Factors influencing nursing home placement of patients with dementia: a retrospective, single-centre study in Japan. Psychogeriatrics 2019; 19:111-116. [PMID: 30294822 DOI: 10.1111/psyg.12373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/04/2018] [Indexed: 11/29/2022]
Abstract
AIM This was an exploratory study to examine the factors influencing nursing home placement (NHP) in Japan. METHODS For this analysis, 633 patients were selected. The data were collected from the clinical records of each patient. A log-rank test was performed. The time from the patient's first visit to the clinic until the nursing home placement was the independent variable. Age (<80 or ≥80 years), biological sex (male or female), Clinical Dementia Rating scale (CDR) score (overall index 0.5, 1, 2, or 3), living situation (living alone or with someone), and voxel-based specific regional analysis systems for Alzheimer's disease Z-score (<2 or ≥2) were the dependent variables. Survival curves were obtained by using the Kaplan-Meier estimate. After the log-rank test, we conducted a Cox proportional hazards regression analysis. RESULTS The results of log-rank test indicated that all the variables could significantly influence time to NHP. Cox proportional hazards regression analysis suggested that CDR 3 exhibited the highest hazard ratio and Z-score showed the lowest hazard ratio. There were significant differences in age, sex, CDR 2, CDR 3, and living situation. CONCLUSIONS The results indicated that the voxel-based specific regional analysis systems for Alzheimer's disease Z-score is unlikely to influence NHP. This may suggest that even if the atrophy in the medial temporal lobe is rather progressed, patients can remain living at their own home with protective factors. Future studies need to investigate the risk and protective factors of time to NHP by combining the variables.
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Affiliation(s)
- Kazumi Ota
- Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | | | | | | | - Toshihiko Matsumoto
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
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18
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Toot S, Swinson T, Devine M, Challis D, Orrell M. Causes of nursing home placement for older people with dementia: a systematic review and meta-analysis. Int Psychogeriatr 2017; 29:195-208. [PMID: 27806743 DOI: 10.1017/S1041610216001654] [Citation(s) in RCA: 218] [Impact Index Per Article: 31.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Up to half of people with dementia in high income countries live in nursing homes and more than two-thirds of care home residents have dementia. Fewer than half of these residents report good quality of life and most older people are anxious about the prospect of moving into a nursing home. Robust evidence is needed as to the causes of admission to nursing homes, particularly where these risk factors are modifiable. METHODS We conducted a systematic literature search to identify controlled comparison studies in which the primary outcome was admission to nursing home of older adults with dementia. Identified studies were assessed for validity and 26 (17 cohort and 9 case-control) were included. Qualitative and quantitative analyses were conducted, including meta-analysis of 15 studies. RESULTS Poorer cognition and behavioral and psychological symptoms of dementia (BPSD) were consistently associated with an increased risk of nursing home admission and most of our meta-analyses demonstrated impairments in activities of daily living as a significant risk. The effects of community support services were unclear, with both high and low levels of service use leading to nursing home placement. There was an association between caregiver burden and risk of institutionalization, but findings with regard to caregiver depression varied, as did physical health associations, with some studies showing an increased risk of nursing home placement following hip fracture, reduced mobility, and multiple comorbidities. CONCLUSION We recommend focusing on cognitive enhancement strategies, assessment and management of BPSD, and carer education and support to delay nursing home placement.
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19
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Seitz DP, Gill SS, Austin PC, Bell CM, Anderson GM, Gruneir A, Rochon PA. Rehabilitation of Older Adults with Dementia After Hip Fracture. J Am Geriatr Soc 2016; 64:47-54. [PMID: 26782851 DOI: 10.1111/jgs.13881] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the effects of postoperative rehabilitation on the outcomes of older adults with dementia who experienced hip fracture. DESIGN Retrospective cohort study. SETTING Ontario, Canada. PARTICIPANTS Community-dwelling adults with dementia who underwent hip fracture surgery between 2003 and 2011. Participants were categorized as no rehabilitation, complex continuing care (CCC), home-care based rehabilitation (HCR), and inpatient rehabilitation (IPR). MEASUREMENTS Time to long-term care (LTC) placement, mortality, and risk of repeat hip fracture and falls. RESULTS Of 11,200 individuals with dementia who experienced a hip fracture during the study period, 4,494 (40.1%) received no rehabilitation, 2,474 (22.1%) were admitted to CCC, 1,157 (10.3%) received HCR, and 3,075 (27.4%) received IPR. HCR and IPR were associated with less risk of LTC admission after discharge from hospital than no rehabilitation. All three forms of rehabilitation were associated with lower risk of mortality than no rehabilitation, with the greatest effect observed with IPR. HCR was associated with a higher risk of falls than no rehabilitation (P=.03); there were no other significant between-group differences in risk of falls or repeat fractures (P>.05). CONCLUSION Postfracture rehabilitation for older adults with dementia is associated with lower risk of LTC placement and mortality. Improving access to rehabilitation services for this vulnerable population may improve postfracture outcomes.
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Affiliation(s)
- Dallas P Seitz
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.,Institute for Clinical Evaluative Sciences Queen's, Kingston, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sudeep S Gill
- Institute for Clinical Evaluative Sciences Queen's, Kingston, Ontario, Canada.,Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Chaim M Bell
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Medicine, Mt. Sinai Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey M Anderson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Andrea Gruneir
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Paula A Rochon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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20
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Abstract
The nursing home placement process is complex and difficult for family caregivers. This qualitative descriptive study examines the experiences of caregivers involved in the management of care and placement of an older family member using the Family Management Style Framework. Ten caregivers were recruited from four nursing homes in the Midwest. The caregivers were interviewed shortly after placement and again 3 months post-placement. Results provide a unique understanding of care management and the nursing home placement process from the perspective of the primary family caregiver. Overall, there were similarities across the same types of caregiving dyads, for example, spousal and adult-children caregivers. Caregivers expressed the need to maintain the identity of their older family member, a familial responsibility for caregiving, and change in their family relationship over time. Appreciating caregivers' challenges and needs gives health care professionals a better understanding for how to provide assistance for a smoother nursing home transition.
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21
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Wattmo C, Londos E, Minthon L. Solitary living in Alzheimer's disease over 3 years: association between cognitive and functional impairment and community-based services. Clin Interv Aging 2014; 9:1951-62. [PMID: 25484578 PMCID: PMC4238751 DOI: 10.2147/cia.s71709] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Many individuals with Alzheimer’s disease (AD) live alone, and this figure is expected to increase. This study aimed to describe the cognitive and functional abilities of solitary-living AD patients, and the potential predictors of their usage of community-based services. Methods This 3-year, prospective, multicenter study included 1,021 participants with mild-to-moderate AD (Mini-Mental State Examination score, 10–26) treated with a cholinesterase inhibitor in a routine clinical setting. At baseline and every 6 months, patients were assessed using cognitive, instrumental, and basic activities of daily living (ADL) scales, and service utilization was recorded. Logistic regression models were used to predict the usage of community-based services. Results At the start of cholinesterase inhibitor therapy (time of AD diagnosis), 355 individuals (35%) were living alone. They were mainly female, older, had more impaired basic ADL capacity, and had a larger number of concomitant medications when compared with those living with family. Regarding the solitary-living patients, lower instrumental ADL (IADL) ability and more medications were independent predictors of usage of home-help services, whereas more impaired IADL at baseline and faster IADL deterioration were predictors of nursing home admission. For those living with family, older age, lower basic ADL, and a greater number of medications predicted home-help services, whereas a larger amount of home help predicted nursing home placement. In addition, female sex was a risk factor for both the utilization of home-help services and nursing home placement. Cognitive ability was not significantly associated with the usage of community-based services. Conclusion A large number of AD patients, predominantly females, live alone with severe cognitive and functional impairment. The amount of home-help services used did not reflect cognitive severity, suggesting that home help did not meet the needs related to cognitive deterioration. Increased knowledge of how community-based services can better accommodate the care needs of solitary-living individuals with AD is essential.
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Affiliation(s)
- Carina Wattmo
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Elisabet Londos
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Lennart Minthon
- Clinical Memory Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
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22
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Kraijo H, de Leeuw R, Schrijvers G. How spouses evaluate Nursing Home Placement of their demented partner: a study about the end of perseverance time. Scand J Caring Sci 2014; 29:101-9. [PMID: 24698027 DOI: 10.1111/scs.12137] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 03/03/2014] [Indexed: 11/30/2022]
Abstract
AIM This study was about the final decision by spouses to have their demented partner placed in a nursing home. The central question was whether the admission took place in the right time in their point of view. METHOD Fourteen partners of persons with dementia evaluated the nursing home placement. They were interviewed at home using a semi-structured questionnaire. Grounded theory was used to explore the process of decision-making. In addition to the interviews, quantitative data were used from a 2-year follow-up study. RESULTS Results underline that the placement decision had to be made in phases over time. The first decision is about placement of the relative on a waiting list, and the second decision is about the actual placement in a nursing home once a place becomes available. This second and final decision often had to be taken under time pressure to avoid a place in the nursing home being left empty. If they had been given more time and space to reconsider their admission decision, most partners said they could have had continued providing homecare longer. During the investigation, the following classification in timeliness of the admission emerged: Placement was at the right time, too early, too late or out of control. CONCLUSION Spouses indicated they could have kept on giving care for a longer period of time if they had been given more time and space to make their final decision about the admission of their partner. It may be helpful for informal and formal carers to focus on perseverance time in considering placement or prolonged support at home. Placement at an appropriate time may lead to a higher degree of well-being of informal carers before and especially after the admission.
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Affiliation(s)
- Henk Kraijo
- Julius Centre for Health Sciences and Primary Care, Utrecht MC, Utrecht, The Netherlands
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23
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Kelly R, Puurveen G, Gill R. The Effect of Adult Day Services on Delay to Institutional Placement. J Appl Gerontol 2014; 35:814-35. [PMID: 24717560 DOI: 10.1177/0733464814521319] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/22/2013] [Indexed: 11/16/2022] Open
Abstract
Delays to institutionalization were compared between elderly individuals who differed in the amounts ("dosages") of adult day services (ADS) they attended. A Kaplan-Meier survival analysis revealed higher dosages of ADS to be associated with greater delays to institutionalization. Retrospective data from financial and service utilization systems and from the Resident Assessment Instrument for Home Care (RAI-HC) were then used to fit a Cox regression model that was adjusted for potential selection biases. This model also found systematically lower hazards for institutionalization at higher ADS dosages. The ADS effect did not appear to be an artifact of increased utilization of additional home health services. Results suggest a beneficial effect of ADS on delay to institutionalization that cannot be attributed to home support, respite, or case management services.
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Affiliation(s)
- Ronald Kelly
- Fraser Health Authority, Burnaby, British Columbia, Canada
| | | | - Robert Gill
- Fraser Health Authority, Burnaby, British Columbia, Canada
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24
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Nikzad-Terhune KA, Anderson KA, Newcomer R, Gaugler JE. Do trajectories of at-home dementia caregiving account for burden after nursing home placement? A growth curve analysis. Soc Work Health Care 2010; 49:734-752. [PMID: 20853212 PMCID: PMC2943863 DOI: 10.1080/00981381003635296] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Transitioning to the nursing home setting is a complex process for family caregivers of older adults with dementia. While nursing home placement (NHP) can alleviate certain caregiving responsibilities, new stressors can also emerge. In the present study, the researchers examined how care-related factors can change leading up to NHP and how these factors influence caregiver outcomes following NHP. A sample of 634 family dementia caregivers (n = 634) were surveyed at three six-month intervals prior to NHP and once during the 12 month period following institutionalization. Growth curve modeling revealed dynamic changes in certain factors leading up to NHP (e.g., caregivers' perceived health), while other factors remained stable (e.g., caregiver burden). Several factors emerged as significant predictors of caregiver burden following NHP, including pre-placement burden and adult day service utilization. For geriatric social workers, these findings may be useful in assessing family caregivers, and in the development and utilization of appropriate interventions.
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Affiliation(s)
- Katherina A. Nikzad-Terhune
- Hartford Doctoral Fellow; Graduate Center for Gerontology; University of Kentucky; 306 Wethington Health Sciences Bldg. 900 S. Limestone, Lexington, KY 40536-0200; Phone: 859.257.1450x80268; Fax: 859.323.5747
| | - Keith A. Anderson
- Assistant Professor; College of Social Work; The Ohio State University; 1947 N. College Road, Columbus, OH 43210-1162; Phone: 614.247.8963; Fax: 614.292.6940
| | - Robert Newcomer
- Professor; Department of Social & Behavioral Sciences; University of California, San Francisco; Box 0612, 3333 California St, Laurel Heights 455, San Francisco, CA. 94143 – 0612; Phone: 415.476.1408; Fax: 415.476.6552
| | - Joseph E. Gaugler
- Associate Professor; School of Nursing; University of Minnesota; 6-153 Weaver-Densford Hall, 1331 308 Harvard Street S.E., Minneapolis, MN 55455; Phone: 612.626.2485; Fax: 612.625.7180
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Brodaty H, Mittelman M, Gibson L, Seeher K, Burns A. The effects of counseling spouse caregivers of people with Alzheimer disease taking donepezil and of country of residence on rates of admission to nursing homes and mortality. Am J Geriatr Psychiatry 2009; 17:734-43. [PMID: 19705519 DOI: 10.1097/jgp.0b013e3181a65187] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Does psychosocial intervention for caregivers whose spouses with Alzheimer disease (AD) are taking donepezil delay nursing home (NH) placement or death of patients? DESIGN Randomized controlled trial with 2 years of active treatment and up to 8.5 years of follow-up (mean: 5.4 years, SD: 2.4). SETTING Outpatients of research clinics in Australia, the United Kingdom, and the United States. PARTICIPANTS One hundred and fifty-five persons with AD and their spouses. INTERVENTION Five sessions of individual and family counseling (+ prn ad hoc counseling) or usual care. MEASUREMENTS Time to institutionalization and death using Cox proportional hazards methods. RESULTS Over a mean of 5.4 years (SD: 2.4), there were no differences in NH placement or mortality by intervention group, but there were by country, with Australian patients admitted to NHs earlier than U.S. than U.K. patients. CONCLUSION Earlier NH admission of Australian compared to U.K. and U.S. subjects may be due to differences in health care, NH systems, availability, and affordability.
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