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Yang HJ, Huang X, Liang JB, Jia Z, Wei QG, Wang HX. [Differences in the Elderly Care Service Demand,Preference,and Tendency Between Urban and Rural Areas in the Pearl River Delta]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2024; 46:193-203. [PMID: 38686715 DOI: 10.3881/j.issn.1000-503x.15750] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Objective To understand the differences in the demand,preference,and tendency for elderly care services between urban and rural areas in the Pearl River Delta (PRD),and to provide reference for the planning and balanced allocation of elderly care resources in urban and rural areas. Methods Using the multi-stage stratified random sampling method,we selected 7 community health service centers in 2 prefecture-level cities in the PRD and conducted a questionnaire survey on the elderly care service demand,preference,and tendency among 1919 regular residents aged 60 years and above who attended the centers. Results A total of 641 urban elderly residents (33.4%) and 1278 rural elderly residents (66.6%) were surveyed in the PRD.The urban and rural elderly residents showed differences in the child number (χ2=43.379,P<0.001),willingness to purchase socialized elderly care services (χ2=104.141,P<0.001),and attitudes to the concept of raising child to avoid elderly hardship (χ2=65.632,P<0.001).The proportion (71.8%) of rural elderly residents who prefer family-based elderly care was higher than that (57.1%) of urban elderly residents (χ2=41.373,P<0.001).The proportion (62.2%) of urban elderly residents clearly expressing their willingness to choose institutions for elderly care was higher than that (44.0%) of rural elderly residents (χ2=57.007,P<0.001).Compared with family-based elderly care,the willingness to choose institutional or community-based in-house elderly care was low among the urban elderly residents with surplus monthly household income or balanced income and expenditure;urban males,those with college education background or above,and those who purchased socialized elderly care services tended to prefer community-based in-house elderly care.In rural areas,the elderly residents who had local household registry were prone to choose institutional or community-based in-house elderly care,while those who had more than one child and those who were satisfied with the current living conditions were less willing to choose community-based in-house elderly care. Conclusions It is suggested that the urban-rural differences in the elderly care service demand,preference and tendency should be fully considered in the planning and allocation of urban and rural elderly care resources.Efforts remain to be made to develop diversified social elderly care services tailored to the characteristics of urban and rural areas.
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Affiliation(s)
- Hua-Jie Yang
- 1 School of Health Technology,Guangdong Open University (Guangdong Polytechnic Institute),Zhongshan,Guangdong 528400,China
| | - Xiang Huang
- 2 Department of Public Health Services Management,Sanxiang Community Health Service Centre of Zhongshan,Zhongshan,Guangdong 528463,China
- 3 School of Medicine,Macau University of Science and Technology,Macao Special Administrative Region 999078,China
| | - Jia-Bin Liang
- 2 Department of Public Health Services Management,Sanxiang Community Health Service Centre of Zhongshan,Zhongshan,Guangdong 528463,China
| | - Zhihui Jia
- 4 School of Public Health,Sun Yat-Sen University,Guangzhou 510080,China
| | - Qing-Guo Wei
- 1 School of Health Technology,Guangdong Open University (Guangdong Polytechnic Institute),Zhongshan,Guangdong 528400,China
| | - Hao-Xiang Wang
- 4 School of Public Health,Sun Yat-Sen University,Guangzhou 510080,China
- 5 Young Cadre Branch,Guangdong Primary Healthcare Association,Guangzhou 510000,China
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Harris E. A Third of Older Adults Are Interested in Online-Only Health Services. JAMA 2024; 331:554. [PMID: 38294844 DOI: 10.1001/jama.2023.28338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
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Alao DO, Cevik AA, Grivna M, Eid HO, Abu-Zidan FM. Epidemiological changes of geriatric trauma in the United Arab Emirates. Medicine (Baltimore) 2021; 100:e26258. [PMID: 34087916 PMCID: PMC8183772 DOI: 10.1097/md.0000000000026258] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT We aimed to study the epidemiological changes in geriatric trauma in Al-Ain City, United Arab Emirates, in the past decade to give recommendations on injury prevention.Trauma patients aged 65 years and above who were hospitalized at Al-Ain Hospital for more than 24 hours or died in the hospital after their arrival regardless of the length of stay were studied. Data were extracted from the Al-Ain Hospital trauma registry. Two periods were compared; March 2003 to March 2006 and January 2014 to December 2017. Studied variables which were compared included demography, mechanism of injury and its location, and clinical outcome.There were 66 patients in the first period and 200 patients in the second period. The estimated annual incidence of hospitalized geriatric trauma patients in Al-Ain City was 8.5 per 1000 geriatric inhabitants in the first period compared with 7.8 per 1000 geriatric inhabitants in the second period. Furthermore, mortality was reduced from 7.6% to 2% (P = 0.04). There was a significant increase in falls on the same level by14.9% (62.1%-77%, P = 0.02, Pearson χ2 test). This was associated with a significant increase of injuries occurring at home (55.4%-78.7% P = 0.0003, Fisher Exact test). There was also a strong trend in the reduction of road traffic collision injuries which was reduced by 10.8% (27.3%-16.5%, P = 0.07, Fisher Exact test).Although the incidence and severity of geriatric trauma did not change over the last decade, in-hospital mortality has significantly decreased over time. There was a significant increase in injuries occurring at homes and in falls on the same level. The home environment should be targeted in injury prevention programs so as to reduce geriatric injuries.
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Affiliation(s)
- David O. Alao
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University
- Emergency Department, Al-Ain Hospital
| | - Arif Alper Cevik
- Department of Internal Medicine, College of Medicine and Health Sciences, UAE University
| | - Michal Grivna
- Institute of Public Health, College of Medicine and Health Sciences, UAE University, Al-Ain
| | - Hani O. Eid
- Emergency Department, Mediclinic Airport Road Hospital, Abu Dhabi
| | - Fikri M. Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
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Shao Q, Yuan J, Lin J, Huang W, Ma J, Ding H. A SBM-DEA based performance evaluation and optimization for social organizations participating in community and home-based elderly care services. PLoS One 2021; 16:e0248474. [PMID: 33730070 PMCID: PMC7968683 DOI: 10.1371/journal.pone.0248474] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 02/26/2021] [Indexed: 12/04/2022] Open
Abstract
The community and home-based elderly care service system has been proved an effective pattern to mitigate the elderly care dilemma under the background of accelerating aging in China. In particular, the participation of social organizations in community and home-based elderly care service has powerfully fueled the multi-supply of elderly care. As the industry of the elderly care service is in the ascendant, the management lags behind, resulting in the waste of significant social resources. Therefore, performance evaluation is proposed to resolve this problem. However, a systematic framework for evaluating performance of community and home-based elderly care service centers (CECSCs) is absent. To overcome this limitation, the SBM-DEA model is introduced in this paper to evaluate the performance of CECSCs. 186 social organizations in Nanjing were employed as an empirical study to develop the systematic framework for performance evaluation. Through holistic analysis of previous studies and interviews with experts, a systematic framework with 33 indicators of six dimensions (i.e., financial management, hardware facilities, team building, service management, service object and organization construction) was developed. Then, Sensitivity Analysis is used to screen the direction of performance optimization and specific suggestions were put forward for government, industrial associations and CECSCs to implement. The empirical study shows the proposed framework using SBM-DEA and sensitivity analysis is viable for conducting performance evaluation and improvement of CECSCs, which is conducive to the sustainable development of CECSCs.
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Affiliation(s)
- Qiuhu Shao
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, P. R. China
| | - Jingfeng Yuan
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, P. R. China
- * E-mail:
| | - Jin Lin
- Nanjing Municipal Education Bureau, Nanjing, P. R. China
| | - Wei Huang
- School of Civil Engineering, Sanjiang University, Nanjing, P. R. China
| | - Junwei Ma
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, P. R. China
| | - Hongxing Ding
- Department of Construction and Real Estate, School of Civil Engineering, Southeast University, Nanjing, P. R. China
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Fang M, Echouffo Tcheugui JB, Pankow JS, Windham BG, Selvin E. Patient-reported preventive care practices in older adults with diabetes. Diabet Med 2021; 38:e14508. [PMID: 33368590 PMCID: PMC7887101 DOI: 10.1111/dme.14508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Fang
- Department of Epidemiology and the Welch Center for
Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD
| | - Justin B. Echouffo Tcheugui
- Division of Endocrinology, Diabetes and Metabolism,
Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - James S. Pankow
- Division of Epidemiology and Community Health, University
of Minnesota, Minneapolis, Minnesota
| | - B. Gwen Windham
- Department of Geriatric Medicine, University of Mississippi
School of Medicine, Jackson, Mississippi
| | - Elizabeth Selvin
- Department of Epidemiology and the Welch Center for
Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD
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Abstract
IMPORTANCE Ambulatory follow-up care is frequently recommended after an emergency department (ED) visit. However, the frequency with which follow-up actually occurs and the degree to which follow-up is associated with postdischarge outcomes is unknown. OBJECTIVES To examine the frequency and variation in ambulatory follow-up among Medicare beneficiaries discharged from US EDs and the association between ambulatory follow-up and postdischarge outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 9 470 626 ED visits to 4728 US EDs among Medicare beneficiaries aged 65 and older from 2011 to 2016 who survived the ED visit and were discharged to home used Kaplan-Meier curves and proportional hazards regression. Data analysis was conducted from December 2019 to July 2020. EXPOSURES Ambulatory follow-up after discharge from the ED. MAIN OUTCOMES AND MEASURES Postdischarge mortality, subsequent ED visit, or inpatient hospitalization within 30 days of an index ED visit. RESULTS The study sample consisted of 9 470 626 index outpatient ED visits to 4684 EDs; most visits (5 776 501 [61.0%]) were among women, and the mean (SD) age of patients was 77.3 (8.4) years. In this sample, the cumulative incidence of ambulatory follow-up was 40.5% (3 822 133 patients) at 7 days and 70.8% (6 662 525 patients) at 30 days, after accounting for censoring and for mortality as a competing risk. Characteristics associated with lower rates of ambulatory follow-up included beneficiary Medicaid eligibility (hazard ratio [HR], 0.77; 95% CI, 0.77-0.78; P < .001), Black race (HR, 0.82; 95% CI, 0.81-0.83; P < .001), and treatment at a rural ED (HR, 0.75; 95% CI, 0.73-0.77; P < .001) in the multivariable regression model. Ambulatory follow-up was associated with lower risk of postdischarge mortality (HR, 0.49; 95% CI, 0.49-0.50; P < .001) but higher risk of subsequent inpatient hospitalization (HR, 1.22; 95% CI, 1.21-1.23; P < .001) and ED visits (HR, 1.01; 95% CI, 1.00-1.01; P < .001), adjusting for visit diagnosis, patient demographic characteristics, and chronic conditions. CONCLUSIONS AND RELEVANCE In this cohort study of Medicare beneficiaries discharged from the ED, nearly 30% lacked ambulatory follow-up at 30 days, with variation in follow-up rates by patient and hospital characteristics. Having an ambulatory follow-up visit was associated with higher risk of subsequent hospitalization but lower risk of mortality. Ambulatory care access may be an important driver of clinical outcomes after an ED visit.
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Affiliation(s)
- Michelle P. Lin
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan C. Burke
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Harvard Global Health Institute, Cambridge, Massachusetts
| | - E. John Orav
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tynan H. Friend
- Harvard Global Health Institute, Cambridge, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Laura G. Burke
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Harvard Global Health Institute, Cambridge, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Abstract
The area of mental health is directly affected by the pandemic and its consequences, for various reasons: 1-the pandemic triggered a global lockdown, with dramatic socioeconomic and therefore psychosocial implications; 2-mental health services, which treat by definition a fragile population from the psychological, biological and social points of view, have a complex organizational frame, and it was expected that this would be affected (or overwhelmed) by the pandemic; 3-mental health services should, at least in theory, be able to help guide public health policies when these involve a significant modification of individual behaviour. It was conducted a narrative review of the publications produced by European researchers in the period February-June 2020 and indexed in PubMed. A total of 34 papers were analyzed, which document the profound clinical, organizational and procedural changes introduced in mental health services following this exceptional and largely unforeseen planetary event.Among the main innovations recorded everywhere, the strong push towards the use of telemedicine techniques should be mentioned: however, these require an adequate critical evaluation, which highlights their possibilities, limits, advantages and disadvantages instead of simple triumphalist judgments. Furthermore, should be emphasized the scarcity of quantitative studies conducted in this period and the absence of studies aimed, for example, at exploring the consequences of prolonged and forced face-to-face contact between patients and family members with a high index of "expressed emotions".
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Affiliation(s)
- Serana Meloni
- IRRCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia;
| | | | - Roberta Rossi
- IRRCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia
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Sundling V, Hafskjold L, Eklund JH, Holmström IK, Höglander J, Sundler AJ, van Dulmen S, Eide H. Emotional communication in home care: A comparison between Norway and Sweden. Patient Educ Couns 2020; 103:1546-1553. [PMID: 32173215 DOI: 10.1016/j.pec.2020.03.002] [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] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/16/2020] [Accepted: 03/01/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Given the free movement of workers across countries, knowledge regarding communication differences between countries is imperative. In this study, we explored and compared the supportive responses of nursing staff to older persons' emotions in home care in Norway and Sweden. METHODS The study had an observational, cross-sectional, comparative design, which included 383 audio-recorded home-care visits. Communication was coded using Verona Coding Definitions of Emotional Sequences. Worries and responses were categorised with regard to reference, communicative function and level of person-centredness. Standard statistical tests were used to analyse the data. RESULTS The Swedish nursing staff provided space for further disclosure of worry more frequently than the Norwegian nursing staff (75.0 % versus 60.2 %, χ2 = 20.758, p < 0.01). In all, 65 % of the responses were supportive. Multiple logistic regression analyses showed that highly person-centred responses were independently associated with worries phrasing an emotion, OR (95 % CI) 3.282 (1.524-7.067). CONCLUSION The level of person-centredness was associated with the way in which older persons expressed their distress. The Swedish nursing staff provided opportunities for further disclosure of worries more frequently than the Norwegian nursing staff. PRACTICE IMPLICATIONS Findings of intercultural differences should be incorporated into the training of nursing staff.
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Affiliation(s)
- Vibeke Sundling
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway; National Centre for Optics, Vision and Eye Care, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway; Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway.
| | - Linda Hafskjold
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway; Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway
| | | | - Inger K Holmström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jessica Höglander
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Sandra van Dulmen
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway; NIVEL (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, the Netherlands
| | - Hilde Eide
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Norway
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Abstract
BACKGROUND Compared with those without dementia, older patients with dementia admitted to acute care settings are at higher risk for triad combination of polypharmacy (PP), potentially inappropriate medication (PIM), and drug-drug interaction (DDI), which may consequently result in detrimental health. The aims of this research were to assess risk factors associated with triad combination of PP, PIM and DDI among hospitalized older patients with dementia, and to assess prevalence and characteristics of PP, PIM and DDI in this population. METHODS In this retrospective cross-sectional study, 416 older inpatients diagnosed with dementia and referred for specialist geriatric consultation at a tertiary hospital in Brisbane, Australia during 2006-2016 were enrolled. Patients were categorized into two groups according to their exposure to the combination of PP, PIM and DDI: 'triad combination' and 'non-triad combination'. Data were collected using the interRAI Acute Care (AC) assessment instrument. Independent risk factors of exposure to the triad combination were evaluated using bivariate and multivariate logistic regression analyses. RESULTS Overall, 181 (43.5%) were classified as triad combination group. The majority of the population took at least 1 PIM (56%) or experienced at least one potential DDI (76%). Over 75% of the participants were exposed to polypharmacy. The most common prescribed PIMs were antipsychotics, followed by benzodiazepines. The independent risk factors of the triad combination were the presence of atrial fibrillation diagnosis and higher medications use in cardiac therapy, psycholeptics and psychoanaleptics. CONCLUSIONS The exposure to triad combination of PP, PIM and DDI are common among people with dementia as a result of their vulnerable conditions and the greater risks of adverse events from medications use. This study identified the use of cardiac therapy, psycholeptics and psychoanaleptics as predictors of exposure to PP, PIM and DDI. Therefore, use of these medications should be carefully considered and closely monitored. Furthermore, comprehensive medication reviews to optimize medication prescribing should be initiated and continually implemented for this vulnerable population.
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Affiliation(s)
- Sirasa Ruangritchankul
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nancye M. Peel
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leila Shafiee Hanjani
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Leonard C. Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Adebusoye LA, Olowookere OO, Ajayi SA, Akinmoladun VI, Alonge TO. Mortality Trends among Older Patients Admitted to the Geriatric Centre, University College Hospital, Ibadan, Nigeria, 2013-2017. West Afr J Med 2020; 37:209-215. [PMID: 32476112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Attaining successful clinical outcomes in the management of hospitalised older patients in the overburdened healthcare services in Nigeria constitutes a major challenge against the backdrop of dearth of data on the predictors of mortality among them. OBJECTIVES To describe the mortality trends and associated factors among older patients (>60 years) at the Geriatric Centre, University College Hospital, Ibadan between January 2013 and December 2017. METHODS Hospital records of older patients admitted were analysed. Data extracted included socio-demographic, diagnoses, length of stay from date of admission to discharge or death. Results of vital signs, anthropometric measurements and laboratory tests carried out at admission were also obtained. RESULTS The mean age of the 1,091 older patients admitted was 73.6±8.6 years. The overall crude proportion of in-hospital deaths was 9.0% (males=11.3% > females=7.2%, p=0.024) and it increased from 4.1% in 2013 to 12.1% in 2017. The overall unadjusted 30-day mortality rate per 1000 patient-days was 28.9 deaths (95% CI 23.5-35.3). The predictors of mortality were increased length of stay on admission OR=1.061 (95% CI 1.005-1.119), being retired OR=1.672 (95% CI 1.011-2.778), stroke OR=4.019 (95% CI 2.258- 7.138), heart failure OR=3.435 (95% CI 1.455-8.100), Sepsis OR=2.176 (95% CI 1.294-3.654), Anaemia OR=2.820 (95% CI 1.320-6.017), Dementia OR=3.701 (95% CI 1.433-9.549) and malignancies OR=2.658 (95% CI 1.181-5.979). CONCLUSION There was a temporal increase in mortality among older patients. Similarly, staying longer on admission and chronic medical conditions with their complications were the most significant contributors to mortality.
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Affiliation(s)
- L A Adebusoye
- Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan, Nigeria
| | - O O Olowookere
- Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan, Nigeria
| | - S A Ajayi
- Chief Tony Anenih Geriatric Centre, University College Hospital, Ibadan, Nigeria
| | - V I Akinmoladun
- Department of Oral and Maxillofacial Surgery, University of Ibadan,Nigeria
| | - T O Alonge
- Department of Orthopaedics and Trauma, University College Hospital, Ibadan, Nigeria
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Ashman JJ, Schappert SM, Santo L. Emergency Department Visits Among Adults Aged 60 and Over: United States, 2014-2017. NCHS Data Brief 2020:1-8. [PMID: 32600519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In the United States, the number of older adults is increasing. From 2007 to 2017, the number of adults aged 60 and over increased from 52 million to 71 million, and during the same time period, the share of the U.S. population comprising older adults also increased from 17% to 22% (1,2). During 2014-2017, 20% of all emergency department (ED) visits in the United States were made by patients aged 60 and over, representing an annual average of approximately 29 million ED visits (3-6). Given their growing proportion of the population, older individuals will make up an increasingly larger share of ED visits in the coming years. This report describes ED visits made by adults aged 60 and over, assessing selected characteristics by age.
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Blunt D. Defining, monitoring and improving quality in Welsh care homes. Nurs Older People 2020; 32:28-32. [PMID: 32077271 DOI: 10.7748/nop.2020.e1218] [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] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
Despite the focus on quality in care homes, and the body of evidence that drives policy and practice, care home residents in Wales experience variations in quality of care. Quality is not easily defined, and care providers may have differing views on quality and how it is monitored. Health and social care professionals - including nurses - should understand the factors that affect quality in care homes. Quality improvement projects can support the development of a workplace culture that can sustain quality in care homes. This article defines quality, details methods that may be used to monitor quality, and outlines how quality in care homes can be improved.
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Affiliation(s)
- Duncan Blunt
- Cwm Taf Morgannwg University Health Board, Abercynon, Wales
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Lemelin A, Maucort-Boulch D, Castel-Kremer E, Forestier J, Hervieu V, Lorcet M, Boutitie F, Theillaumas A, Robinson P, Duclos A, Lombard-Bohas C, Walter T. Elderly Patients with Metastatic Neuroendocrine Tumors Are Undertreated and Have Shorter Survival: The LyREMeNET Study. Neuroendocrinology 2020; 110:653-661. [PMID: 31586998 DOI: 10.1159/000503901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/27/2019] [Accepted: 10/04/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The incidence of neuroendocrine tumors (NETs) is rising, especially in elderly patients. The elderly cancer population presents considerable challenges, yet little is known about the characteristics, treatment patterns, and outcomes of metastatic NET (mNET) patients. METHODS The Lyon Real-life Evidence in Metastatic NeuroEndocrine Tumors study (LyREMeNET, NCT03863106) included consecutive mNET patients, diagnosed between January 1990 and December 2017. The exclusion criteria were nonmetastatic NET, poorly differentiated neuroendocrine carcinoma, and mixed neuroendocrine-nonneuroendocrine neoplasms. We aimed to compare patients ≥70 years old to patients <70 years old. RESULTS A total of 866 patients were included, 198 (23%) were ≥70 years old. There was no significant difference in characteristics except that elderly patients had synchronous metastasis more frequently. Elderly patients received significantly fewer treatments (median of 2.0 vs. 3.0 lines, respectively, p < 0.0001), were significantly less frequently treated by chemotherapy (32 vs. 54%), targeted therapy (16 vs. 30%), peptide receptor radionuclide therapy (5 vs. 16%), and they underwent significantly less frequently locoregional intervention. Median overall survival was significantly shorter in elderly patients (5.2 vs. 9.6 years). The most frequent cause of death was related to disease progression (71%). Multivariate analysis found that, after adjustment for tumor location, tumor grade, and number of metastatic sites, age remained significantly associated with overall survival (HR 1.66, 95% CI 1.26-2.18), indicating a poorer survival in patients ≥70 years old in comparison with younger patients (p = 0.0003). CONCLUSION Patients ≥70 years old have a worse survival, die frequently from their disease, and are undertreated compared to younger patients.
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Affiliation(s)
- Annie Lemelin
- Service de Gastroentérologie et d'Oncologie Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Delphine Maucort-Boulch
- Service de Biostatistique, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
- Lyon 1 Claude Bernard University, Lyon, France
| | - Elisabeth Castel-Kremer
- Service de Médecine Gériatrique, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Julien Forestier
- Service de Gastroentérologie et d'Oncologie Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Valérie Hervieu
- Service Central d'Anatomie et Cytologie Pathologiques, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
- Lyon 1 Claude Bernard University, Lyon, France
| | - Marianne Lorcet
- Service de Gastroentérologie et d'Oncologie Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Florent Boutitie
- Service de Biostatistique, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Hospices Civils de Lyon, Université Lyon 1, Lyon, France
| | - Aurélie Theillaumas
- Service de Gastroentérologie et d'Oncologie Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | | | - Antoine Duclos
- Service des Données de Santé, Hospices Civils de Lyon, Health Services and Performance Research lab (HESPER EA 7425), Lyon, France
- Lyon 1 Claude Bernard University, Lyon, France
| | - Catherine Lombard-Bohas
- Service de Gastroentérologie et d'Oncologie Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Thomas Walter
- Service de Gastroentérologie et d'Oncologie Médicale, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France,
- Lyon 1 Claude Bernard University, Lyon, France,
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Detering KM, Buck K, Sellars M, Kelly H, Sinclair C, White B, Nolte L. Prospective multicentre cross-sectional audit among older Australians accessing health and residential aged care services: protocol for a national advance care directive prevalence study. BMJ Open 2019; 9:e031691. [PMID: 31662395 PMCID: PMC6830836 DOI: 10.1136/bmjopen-2019-031691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/28/2019] [Accepted: 10/02/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Advance care planning (ACP), an ongoing communication and planning process, aims to clarify a person's values and preferences, so these guide decision-making if the person becomes unable to make his or her own decisions. Ideally, ACP results in completion of advance care directives (ACD), documents completed by competent people outlining their values, treatment preferences and/or appointment of a substitute decision-maker (SDM). ACDs are most effective at the point of care, where they can be used to inform treatment decisions. Australian governments fund initiatives and have developed policy to increase ACD completion rates. However, little is known about the prevalence of ACDs at the point of care in Australian health services, making ACP evaluation efforts difficult. This study aims to determine the prevalence of ACDs in records of older people in Australian hospitals, aged care facilities and general practices. METHODS AND ANALYSIS This is a national multicentre cross-sectional prevalence study in selected aged care facilities, hospitals and general practices. Following a 2017 feasibility study, a new protocol incorporating key learnings was developed. Sites will be recruited via expression of interest process. Health records of people aged ≥65 years, admitted to or attending services on study day(s) will be audited by trained staff from sites. Site-level data will be collected during the expression of interest. The primary outcome is the presence of at least one ACD in the health record. Secondary outcomes include prevalence of other documented outcomes of ACP (by health practitioner(s)/family/SDM), assessment of ACD quality and content and concordance between the person's documented preferences and any medical treatment orders. Individuals and sites characteristics where ACDs are present will be explored. ETHICS AND DISSEMINATION Protocol approval by Austin Health Human Research Ethics Committee, Melbourne, Australia (reference: HREC/18/Austin/109). Results will be disseminated via peer-reviewed journals and conferences. Participating sites and jurisdictions will receive individualised reports of findings.
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Affiliation(s)
- Karen M Detering
- Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Victoria, Australia
| | - Kimberly Buck
- Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
| | - Marcus Sellars
- Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
| | - Helana Kelly
- Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
| | - Craig Sinclair
- Centre of Excellence in Population Aging Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Ben White
- Australian Centre for Health Research Law, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Linda Nolte
- Advance Care Planning Australia, Austin Health, Heidelberg, Victoria, Australia
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Wang Z, Jiang J, Zeng Q. Medical system and nutrition improvement for the rural elderly. J Health Popul Nutr 2019; 38:27. [PMID: 31627763 PMCID: PMC6798463 DOI: 10.1186/s41043-019-0189-x] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Insufficient nutrition intake has negatively influenced the health of the elderly in rural China where the problem of population aging is serious. The present study aims to explore whether the medical system, called the New Rural Cooperative Medical System (NRCMS), can improve the rural elderly's nutrition intake and the mechanism behind it. METHODS The difference in differences (DID) model and the propensity score matching-difference in differences (PSM-DID) model are both performed to investigate the impact of the medical system on nutrition improvement for the rural elderly. Two thousand seven hundred eighty rural elderly samples tracked in 2000 and 2006 from the China Health and Nutrition Survey are analyzed. Indices for the elderly's nutrition intake includes daily average intake of energy, fat, protein, and carbohydrate. RESULTS The results show that participation in the NRCMS can significantly increase the rural elderly's total energy intake, carbohydrate intake, and protein intake by 206.688 kcal, 36.379 g, and 6.979 g, respectively. A more significant impact of the NRCMS on nutrition intake is observed in the central and near-western where economic development is lagging behind. Also, compared to people of 18-60 age group, such impact is statistically more significant in the elderly for the carbohydrate intake. CONCLUSIONS The NRCMS can improve the rural elderly's nutrition intake in China. As the population ages rapidly in rural China, the present study provides recommendations on how to improve nutrition and health status of the elderly from the aspect of the medical system.
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Affiliation(s)
- Zhenhua Wang
- College of Economics and Management, Shenyang Agricultural University, Shenyang, 110866 China
| | - Jinqi Jiang
- College of Economics and Management, Shenyang Agricultural University, Shenyang, 110866 China
| | - Qiyan Zeng
- College of Economics and Management, Zhejiang A&F University, Hangzhou, 311300 China
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Ang YH, Ginting ML, Wong CH, Tew CW, Liu C, Sivapragasam NR, Matchar DB. From Hospital to Home: Impact of Transitional Care on Cost, Hospitalisation and Mortality. Ann Acad Med Singap 2019; 48:333-337. [PMID: 31875471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Yan Hoon Ang
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore
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Oliveira A, Nossa P, Mota-Pinto A. Assessing Functional Capacity and Factors Determining Functional Decline in the Elderly: A Cross-Sectional Study. ACTA MEDICA PORT 2019; 32:654-660. [PMID: 31625878 DOI: 10.20344/amp.11974] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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] [Received: 02/21/2019] [Accepted: 04/18/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this study is to assess functional capacity and determine the factors associated with functional decline in the elderly in adult day care centres and home care support in the County of Coimbra, Portugal. MATERIAL AND METHODS Cross-sectional study. A total of 115 participants of both genders, aged between 65 and 98, were enrolled in the home care support and adult day care system of the County of Coimbra, Portugal. Functional capacity was assessed using the Barthel index and the Lawton index. Another questionnaire gathered social, demographic and health status information. RESULTS The basic activities of daily living were significantly associated with age, cohabitation, medication usage, falls and multiple morbidity. Analysis of the study's variables and the instrumental activities of daily living found significant associations between age, institutional affiliation, perceived health status, hospitalizations, medication usage, physical exercise, multiple morbidities, falls, and fall prevention. DISCUSSION The results demonstrate that no statistically observable differences were found between gender and functional dependence. A significant association between the Barthel index and cohabitation was also found. We should also highlight that this sample revealed the extremely important role of families in determining the protection of highly dependent older people. Likewise, a significant association was observed between instrumental activities of daily living and levels of physical activity in which greater independence was found in those seniors who practiced physical exercise three or more times per week. CONCLUSION The results of this study allow us to identify factors that may be associated with the functional decline in the elderly. Useful evidence for the adoption of intervention strategies in the elderly population was added, focused on the prevention of functional decline and maintenance of the functional capacities of the elderly.
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Affiliation(s)
| | - Paulo Nossa
- Faculty of Arts and Humanities. University of Coimbra/CEGOT. Coimbra. Portugal
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Ahouah M, Rothan-Tondeur M. End-Users and Caregivers' Involvement in Health Interventional Research Carried Out in Geriatric Facilities: A Systematic Review. Int J Environ Res Public Health 2019; 16:ijerph16162812. [PMID: 31394752 PMCID: PMC6719053 DOI: 10.3390/ijerph16162812] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 12/03/2022]
Abstract
Public involvement (PI) is of great interest. However, little is known about this topic in the design, development, and/or implementation of health interventions in geriatric facilities. This study aimed to provide a critical overview of the involvement of caregivers and end-users in interventions in these facilities, based on Rifkin’s analytical framework. This systematic review, supplemented by a questionnaire to the corresponding authors, covered non-drug intervention reports targeting nurses, doctors, residents, and their relatives. Articles were published in Pubmed, Medline, Scopus, and Cinahl, from January 2016 to April 2018. Ninety-seven articles were included. The review shows a low level or partial PI in geriatric facilities where it exists. These results are further supported by the authors’ responses to the questionnaire. PI remains uncommon in geriatric institutions and consists of a consumerist model, suggesting the need for improved practices. More efforts are needed to experiment with recommendations to meet the challenges of PI and enhance the public ownership of interventions. The protocol was registered on Prospero under the number CRD42018098504.
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Affiliation(s)
- Mathieu Ahouah
- University Paris 13, Sorbonne Paris Cite, Nursing Sciences Research chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, F-93017 Bobigny, France.
| | - Monique Rothan-Tondeur
- University Paris 13, Sorbonne Paris Cite, Nursing Sciences Research chair, Laboratory Educations and Health Practices (LEPS), (EA 3412), UFR SMBH, F-93017 Bobigny, France
- Assistance Publique Hôpitaux de Paris (AP HP), Nursing sciences Research Chair, 75004 Paris, France
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Kim YI, Kim YY, Yoon JL, Won CW, Ha S, Cho KD, Park BR, Bae S, Lee EJ, Park SY, Park JH, Lee KR, Lee D, Jeong SL, Kang HS. Cohort Profile: National health insurance service-senior (NHIS-senior) cohort in Korea. BMJ Open 2019; 9:e024344. [PMID: 31289051 PMCID: PMC6615810 DOI: 10.1136/bmjopen-2018-024344] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The National Health Insurance Service (NHIS)-Senior was set up to provide high-quality longitudinal data that can be used to explore various aspects of changes in the socio-economical and health status of older adults, to predict risk factors and to investigate their health outcomes. PARTICIPANTS The NHIS-Senior cohort, a Korean nationwide retrospective administrative data cohort, is composed of older adults aged 60 years and over in 2002. It consists of 558 147 people selected by 10% simple random sampling method from a total of 5.5 million subjects aged 60+ in the National Health Information Database. The cohort was followed up through 2015 for all subjects, except for those who were deceased. FINDINGS TO DATE The healthcare utilisation and admission rates were the highest for acute upper respiratory infections and influenza (75.2%). The age-standardised (defined with reference to the world standard population) mortality rate for 10 years (through 2012) was 4333 per 100 000 person-years. Malignant neoplasms were the most common cause of death in both sexes (1032.1 per 100 000 person-years for men, 376.7 per 100 000 person-years for women). A total of 34 483 individuals applied for long-term care service in 2008, of whom 17.9% were assessed as grade 1, meaning that they were completely dependent on the help of another person to live daily life. FUTURE PLANS The data are provided for the purposes of policy and academic research under the Act on Promotion of the Provision and Use of Public Data in Korea. The NHIS-Senior cohort data are only available for Korean researchers at the moment, but it is possible for researchers outside the country to gain access to the data by conducting a joint study with a Korean researcher. The cohort will be maintained and continuously updated by the NHIS.
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Affiliation(s)
- Yong Ik Kim
- National Health Insurance Service, Wonju, Gangwon-do, Republic of Korea
| | - Yeon-Yong Kim
- Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea
| | - Jong Lull Yoon
- Hallym University College of Medicine, Chuncheon, Gangwon, Republic of Korea
| | - Chang Won Won
- Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Seongjun Ha
- Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea
| | - Kyu-Dong Cho
- National Health Insurance Service, Wonju, Gangwon-do, Republic of Korea
| | - Bo Ram Park
- National Health Insurance Service, Wonju, Gangwon-do, Republic of Korea
| | - Sejin Bae
- National Health Insurance Service, Wonju, Gangwon-do, Republic of Korea
| | - Eun-Joo Lee
- Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea
| | - Seong Yong Park
- National Health Insurance Service, Wonju, Gangwon-do, Republic of Korea
| | - Jong Heon Park
- Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea
| | - Kyeong-ran Lee
- National Health Insurance Service, Wonju, Gangwon-do, Republic of Korea
| | - Donghun Lee
- National Health Insurance Service, Wonju, Gangwon-do, Republic of Korea
| | - Seung-lyeal Jeong
- Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea
| | - Hyung-soo Kang
- National Health Insurance Service, Wonju, Gangwon-do, Republic of Korea
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Farhat NM, Vordenberg SE, Marshall VD, Suh TT, Remington TL. Evolution of interdisciplinary geriatric transitions of care on readmission rates. Am J Manag Care 2019; 25:e219-e223. [PMID: 31318513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate the effect of an interdisciplinary transitions of care (TOC) service on readmission rates in a geriatric population. STUDY DESIGN Single-center retrospective cohort study of adults 60 years or older discharged from an academic medical center. METHODS From July 1, 2013, to February 21, 2016, a total of 4626 patients discharged from 1 hospital, including inpatient, emergency department, observation, and short-stay units, were included. Cases were scheduled for a TOC service with the interdisciplinary team. Controls received usual care at other sites. All-cause 14-, 30-, and 90-day readmission rates between propensity score-matched study groups were evaluated by intention-to-treat (ITT), per-protocol (PP), and as-treated methods. RESULTS During the study period, 513 patients were scheduled for at least 1 component of the TOC intervention (ITT group). Of those patients, 215 completed all scheduled visits (PP group). Readmission rate after 30 days demonstrated no difference in the ITT group compared with the control group (12.8% vs 10.7%; P = .215), although it was significantly lower in the PP group in comparison with the control group (12.8% vs 7.9%; P = .042). CONCLUSIONS An interdisciplinary team based in a patient-centered medical home improved readmission rates for all patients who completed the intervention (PP group).
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Affiliation(s)
- Nada M Farhat
- Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202.
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Chen Y, Wilson L, Kornak J, Dudley RA, Merrilees J, Bonasera SJ, Byrne CM, Lee K, Chiong W, Miller BL, Possin KL. The costs of dementia subtypes to California Medicare fee-for-service, 2015. Alzheimers Dement 2019; 15:899-906. [PMID: 31175026 PMCID: PMC7183386 DOI: 10.1016/j.jalz.2019.03.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 08/21/2018] [Revised: 03/18/2019] [Accepted: 03/25/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Dementia is among the costliest of medical conditions, but it is not known how these costs vary by dementia subtype. METHODS The effect of dementia diagnosis subtype on direct health care costs and utilization was estimated using 2015 California Medicare fee-for-service data. Potential drivers of increased costs in Lewy body dementia (LBD), in comparison to Alzheimer's disease, were tested. RESULTS 3,001,987 Medicare beneficiaries were identified, of which 8.2% had a dementia diagnosis. Unspecified dementia was the most common diagnostic category (59.6%), followed by Alzheimer's disease (23.2%). LBD was the costliest subtype to Medicare, on average, followed by vascular dementia. The higher costs in LBD were explained in part by falls, urinary incontinence or infection, depression, anxiety, dehydration, and delirium. DISCUSSION Dementia subtype is an important predictor of health care costs. Earlier identification and targeted treatment might mitigate the costs associated with co-occurring conditions in LBD.
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Affiliation(s)
- Yingjia Chen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Leslie Wilson
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - R Adams Dudley
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA; Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen J Bonasera
- Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, University of Nebraska Medical Center, Omaha, NE, USA
| | - Christie M Byrne
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Kirby Lee
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA
| | - Winston Chiong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA; Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Katherine L Possin
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA; Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.
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Abstract
INTRODUCTION Social networks play a role in slowing the development of dementia. However, there is a need for further investigation of the effects of improving social networks on health-related quality of life and cognitive performance. Targeted community aged care services are a central strategy for supporting older adults to initiate and maintain their social engagement with other individuals at all stages of later life. This protocol describes a prospective observational cohort study aimed at (1) characterising interpersonal relationships in older adults receiving community care services, (2) assessing the relationship social networks and health-related quality of life and cognition and (3) identifying the association between community care use, social networks and cognition. The findings will contribute to our understanding of how specific social network structures and social support services can maintain cognitive function in community-dwelling older adults. METHODS AND ANALYSIS This is a prospective, observational cohort study of 201 older Australians residing in the community and receiving care services from one of three aged care organisations. Clients with a history of neurological injury will be excluded. Participants will undergo baseline measures of social networks, health-related quality of life and cognitive function, and a follow-up at 6 months. Service use and sociodemographic variables will also be collected. The primary outcome is cognitive function, and secondary outcomes include social networks and health-related quality of life. Multivariable linear regression will test the hypothesis that increased social networks are associated with an increase in cognitive function. ETHICS AND DISSEMINATION Approval of the study by Macquarie University Research Ethics Committee (reference number 5201831394062) has been obtained. This work will be disseminated by publication of peer-reviewed manuscripts, presentations in abstract form at scientific meetings and results will be made available to home and community-based care older adults and care staff of the involved organisations. TRIAL REGISTRATION NUMBER ACTRN12618001723279; Pre-results.
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Affiliation(s)
- Joyce Siette
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Andrew Georgiou
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Abstract
BACKGROUND Elder people aged ≥45 years often have more healthcare needs than the younger. But the Chinese elderly are less likely to see a doctor when ill. In this article, this phenomenon is abbreviated as "not see a doctor". This study aimed to describe the reason distribution of"not see a doctor" among the Chinese elderly. Specifically,we examined the reasons why"not see a doctor" happened to the Chinese elderly with different characteristics. METHODS In order to explore the associations between various predisposing, enabling and need factors and "not see a doctor" in China, this cross-sectional study used the data from the 2015 wave 4 of the China Health and Retirement Longitudinal Study (CHARLS). Using multivariate analyses, associations between "not see a doctor" and factors were accessed. Models were estimated using a binary model with negative log-log link function (cases versus controls) and multinomial logit analysis (reasons for "not see a doctor"). RESULTS Adjusted by individual weight, the analysis included 16,277 people aged ≥45 years, of whom 11% reported "not see a doctor". Overall, those with older age, other marital status (except married) and poorer health status were more likely to report "not see a doctor". No significant associations were found between income and "not see a doctor". The majority of cases report "no need" as the reason for their "not see a doctor". Except reason "no need", factor associated with the healthcare system-cost-accounted for the most case of "not see a doctor". Those without health insurance are more likely not to see a doctor due to affordability issues. CONCLUSIONS This quantitative study suggests that "not see a doctor" is more likely to happen due to age and marital status issues, especially affordability issues. For China, it is important to enforce the policy of reducing of healthcare fees and increasing health insurance coverage.
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Affiliation(s)
- Shangren Qin
- Hangzhou Normal University, 2318 Yuhangtang Road, Hangzhou, 311121 China
| | - Ye Ding
- Department of Public Health, Hangzhou Medical College, 481 Binwen Road, Hangzhou, 310053 China
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Ratcliffe J, Cameron I, Lancsar E, Walker R, Milte R, Hutchinson CL, Swaffer K, Parker S. Developing a new quality of life instrument with older people for economic evaluation in aged care: study protocol. BMJ Open 2019; 9:e028647. [PMID: 31129602 PMCID: PMC6538028 DOI: 10.1136/bmjopen-2018-028647] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The ageing of the population represents a significant challenge for aged care in Australia and in many other countries internationally. In an environment of increasing resource constraints, new methods, techniques and evaluative frameworks are needed to support resource allocation decisions that maximise the quality of life and well-being of older people. Economic evaluation offers a rigorous, systematical and transparent framework for measuring quality and efficiency, but there is currently no composite mechanism for incorporating older people's values into the measurement and valuation of quality of life for quality assessment and economic evaluation. In addition, to date relatively few economic evaluations have been conducted in aged care despite the large potential benefits associated with their application in this sector. This study will generate a new preference based older person-specific quality of life instrument designed for application in economic evaluation and co-created from its inception with older people. METHODS AND ANALYSIS A candidate descriptive system for the new instrument will be developed by synthesising the findings from a series of in-depth qualitative interviews with 40 older people currently in receipt of aged care services about the salient factors which make up their quality of life. The candidate descriptive system will be tested for construct validity, practicality and reliability with a new independent sample of older people (n=100). Quality of life state valuation tasks using best worst scaling (a form of discrete choice experiment) will then be undertaken with a representative sample of older people currently receiving aged care services across five Australian states (n=500). A multinomial (conditional) logistical framework will be used to analyse responses and generate a scoring algorithm for the new preference-based instrument. ETHICS AND DISSEMINATION The new quality of life instrument will have wide potential applicability in assessing the cost effectiveness of new service innovations and for quality assessment across the spectrum of ageing and aged care. Results will be disseminated in ageing, quality of life research and health economics journals and through professional conferences and policy forums. This study has been reviewed by the Human Research Ethics Committee of the University of South Australia and has ethics approval (Application ID: 201644).
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Affiliation(s)
- Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ian Cameron
- Rehabilitation Studies Unit, University of Sydney, Sydney, New South Wales, Australia
| | - Emily Lancsar
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ruth Walker
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Milte
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Claire Louise Hutchinson
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Kate Swaffer
- Dementia Alliance International, Adelaide, South Australia, Australia
| | - Stuart Parker
- Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
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Absolute and relative morbidity burdens attributable to various illnesses and injuries, non-service member beneficiaries of the Military Health System, 2018. MSMR 2019; 26:40-50. [PMID: 31125252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Dupuis K, Reed M, Bachmann F, Lemke U, Pichora-Fuller MK. The Circle of Care for Older Adults With Hearing Loss and Comorbidities: A Case Study of a Geriatric Audiology Clinic. J Speech Lang Hear Res 2019; 62:1203-1220. [PMID: 31026196 DOI: 10.1044/2018_jslhr-h-ascc7-18-0140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose Older adults seeking audiologic rehabilitation often present with medical comorbidities, yet these realities of practice are poorly understood. Study aims were to examine (a) the frequency of identification of selected comorbidities in clients of a geriatric audiology clinic, (b) the influence of comorbidities on audiology practice, and (c) the effect of comorbidities on rehabilitation outcomes. Method The records of 135 clients ( M age = 86 years) were examined. Information about comorbidities came from audiology charts (physical paper files) and hospital electronic health records (EHRs). Data about rehabilitation recommendations and outcomes came from the charts. Focus groups with audiologists probed their views of how comorbidities influenced their practice. Results The frequency of identification was 68% for visual, 50% for cognitive, and 42% for manual dexterity issues; 84% had more than one comorbidity. Also noted were hypertension (43%), falls (33%), diabetes (13%), and depression (16%). Integrating information from the audiology chart and EHR provided a more complete understanding of comorbidities. Information about hearing in the EHR included logs of outpatient audiology visits (75% of 135 cases), audiologists' care notes for inpatients and long-term care residents (25%), and entries by other health professionals (60%). Modifications to audiology practice were common and varied depending on comorbidity. High rates of success were achieved regardless of comorbidities. Conclusions In this clinic, successful outcomes were achieved by modifying audiology practice for clients with comorbidities. Increased interprofessional communication among clinicians in the circle of care could improve care planning and outcomes for older adults with hearing loss.
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Affiliation(s)
- Kate Dupuis
- Hearing Services, Baycrest Health Sciences, Toronto, Ontario, Canada
- Department of Psychology, University of Toronto, Ontario, Canada
- Sheridan Centre for Elder Research, Sheridan College, Oakville, Ontario, Canada
| | - Marilyn Reed
- Hearing Services, Baycrest Health Sciences, Toronto, Ontario, Canada
| | | | | | - M Kathleen Pichora-Fuller
- Department of Psychology, University of Toronto, Ontario, Canada
- Rotman Research Institute, Toronto, ON, Canada
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Akdeniz M, Hahnel E, Ulrich C, Blume-Peytavi U, Kottner J. Prevalence and associated factors of skin cancer in aged nursing home residents: A multicenter prevalence study. PLoS One 2019; 14:e0215379. [PMID: 31009466 PMCID: PMC6476496 DOI: 10.1371/journal.pone.0215379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/01/2019] [Indexed: 11/18/2022] Open
Abstract
Non-melanoma-skin cancer is an emerging clinical problem in the elderly, fair skinned population which predominantly affects patients aged older than 70 years. Its steady increase in incidence rates and morbidity is paralleled by related medical costs. Despite the fact that many elderly patients are in need of care and are living in nursing homes, specific data on the prevalence of skin cancer in home care and the institutional long-term care setting is currently lacking. A representative multicenter prevalence study was conducted in a random sample of ten institutional long-term care facilities in the federal state of Berlin, Germany. In total, n = 223 residents were included. Actinic keratoses, the precursor lesions of invasive cutaneous squamous cell carcinoma were the most common epithelial skin lesions (21.1%, 95% CI 16.2 to 26.9). Non-melanoma skin cancer was diagnosed in 16 residents (7.2%, 95% CI 4.5 to 11.3). None of the residents had a malignant melanoma. Only few bivariate associations were detected between non-melanoma skin cancer and demographic, biographic and functional characteristics. Male sex was significantly associated with actinic keratosis whereas female sex was associated with non-melanoma skin cancer. Smoking was associated with an increased occurrence of non-melanoma skin cancer. Regular dermatology check-ups in nursing homes would be needed but already now due to financial limitations, lack of time in daily clinical practice and limited number of practising dermatologists, it is not the current standard. With respect to the worldwide growing aging population new programs and decisions are required. Overall, primary health care professionals should play a more active role in early diagnosis of skin cancer in nursing home residents. Dermoscopy courses, web-based or smartphone-based applications and teledermatology may support health care professionals to provide elderly nursing home residents an early diagnosis of skin cancer.
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Affiliation(s)
- Merve Akdeniz
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Germany
| | - Elisabeth Hahnel
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Germany
| | - Claas Ulrich
- Department of Dermatology and Allergy, Skin Cancer Center, Charité-Universitätsmedizin, Berlin, Germany
| | - Ulrike Blume-Peytavi
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Germany
| | - Jan Kottner
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Germany
- * E-mail:
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Hillman A, Latimer J. Somaticization, the making and unmaking of minded persons and the fabrication of dementia. Soc Stud Sci 2019; 49:208-226. [PMID: 30834820 PMCID: PMC6902807 DOI: 10.1177/0306312719834069] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This article examines the strategies by which the different and variable signs of failing mental powers become known sufficiently for 'dementia' to be made into a stable bio-clinical entity, that can be tested, diagnosed and perhaps one day even treated. Drawing on data from ethnographic observations in memory clinics, together with interviews with associated scientists and clinicians, we document the challenges that clinicians face across the clinical and research domain in making dementia a stable object of their investigation. We illustrate how the pressure for early diagnoses of dementia creates tensions between the scientific representations of early dementia and its diagnosis in the clinic. Our aim is to highlight the extent to which the work of diagnosing dementia involves an intricate process of smoothing out seemingly insurmountable problems, such as the notoriously elusive connections between brain/mind and body/person. Furthermore, we show that a part of this process involves enrolling patients as minded, agentic subjects, the very subjects who are excluded from dementia science research in pursuit of biomarkers for the pre-clinical detection of dementia.
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Affiliation(s)
- Alexandra Hillman
- Alexandra Hillman, WISERD, School of Social Sciences, Cardiff University, 38 Park Place, Cathays, Cardiff CF10 3BB, UK.
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Abstract
INTRODUCTION AND OBJECTIVE The Polish health service is in need of improvement because of the increasing number of geriatric patients. Identifying the resources available to patients is important for ameliorating deficits. The goal of this research was to measure the health and wellbeing of seniors and to investigate to what extent health services meet their needs. Differences in access and scope of received services between patients from different localities (i.e villages, small towns and big cities) were analysed. MATERIAL AND METHODS Questionnaires (Satisfaction with Life Scale; VAS Numeric Pain Distress Scale) and a structured interview assessing the quality of healthcare were carried out in 2015 on a sample of 459 seniors. Each candidate gave consent for participation in the study. Statistica 12.5 software was used for analyses. RESULTS The overall measure of satisfaction with life of the respondents (M=22.34 SD=5.78) was good. Inhabitants of small towns had a significantly lower sense of quality of life than seniors from big cities (Tukey HSD = 0.047, p<.05). Multimorbidity and polypharmacy were present to a limited extent. The issue of discrimination of older individuals by medical personnel affected a fifth of seniors living in villages, and one- third of those living in big cities. Geriatric patients did not have equal opportunities for access to medical services. CONCLUSIONS State-provided geriatric care is insufficient and does not meet the real needs of patients. A holistic care approach and/or individualized care for older adults are often indicated but are only theoretical constructs in Poland. This inefficient system places the burden of caregiving on the family of the ageing patient. Anxiety among geriatric patients is growing regarding exclusion and lack of care.
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Exley J, Abel GA, Fernandez JL, Pitchforth E, Mendonca S, Yang M, Roland M, McGuire A. Impact of the Southwark and Lambeth Integrated Care Older People's Programme on hospital utilisation and costs: controlled time series and cost-consequence analysis. BMJ Open 2019; 9:e024220. [PMID: 30833317 PMCID: PMC6443075 DOI: 10.1136/bmjopen-2018-024220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To estimate the impact on hospital utilisation and costs of a multi-faceted primary care intervention for older people identified as being at risk of avoidable hospitalisation. DESIGN Observational study: controlled time series analysis and estimation of costs and cost consequences of the Programme. General practitioner (GP)'s practice level data were analysed from 2009 to 2016 (intervention operated from 2012 to 2016). Mixed-effect Poisson regression models of hospital utilisation included comparisons with control practices and background trends in addition to within-practice comparisons. Cost estimation used standard tariff values. SETTING 94 practices in Southwark and Lambeth and 263 control practices from other parts of England. MAIN OUTCOME MEASURES Hospital utilisation: emergency department attendance, emergency admissions, emergency admissions for ambulatory sensitive conditions, outpatient attendance, elective admission and length of stay. RESULTS By the fourth year of the Programme, there were reductions in accident and emergency (A&E) attendance (rate ratio 0.944, 95% CI 0.913 to 0.976), outpatient attendances (rate ratio 0.938, 95% CI 0.902 to 0.975) and elective admissions (rate ratio 0.921, 95% CI 0.908 to 0.935) but there was no evidence of reduced emergency admissions. The costs of the Programme were £149 per resident aged 65 and above but savings in hospital costs were only £86 per resident aged 65 and above, equivalent to a net increase in health service expenditure of £64 per resident though the Programme was nearly cost neutral if set-up costs were excluded. Holistic assessments carried out by GPs and consequent Integrated Care Management (ICM) plans were associated with increases in elective activity and costs; £126 increase in outpatient attendance and £936 in elective admission costs per holistic assessment carried out, and £576 increase in outpatient and £5858 in elective admission costs per patient receiving ICM. CONCLUSIONS The Older People's Programme was not cost saving. Some aspects of the Programme were associated with increased costs of elective care, possibly through the identification of unmet need.
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Affiliation(s)
- Josephine Exley
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, Cambridgeshire, UK
| | - Gary A Abel
- University of Exeter Medical School, Exeter, UK
| | - José-Luis Fernandez
- Personal Social Services Research Unit, London School of Economics, London, UK
| | | | - Silvia Mendonca
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
| | - Miaoqing Yang
- Cambridge Centre for Health Services Research, RAND Europe, Cambridge, Cambridgeshire, UK
| | - Martin Roland
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK
| | - Alistair McGuire
- Department of Health Policy, London School of Economics, London, UK
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Kong F, Xu L, Kong M, Li S, Zhou C, Li J, Sun L, Qin W. The Relationship between Socioeconomic Status, Mental Health, and Need for Long-Term Services and Supports among the Chinese Elderly in Shandong Province-A Cross-Sectional Study. Int J Environ Res Public Health 2019; 16:ijerph16040526. [PMID: 30781757 PMCID: PMC6406556 DOI: 10.3390/ijerph16040526] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 12/23/2022]
Abstract
This study aims to clarify the association between socioeconomic status (SES), mental health, and the need for long-term services and support (NLTSS) of the Chinese elderly, and further, to provide evidence-based suggestions for the development of the long-term services and support (LTSS) system in China. A cross-sectional survey using a multi-stage random sampling method was conducted in Shandong Province, China, in 2017. Data were collected from seniors aged over 60 years old through questionnaires by face-to face interviews. A total of 7070 subjects were included in the final database (40.3% male and 59.7% female). A chi-square test analysis and structural equation modeling (SEM) were employed to explore the relationship between SES, mental health, and NLTSS for both male and female elderly people. The SEM analysis showed that mental health was significantly and negatively associated with NLTSS for both male elderly and female elderly, and it was slightly stronger among the male elderly. A significant and negative relationship was observed between SES and NLTSS for both genders, and the association was stronger among the female elderly. SES exerted a positive effect on mental health for both male and female elderly people, and a slightly stronger effect was found among the male elderly. Advice for the development of a LTSS system in China was given based on the above results.
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Affiliation(s)
- Fanlei Kong
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.
| | - Lingzhong Xu
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai 200032, China.
| | - Mei Kong
- Research Center of Economics and Resource Management, Beijing Normal University, Beijing 100875, China.
| | - Shixue Li
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.
| | - Chengchao Zhou
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.
| | - Jiajia Li
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.
| | - Long Sun
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.
| | - Wenzhe Qin
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wenhuaxi Road, Jinan 250012, China.
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Wu X, Law CK, Yip PSF. A Projection of Future Hospitalisation Needs in a Rapidly Ageing Society: A Hong Kong Experience. Int J Environ Res Public Health 2019; 16:ijerph16030473. [PMID: 30736289 PMCID: PMC6388233 DOI: 10.3390/ijerph16030473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 12/02/2022]
Abstract
To assess the impact of ageing on hospitalisation in a rapidly ageing society. A study using retrospective and prospective data was conducted using hospitalisation data with age-specific admission rates in the period from 2001–2010 and demographic data from the period of 2001–2066 by the United Nations. The Hong Kong Special Administrative Region (SAR) with a 7 million population experiences extreme low fertility (1.1 children per woman) and long life expectancy (84 years old). Days of hospitalisation: For the period 2010–2066, the length of stay (LOS) in the age group 85+ is projected to increase by 555.3% while the LOS for the whole population is expected to increase by only 134.4% and by ageing only. In 2010, the proportion in the LOS contributed to by the oldest age group (85+) was 15%. In 2066, this proportion is projected to nearly triple (42%). Around 70% of the projected days of hospitalisation would be taken by people aged 75 years and above. It is projected that this phenomenon would be converted to a more balanced structure when the demographic transition changes into a more stable distribution. Apparently, the impact of ageing on the public hospital system has not been well understood and prepared. The determined result provides insight into monitoring the capacity of the hospital system to cope with a rapidly changing demographic society. It provides empirical evidence of the impact of ageing on the public hospitalisation system. It gives a long term projection up to the year 2066 while the situation would be different from the transient period of 2016–2030. The analysis adopts a fixed rate approach, which assumes the LOS to be only driven by demographic factors, while any improvements in health technologies and health awareness are not accounted for. Only inpatient data from the Hospital Authority were used, nonetheless, they are the best available for the study. Due to the limitation of data, proximity to death is not controlled in conducting this analysis.
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Affiliation(s)
- Xueyuan Wu
- Department of Economics, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Chi-Kin Law
- Centre for Applied Health Economics, Menzies Health Institute Queensland, School of Medicine, Griffith University, Nathan, QLD 4111, Australia.
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
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Willink A, Kasper J, Skehan ME, Wolff JL, Mulcahy J, Davis K. Are Older Americans Getting the Long-Term Services and Supports They Need? Issue Brief (Commonw Fund) 2019; 2019:1-9. [PMID: 30681291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
ISSUE Older adults' needs have evolved and are no longer met by the Medicare program. With the recent passage of the Bipartisan Budget Act of 2018 (BBA), Medicare Advantage (MA) plans can now provide beneficiaries with nonmedical benefits, such as long-term services and supports (LTSS), which Medicare does not cover. GOAL To examine the use of LTSS among Medicare beneficiaries age 65 and older living in the community and explore differences by age, income, and other variables. METHODS Descriptive analyses of the National Health and Aging Trends Study (NHATS), 2015. FINDINGS AND CONCLUSIONS Two-thirds of older adults living in the community use some degree of LTSS. Reliance on assistive devices and environmental modifications is high; however many adults, particularly dual-eligible beneficiaries, experience adverse consequences of not receiving care. Although the recent policy change allowing MA plans to offer LTSS benefits is an important step toward meeting the medical and nonmedical needs of Medicare beneficiaries, only the one-third of Medicare beneficiaries enrolled in MA plans stand to benefit. Accountable care organizations operating in traditional Medicare also should have the increased flexibility to provide nonmedical services.
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Affiliation(s)
| | | | | | | | | | - Karen Davis
- Johns Hopkins Bloomberg School of Public Health
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Spiers G, Matthews FE, Moffatt S, Barker RO, Jarvis H, Stow D, Kingston A, Hanratty B. Impact of social care supply on healthcare utilisation by older adults: a systematic review and meta-analysis. Age Ageing 2019; 48:57-66. [PMID: 30247573 PMCID: PMC6322507 DOI: 10.1093/ageing/afy147] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/20/2018] [Accepted: 08/29/2018] [Indexed: 11/13/2022] Open
Abstract
Objective to investigate the impact of the availability and supply of social care on healthcare utilisation (HCU) by older adults in high income countries. Design systematic review and meta-analysis. Data sources medline, EMBASE, Scopus, Health Management Information Consortium, Cochrane Database of Systematic Reviews, NIHR Health Technology Assessment, NHS Economic Evaluation Database, Database of Abstracts of Reviews of Effectiveness, SCIE Online and ASSIA. Searches were carried out October 2016 (updated April 2017 and May 2018). (PROSPERO CRD42016050772). Study selection observational studies from high income countries, published after 2000 examining the relationship between the availability of social care (support at home or in care homes with or without nursing) and healthcare utilisation by adults >60 years. Studies were quality assessed. Results twelve studies were included from 11,757 citations; ten were eligible for meta-analysis. Most studies (7/12) were from the UK. All reported analysis of administrative data. Seven studies were rated good in quality, one fair and four poor. Higher social care expenditure and greater availability of nursing and residential care were associated with fewer hospital readmissions, fewer delayed discharges, reduced length of stay and expenditure on secondary healthcare services. The overall direction of evidence was consistent, but effect sizes could not be confidently quantified. Little evidence examined the influence of home-based social care, and no data was found on primary care use. Conclusions adequate availability of social care has the potential to reduce demand on secondary health services. At a time of financial stringencies, this is an important message for policy-makers.
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Affiliation(s)
- G Spiers
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - F E Matthews
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - S Moffatt
- Institute for Health & Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, UK
| | - R O Barker
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - H Jarvis
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - D Stow
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - A Kingston
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
| | - B Hanratty
- Institute of Health & Society, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing & Vitality, Newcastle upon Tyne, UK
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de Oliveira SBV, Barroso SCC, Bicalho MAC, Reis AMM. Profile of drugs used for self-medication by elderly attended at a referral center. Einstein (Sao Paulo) 2018; 16:eAO4372. [PMID: 30517365 PMCID: PMC6276811 DOI: 10.31744/einstein_journal/2018ao4372] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/21/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To determine the profile of medications used for self-medication by the elderly. METHODS A cross-sectional study based on interviews with elderly seen at a reference center for Elderly Health of a teaching hospital, from July 2014 to July 2015. Clinical, demographic and pharmacotherapeutic data were collected. RESULTS A total of 170 elderly were interviewed, 85.9% female, and the median age was 76 years. The frequency of self-medication was 80.5%. The most used medications for self-medication were central acting muscle relaxants, analgesics and antipyretics, non-steroidal anti-inflammatory and antirheumatic agents. Among the elderly who practiced self-medication, 55.5% used drugs that were inappropriate for the elderly, according to Beers criteria of 2015, and 56.9% used medications that showed therapeutic duplicity with the prescribed drugs. We identified 57 drugs used for self-medication, of which 30 (52.6%) were classified as over-the-counter and 27 (47.4%) as prescription drugs. Approximately 68.6% of elderly had at least one interaction involving drugs prescribed and those used for self-medication. CONCLUSION The practice of self-medication was frequent in the elderly studied. The widespread use of over-the-counter drugs and/or potentially inappropriate medications for elderly increases the risk of drug interactions and adverse events.
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Affiliation(s)
- Samanta Bárbara Vieira de Oliveira
- Instituto Jenny de Andrade Faria de Atenção à Saúde do Idoso e da Mulher, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Soraya Coelho Costa Barroso
- Instituto Jenny de Andrade Faria de Atenção à Saúde do Idoso e da Mulher, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maria Aparecida Camargos Bicalho
- Instituto Jenny de Andrade Faria de Atenção à Saúde do Idoso e da Mulher, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Foster S. Solving the 'stranded patient' problem. Br J Nurs 2018; 27:1285. [PMID: 30457379 DOI: 10.12968/bjon.2018.27.21.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sam Foster, Chief Nurse, Oxford University Hospitals, explains the steps being taken to improve collaboration between health and social care in her trust area to ensure patients are sent home promptly and safely.
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Affiliation(s)
- Sam Foster
- Chief Nurse, Oxford University Hospitals
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Ramírez-Martín R, Rodríguez-Sánchez I, Moral-Cuesta D, Menéndez-Colino R, Díaz de Bustamante Ussia M, González-Montalvo JI. [A survey on geriatric consultation activity in Spanish hospitals]. Rev Esp Geriatr Gerontol 2018; 53:359-360. [PMID: 29625711 DOI: 10.1016/j.regg.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/03/2018] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Raquel Ramírez-Martín
- Servicio de Geriatría, Hospital Universitario La Paz, Instituto de Investigación del Hospital Universitario La Paz IdiPAZ, Madrid, España.
| | - Isabel Rodríguez-Sánchez
- Servicio de Geriatría, Hospital Universitario La Paz, Instituto de Investigación del Hospital Universitario La Paz IdiPAZ, Madrid, España
| | - Débora Moral-Cuesta
- Servicio de Geriatría, Hospital Universitario La Paz, Instituto de Investigación del Hospital Universitario La Paz IdiPAZ, Madrid, España
| | - Rocío Menéndez-Colino
- Servicio de Geriatría, Hospital Universitario La Paz, Instituto de Investigación del Hospital Universitario La Paz IdiPAZ, Madrid, España
| | - Macarena Díaz de Bustamante Ussia
- Servicio de Geriatría, Hospital Universitario La Paz, Instituto de Investigación del Hospital Universitario La Paz IdiPAZ, Madrid, España
| | - Juan I González-Montalvo
- Servicio de Geriatría, Hospital Universitario La Paz, Instituto de Investigación del Hospital Universitario La Paz IdiPAZ, Madrid, España
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Ghesquiere AR, Pepin R, Kinsey J, Bartels SJ, Bruce ML. Factors associated with depression detection in a New Hampshire mental health outreach program. Aging Ment Health 2018; 22:1471-1476. [PMID: 28812372 PMCID: PMC5815953 DOI: 10.1080/13607863.2017.1364346] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES For mental health outreach programs for older adults, accurately detecting depression is key to quality service provision. Multiple factors, including gender, cognitive impairment, or recent bereavement may affect depression detection, but this is under-studied. Therefore, we sought to both establish rates of depressive symptom detection and to examine factors associated with inaccuracies of detecting depression among participants in a mental health outreach program serving older adults. METHOD We conducted a chart review of 1126 cases in an older adult-focused mental health outreach program in New Hampshire, the Referral Education Assistance & Prevention (REAP) program. Accuracy of depression detection was identified by comparing screen-positive scores for depressive symptoms on the 15-item Geriatric Depression Scale (GDS) to depression identification by counselors on a 'presenting concerns' list. RESULTS Inaccurate depression detection (positive on the GDS but depression not identified by counselors) occurred in 27.6% of cases. Multivariate regression analyses indicated that anxiety, cognitive concerns, and rurality were all associated with detection innaccuracy. CONCLUSION This study appears to be the first to examine factors influencing depression detection in a mental health outreach program. Future efforts should help ensure that all older mental health outreach clients have depression detected at optimal rates.
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Affiliation(s)
- Angela R Ghesquiere
- a Brookdale Center for Healthy Aging, Hunter College , City University of New York , NY , USA
| | - Renee Pepin
- b Dartmouth Centers for Health and Aging , Lebanon , NH , USA
| | | | - Stephen J Bartels
- d The Dartmouth Institute, Geisel School of Medicine at Dartmouth, and Dartmouth Centers for Health and Aging , Lebanon , NH , USA
| | - Martha L Bruce
- d The Dartmouth Institute, Geisel School of Medicine at Dartmouth, and Dartmouth Centers for Health and Aging , Lebanon , NH , USA
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Deborah OML, Chiu MYL, Cao K. Geographical Accessibility of Community Health Assist System General Practitioners for the Elderly Population in Singapore: A Case Study on the Elderly Living in Housing Development Board Flats. Int J Environ Res Public Health 2018; 15:E1988. [PMID: 30213094 PMCID: PMC6163585 DOI: 10.3390/ijerph15091988] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 11/17/2022]
Abstract
Accessible primary healthcare is important to national healthcare in general and for older persons in particular, in societies where the population is ageing rapidly, as in Singapore. However, although much policy and research efforts have been put into this area, we hardly find any spatial perspective to assess the accessibility of these primary healthcare services. This paper analyzes the geographical accessibility of one major healthcare service in Singapore, namely, General Practitioners (GPs) services under the Community Health Assist Scheme (CHAS) for older persons. A Python script was developed to filter the website data of the Housing Development Board (HDB) of Singapore. The data derived was comprehensively analyzed by an Enhanced 2-Step Floating Catchment Area (E2SFCA) method based on a Gaussian distance-decay function and the GIS technique. This enabled the identification of areas with relatively weak geographical accessibility of CHAS-GPs. The findings are discussed along with suggestions for health practitioners, service planners and policy makers. Despite its initial nature, this study has demonstrated the value of innovative approaches in data collection and processing for the elderly-related studies, and contributed to the field of healthcare services optimization and possibly to other human services.
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Affiliation(s)
- Ong Ming Lee Deborah
- Department of Geography, National University of Singapore, Singapore, Singapore.
| | - Marcus Yu Lung Chiu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China.
| | - Kai Cao
- Department of Geography, National University of Singapore, Singapore, Singapore.
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Li X, Chen M, Wang Z, Si L. Forgone care among middle aged and elderly with chronic diseases in China: evidence from the China Health and Retirement Longitudinal Study Baseline Survey. BMJ Open 2018; 8:e019901. [PMID: 29549207 PMCID: PMC5857704 DOI: 10.1136/bmjopen-2017-019901] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/31/2018] [Accepted: 02/05/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE In general, published studies analyse healthcare utilisation, rather than foregone care, among different population groups. The assessment of forgone care as an aspect of healthcare system performance is important because it indicates the gap between perceived need and actual utilisation of healthcare services. This study focused on a specific vulnerable group, middle-aged and elderly people with chronic diseases, and evaluated the prevalence of foregone care and associated factors among this population in China. METHODS Data were obtained from a nationally representative household survey of middle-aged and elderly individuals (≥45 years), the China Health and Retirement Longitudinal Study, which was conducted by the National School of Development of Peking University in 2013. Descriptive statistics were used to analyse sample characteristics and the prevalence of foregone care. Andersen's healthcare utilisation and binary logistic models were used to evaluate the determinants of foregone care among middle-aged and elderly individuals with chronic diseases. RESULTS The prevalence of foregone outpatient and inpatient care among middle-aged and elderly people was 10.21% and 6.84%, respectively, whereas the prevalence of foregone care for physical examinations was relatively high (57.88%). Predisposing factors, including age, marital status, employment, education and family size, significantly affected foregone care in this population. Regarding enabling factors, individuals in the highest income group reported less foregone inpatient care or physical examinations compared with those in the lowest income group. Social healthcare insurance could significantly reduce foregone care in outpatient and inpatient situations; however, these schemes (except for urban employee medical insurance) did not appear to have a significant impact on foregone care involving physical examinations. CONCLUSION In China, policy-makers may need to further adjust healthcare policies, such as health insurance schemes, and improve the hierarchical medical system, to promote reduction in foregone care and effective utilisation of health services.
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Affiliation(s)
- Xiangjun Li
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Mingsheng Chen
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
- Nanjing Medical University, Institute of Healthy Jiangsu Construction & Development, Nanjing, China
| | - Zhonghua Wang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
- Nanjing Medical University, Institute of Healthy Jiangsu Construction & Development, Nanjing, China
| | - Lei Si
- Centre for the Health Economy, Macquarie University, New South Wales, Australia
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Storeng SH, Sund ER, Krokstad S. Factors associated with basic and instrumental activities of daily living in elderly participants of a population-based survey: the Nord-Trøndelag Health Study, Norway. BMJ Open 2018; 8:e018942. [PMID: 29530908 PMCID: PMC5857703 DOI: 10.1136/bmjopen-2017-018942] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To investigate factors associated with the need for assistance in basic and instrumental activities of daily living in Norwegian elderly. DESIGN Prospective cohort study. SETTING The Nord-Trøndelag Health Study (HUNT), a large population-based health survey in Norway. PARTICIPANTS 5050 individuals aged 60-69 years old at baseline in HUNT2 (1995-1997) who also participated in HUNT3 (2006-2008) were included in the study. 676/693 individuals were excluded in the analyses due to missing outcomes. OUTCOMES Needing assistance in one or more basic or instrumental activities of daily living reported in HUNT3. RESULTS In adjusted multinomial logistic regression analyses, poor self-rated health and depression were the strongest risk factors for needing assistance in one or more basic activities of daily living in HUNT3, with ORs of 2.13 (1.35 to 3.38) and 1.58 (0.91 to 2.73). Poor self-rated health and poor life satisfaction were the strongest risk factors for needing assistance in one or more instrumental activities of daily living in HUNT3, with ORs of 2.30 (1.93 to 2.74) and 2.29 (1.86 to 2.81), respectively. Excessive sitting time, short or prolonged sleeping time, and physical inactivity seemed to be the most important lifestyle risk factors for basic/instrumental activities of daily living (ADL/IADL) disability. The studied factors were, in general, greater risk factors for mortality during follow-up than for ADL/IADL disability. Smoking was the strongest risk factor for mortality during follow-up and non-participation in HUNT3. Smoking and low social participation were the strongest risk factors for non-participation in HUNT3. CONCLUSIONS Subjective health perception, life satisfaction and depression were the strongest risk factors for needing assistance in one or more basic/instrumental activities of daily living later in life. These factors could be possible targets for prevention purposes.
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Affiliation(s)
- Siri Høivik Storeng
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Erik R Sund
- Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Steinar Krokstad
- Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Abstract
Community hospitals have been supported by the general public and by professionals as one means of increasing choice between local, low technology, care and high technology care at the district general hospital. However, there is no information on the impact of community hospitals on district general hospital use subsequent to NHS and community care reforms. Examination of routinely gathered activity data in the Bath Health District revealed that availability of community hospital beds was associated with reduced use of central inpatient services in the city of Bath. The reduction was most apparent for medical and geriatric beds. Decrease in the use of surgical beds was small. However, total inpatient bed use (including central and community hospital beds) was higher in the population with access to community hospital beds. We conclude that community hospitals offer one option for accessible health care and, as such, merit systematic evaluation of costs and benefits. This study presents some evidence that savings could be achieved through improved efficiency.
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Affiliation(s)
- C Hine
- Health Commission for Wiltshire and Bath, Devizes, England
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Kietzman KG, Dupuy D, Damron-Rodriguez J, Palimaru A, del Pino HE, Frank JC. Older Californians and the Mental Health Services Act: Is an Older Adult System of Care Supported? Policy Brief UCLA Cent Health Policy Res 2018:1-8. [PMID: 29461025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This policy brief summarizes findings from the first study to evaluate how California's public mental health delivery system has served older adults (60 years of age and over) since the passage of the Mental Health Services Act (MHSA) in 2004. Study findings indicate that there are unmet needs among older adults with mental illness in the public mental health delivery system. There are deficits in the involvement of older adults in the required MHSA planning processes and in outreach and service delivery, workforce development, and outcomes measurement and reporting. There is also evidence of promising programs and strategies that counties have advanced to address these deficits. Recommendations for improving mental health services for older adults include designating a distinct administrative and leadership structure for older adult services in each county; enhancing older adult outreach and documentation of unmet need; promoting standardized geriatric training of providers; instituting standardized data-reporting requirements; and increasing service integration efforts, especially between medical, behavioral health, aging, and substance use disorder services.
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Affiliation(s)
| | | | | | | | - Homero E del Pino
- Department of Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine
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von Berenberg P, Dräger D, Zahn T, Neuwirth J, Kuhlmey A, Gellert P. Chronic conditions and use of health care service among German centenarians. Age Ageing 2017; 46:939-945. [PMID: 28164210 DOI: 10.1093/ageing/afx008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Received: 10/06/2016] [Indexed: 11/12/2022] Open
Abstract
Background there is limited data comparing conditions and health service use across care settings in centenarians. To improve health service delivery in centenarians, the aim of this study was to compare the proportion of centenarians who have chronic conditions, take medication and use health care services across different care settings. Methods this cohort study uses routine data from a major health insurance company serving Berlin, Germany and the surrounding region, containing almost complete information on health care transactions. The sample comprised all insured individuals aged 100 years and older (N = 1,121). Community-dwelling and institutionalised individuals were included. Charlson comorbidity index was based on 5 years of recordings. Hospital stays, medical specialist visits and medication prescribed in the previous year were analysed. Results while 6% of the centenarians did not receive any support; 45% received family homecare or homecare by professional care services; 49% were in long-term care. The most frequent conditions were dementia and rheumatic disease/arthritis, with the highest prevalence found among long-term care residents. A total of 97% of the centenarians saw a general practitioner in the previous year. Women were more often in long-term care and less often without any care. Centenarians with long-term care showed higher proportions of comorbidities, greater medication use, and more visits to medical specialists compared with centenarians in other care settings. Conclusions the higher prevalence of dementia and rheumatic disease/arthritis in long-term care compared to other care settings emphasises the role of these diseases in relation to the loss of physical and cognitive functioning.
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Affiliation(s)
- Petra von Berenberg
- Institute of Medical Sociology, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of General, Visceral and Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dagmar Dräger
- Institute of Medical Sociology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Zahn
- GeWINO-Health Research Institute, AOK Nordost, Berlin, Germany
| | - Julia Neuwirth
- GeWINO-Health Research Institute, AOK Nordost, Berlin, Germany
| | - Adelheid Kuhlmey
- Institute of Medical Sociology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Gellert
- Institute of Medical Sociology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Forma L, Jylhä M, Pulkki J, Aaltonen M, Raitanen J, Rissanen P. Trends in the use and costs of round-the-clock long-term care in the last two years of life among old people between 2002 and 2013 in Finland. BMC Health Serv Res 2017; 17:668. [PMID: 28927415 PMCID: PMC5606077 DOI: 10.1186/s12913-017-2615-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The structure of long-term care (LTC) for old people has changed: care has been shifted from institutions to the community, and death is being postponed to increasingly old age. The aim of the study was to analyze how the use and costs of LTC in the last two years of life among old people changed between 2002 and 2013. METHODS Data were derived from national registers. The study population contains all those who died at the age of 70 years or older in 2002-2013 in Finland (N = 427,078). The costs were calculated using national unit cost information. Binary logistic regression and Cox proportional hazard models were used to study the association of year of death with use and costs of LTC. RESULTS The proportion of those who used LTC and the sum of days in LTC in the last two years of life increased between 2002 and 2013. The mean number of days in institutional LTC decreased, while that for sheltered housing increased. The costs of LTC per user decreased. CONCLUSIONS Use of LTC in the last two years of life increased, which was explained by the postponement of death to increasingly old age. Costs of LTC decreased as sheltered housing replaced institutional LTC. However, an accurate comparison of costs of different types of LTC is difficult, and the societal costs of sheltered housing are not well known.
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Affiliation(s)
- Leena Forma
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
| | - Marja Jylhä
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
| | - Jutta Pulkki
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
| | - Mari Aaltonen
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
- Institute for Advanced Social Research, University of Tampere, Tampere, Finland
| | - Jani Raitanen
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
- UKK-Institute for Health Promotion, Tampere, Finland
| | - Pekka Rissanen
- Faculty of Social Sciences (health sciences) and Gerontology Research Center (GEREC), University of Tampere, 33014 Tampere, Finland
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Abstract
BACKGROUND Since the number of elderly people will rise in the years to come, knowledge about their health trends is important for social planning. The objective of this study was to investigate trends in health development among elderly people over 70 years in Nord-Trøndelag county. MATERIAL AD METHOD In the Nord-Trøndelag Health Study (HUNT) we have collected health data over three rounds: HUNT1 (1984 – 86), HUNT2 (1995 – 97) and HUNT3 (2006 – 08). Using cross-sectional analyses, we have studied changes in self-reported health, level of functioning and the use of health services. The material includes 12 391 persons (85 % participation) in HUNT1, 11 069 (69.3 % participation) in HUNT2 and 8 194 in HUNT3 (54.7 % participation). RESULTS Subjective health and activities of daily living (ADL functions) were assessed as better in HUNT3 than in HUNT2. Self-reported physical activity increased from HUNT1 to HUNT3. The use of home-help services decreased from HUNT2 to HUNT3, while the use of nursing homes and home nursing services remained unchanged. The use of general practitioner services increased in all periods, while the use of outpatient services increased strongly from HUNT1 to HUNT2. INTERPRETATION It appears that the elderly inhabitants of Nord-Trøndelag county feel that their health has improved and that they have become more self-reliant and more physically active in the period from 1984 to 2008, but the findings need to be interpreted with some caution due to the decline in the participation rate from HUNT1 to HUNT3.
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Aziz O, Klenk J, Schwickert L, Chiari L, Becker C, Park EJ, Mori G, Robinovitch SN. Validation of accuracy of SVM-based fall detection system using real-world fall and non-fall datasets. PLoS One 2017; 12:e0180318. [PMID: 28678808 PMCID: PMC5498034 DOI: 10.1371/journal.pone.0180318] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 05/08/2017] [Indexed: 11/18/2022] Open
Abstract
Falls are a major cause of injuries and deaths in older adults. Even when no injury occurs, about half of all older adults who fall are unable to get up without assistance. The extended period of lying on the floor often leads to medical complications, including muscle damage, dehydration, anxiety and fear of falling. Wearable sensor systems incorporating accelerometers and/or gyroscopes are designed to prevent long lies by automatically detecting and alerting care providers to the occurrence of a fall. Research groups have reported up to 100% accuracy in detecting falls in experimental settings. However, there is a lack of studies examining accuracy in the real-world setting. In this study, we examined the accuracy of a fall detection system based on real-world fall and non-fall data sets. Five young adults and 19 older adults went about their daily activities while wearing tri-axial accelerometers. Older adults experienced 10 unanticipated falls during the data collection. Approximately 400 hours of activities of daily living were recorded. We employed a machine learning algorithm, Support Vector Machine (SVM) classifier, to identify falls and non-fall events. We found that our system was able to detect 8 out of the 10 falls in older adults using signals from a single accelerometer (waist or sternum). Furthermore, our system did not report any false alarm during approximately 28.5 hours of recorded data from young adults. However, with older adults, the false positive rate among individuals ranged from 0 to 0.3 false alarms per hour. While our system showed higher fall detection and substantially lower false positive rate than the existing fall detection systems, there is a need for continuous efforts to collect real-world data within the target population to perform fall validation studies for fall detection systems on bigger real-world fall and non-fall datasets.
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Affiliation(s)
- Omar Aziz
- Injury Prevention and Mobility Laboratory, Simon Fraser University, Burnaby, British Columbia, Canada
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
- * E-mail:
| | - Jochen Klenk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Lars Schwickert
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Bologna, Italy
| | - Clemens Becker
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Edward J. Park
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
| | - Greg Mori
- School of Computing Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Stephen N. Robinovitch
- Injury Prevention and Mobility Laboratory, Simon Fraser University, Burnaby, British Columbia, Canada
- School of Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
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Bae B, Choi BR, Song I. The impact of change from copayment to coinsurance on medical care usage and expenditure in outpatient setting in older Koreans. Int J Health Plann Manage 2017; 33:235-245. [PMID: 28370318 DOI: 10.1002/hpm.2416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Received: 02/27/2017] [Accepted: 03/02/2017] [Indexed: 11/07/2022] Open
Abstract
Patient cost-sharing change was implemented on August 1, 2007, for outpatient care in the clinic setting in Korea from copayment to coinsurance. This study aims to estimate the effect of the policy change on medical care usage and expenditure in older Koreans. By using national health insurance claims data from the Health Insurance Reimbursement Assessment Service, this study analyzed the entire 137 million claims for a total of approximately 4.1 million patients aged 60 to 69 years who had been diagnosed and/or treated for outpatient care in clinics from January 1, 2007, to December 31, 2008. Medical care usage was defined as the proportion of all beneficiaries in each group who visited clinics and the mean number of visit days per beneficiary. Medical care expenditure per visit day was expressed as total costs, reimbursed amount, and patient's out-of-pocket payment. Data on January through June of 2008 were analyzed as compared with the same months of 2007. Raw difference-in-difference and multiple regression analyses were performed. The interaction coefficients, which measured the impact of cost-sharing change, was -0.078 in model 1 and -0.039 in model 2 (P < .0001). In conclusion, a cost-sharing change from copayment to coinsurance reduced medical care usage and expenditure.
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Affiliation(s)
- Byoungjun Bae
- Bureau of Health Policy, Ministry of Health and Welfare, Sejong, South Korea
| | - Bo Ram Choi
- Department of Nursing, Yong-In Songdam College, Yongin-si, Gyeonggi-do, South Korea
| | - Inmyung Song
- Division of Risk Assessment and International Cooperation, Korea Centers for Disease Control and Prevention, Cheongju, South Korea
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Ewen HH, Washington TR, Emerson KG, Carswell AT, Smith ML. Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services. Int J Environ Res Public Health 2017; 14:ijerph14030330. [PMID: 28327507 PMCID: PMC5369165 DOI: 10.3390/ijerph14030330] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/13/2017] [Accepted: 03/17/2017] [Indexed: 11/29/2022]
Abstract
Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place.
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Affiliation(s)
- Heidi H Ewen
- Institute of Gerontology, College of Public Health, The University of Georgia, 102 Spear Road, Hudson Hall, Athens, GA 30602, USA.
- Department of Financial Planning, Housing, and Consumer Economics, The University of Georgia, Athens, GA 30602, USA.
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
| | | | - Kerstin G Emerson
- Institute of Gerontology, College of Public Health, The University of Georgia, 102 Spear Road, Hudson Hall, Athens, GA 30602, USA.
- Department of Health Policy and Management, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
| | - Andrew T Carswell
- Department of Financial Planning, Housing, and Consumer Economics, The University of Georgia, Athens, GA 30602, USA.
| | - Matthew Lee Smith
- Institute of Gerontology, College of Public Health, The University of Georgia, 102 Spear Road, Hudson Hall, Athens, GA 30602, USA.
- Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA 30602, USA.
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, College Station, TX 77843, USA.
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