Transitions in care for older adults with and without dementia

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Abstract

Objectives To describe transitions in care of persons with dementia with attention to nursing facility transitions. Design Prospective cohort. Setting Public health system. Participants Four thousand one hundred ninety-seven community-dwelling older adults. Measurements Participants' electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Data Set (MDS), and the Outcome and Assessment Information Set (OASIS) from 2001 to 2008 with a mean follow-up of 5.2 years from the time of enrollment. Results Older adults with prevalent (n = 524) or incident (n = 999) dementia had greater Medicare (44.7% vs 44.8% vs 11.4%, P <.001) and Medicaid (21.0% vs 16.8% vs 1.4%, P <.001) nursing facility use, greater hospital (76.2% vs 86.0% vs 51.2%, P <.001) and home health (55.7% vs 65.2% vs 27.3%, P <.001) use, more transitions in care per person-year of follow-up (2.6 vs 2.7 vs 1.4, P <.001), and more mean total transitions (11.2 vs 9.2 vs 3.8, P <.001) than those who were never diagnosed (n = 2,674). For the 1,523 participants with dementia, 74.5% of transitions to nursing facilities were transfers from hospitals. For transitions from nursing facilities, the conditional probability was 41.0% for a return home without home health care, 10.7% for home health care, and 39.8% for a hospital transfer. Of participants with dementia with a rehospitalization within 30 days, 45% had been discharged to nursing facilities from the index hospitalization. At time of death, 46% of participants with dementia were at home, 35% were in the hospital, and 19% were in a nursing facility. Conclusion Individuals with dementia live and frequently die in community settings. Nursing facilities are part of a dynamic network of care characterized by frequent transitions.

Original languageEnglish
Pages (from-to)813-820
Number of pages8
JournalJournal of the American Geriatrics Society
Volume60
Issue number5
DOIs
StatePublished - May 2012

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Dementia
Nursing
Medicaid
Home Care Services
Medicare
Delivery of Health Care
Independent Living
Electronic Health Records
Transitional Care
Hospitalization
Public Health
Outcome Assessment (Health Care)
Health

Keywords

  • Alzheimer's disease
  • healthcare utilization
  • nursing facilities
  • transitions in care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

@article{4e13e903f01c4eaa8e32211f018bdfd0,
title = "Transitions in care for older adults with and without dementia",
abstract = "Objectives To describe transitions in care of persons with dementia with attention to nursing facility transitions. Design Prospective cohort. Setting Public health system. Participants Four thousand one hundred ninety-seven community-dwelling older adults. Measurements Participants' electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Data Set (MDS), and the Outcome and Assessment Information Set (OASIS) from 2001 to 2008 with a mean follow-up of 5.2 years from the time of enrollment. Results Older adults with prevalent (n = 524) or incident (n = 999) dementia had greater Medicare (44.7{\%} vs 44.8{\%} vs 11.4{\%}, P <.001) and Medicaid (21.0{\%} vs 16.8{\%} vs 1.4{\%}, P <.001) nursing facility use, greater hospital (76.2{\%} vs 86.0{\%} vs 51.2{\%}, P <.001) and home health (55.7{\%} vs 65.2{\%} vs 27.3{\%}, P <.001) use, more transitions in care per person-year of follow-up (2.6 vs 2.7 vs 1.4, P <.001), and more mean total transitions (11.2 vs 9.2 vs 3.8, P <.001) than those who were never diagnosed (n = 2,674). For the 1,523 participants with dementia, 74.5{\%} of transitions to nursing facilities were transfers from hospitals. For transitions from nursing facilities, the conditional probability was 41.0{\%} for a return home without home health care, 10.7{\%} for home health care, and 39.8{\%} for a hospital transfer. Of participants with dementia with a rehospitalization within 30 days, 45{\%} had been discharged to nursing facilities from the index hospitalization. At time of death, 46{\%} of participants with dementia were at home, 35{\%} were in the hospital, and 19{\%} were in a nursing facility. Conclusion Individuals with dementia live and frequently die in community settings. Nursing facilities are part of a dynamic network of care characterized by frequent transitions.",
keywords = "Alzheimer's disease, healthcare utilization, nursing facilities, transitions in care",
author = "Christopher Callahan and Gregory Arling and Wanzhu Tu and Marc Rosenman and Steven Counsell and Stump, {Timothy E.} and Hugh Hendrie",
year = "2012",
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language = "English",
volume = "60",
pages = "813--820",
journal = "Journal of the American Geriatrics Society",
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T1 - Transitions in care for older adults with and without dementia

AU - Callahan, Christopher

AU - Arling, Gregory

AU - Tu, Wanzhu

AU - Rosenman, Marc

AU - Counsell, Steven

AU - Stump, Timothy E.

AU - Hendrie, Hugh

PY - 2012/5

Y1 - 2012/5

N2 - Objectives To describe transitions in care of persons with dementia with attention to nursing facility transitions. Design Prospective cohort. Setting Public health system. Participants Four thousand one hundred ninety-seven community-dwelling older adults. Measurements Participants' electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Data Set (MDS), and the Outcome and Assessment Information Set (OASIS) from 2001 to 2008 with a mean follow-up of 5.2 years from the time of enrollment. Results Older adults with prevalent (n = 524) or incident (n = 999) dementia had greater Medicare (44.7% vs 44.8% vs 11.4%, P <.001) and Medicaid (21.0% vs 16.8% vs 1.4%, P <.001) nursing facility use, greater hospital (76.2% vs 86.0% vs 51.2%, P <.001) and home health (55.7% vs 65.2% vs 27.3%, P <.001) use, more transitions in care per person-year of follow-up (2.6 vs 2.7 vs 1.4, P <.001), and more mean total transitions (11.2 vs 9.2 vs 3.8, P <.001) than those who were never diagnosed (n = 2,674). For the 1,523 participants with dementia, 74.5% of transitions to nursing facilities were transfers from hospitals. For transitions from nursing facilities, the conditional probability was 41.0% for a return home without home health care, 10.7% for home health care, and 39.8% for a hospital transfer. Of participants with dementia with a rehospitalization within 30 days, 45% had been discharged to nursing facilities from the index hospitalization. At time of death, 46% of participants with dementia were at home, 35% were in the hospital, and 19% were in a nursing facility. Conclusion Individuals with dementia live and frequently die in community settings. Nursing facilities are part of a dynamic network of care characterized by frequent transitions.

AB - Objectives To describe transitions in care of persons with dementia with attention to nursing facility transitions. Design Prospective cohort. Setting Public health system. Participants Four thousand one hundred ninety-seven community-dwelling older adults. Measurements Participants' electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Data Set (MDS), and the Outcome and Assessment Information Set (OASIS) from 2001 to 2008 with a mean follow-up of 5.2 years from the time of enrollment. Results Older adults with prevalent (n = 524) or incident (n = 999) dementia had greater Medicare (44.7% vs 44.8% vs 11.4%, P <.001) and Medicaid (21.0% vs 16.8% vs 1.4%, P <.001) nursing facility use, greater hospital (76.2% vs 86.0% vs 51.2%, P <.001) and home health (55.7% vs 65.2% vs 27.3%, P <.001) use, more transitions in care per person-year of follow-up (2.6 vs 2.7 vs 1.4, P <.001), and more mean total transitions (11.2 vs 9.2 vs 3.8, P <.001) than those who were never diagnosed (n = 2,674). For the 1,523 participants with dementia, 74.5% of transitions to nursing facilities were transfers from hospitals. For transitions from nursing facilities, the conditional probability was 41.0% for a return home without home health care, 10.7% for home health care, and 39.8% for a hospital transfer. Of participants with dementia with a rehospitalization within 30 days, 45% had been discharged to nursing facilities from the index hospitalization. At time of death, 46% of participants with dementia were at home, 35% were in the hospital, and 19% were in a nursing facility. Conclusion Individuals with dementia live and frequently die in community settings. Nursing facilities are part of a dynamic network of care characterized by frequent transitions.

KW - Alzheimer's disease

KW - healthcare utilization

KW - nursing facilities

KW - transitions in care

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