Transitions in Care in a Nationally Representative Sample of Older Americans with Dementia

Christopher M. Callahan, Wanzhu Tu, Kathleen T. Unroe, Michael A. LaMantia, Timothy E. Stump, Daniel O. Clark

Research output: Contribution to journalArticle

31 Scopus citations


Objectives To describe transitions in care for older adults with dementia identified from a nationally representative cohort and to describe transition rates in those with more-severe levels of cognitive and functional impairment. Design Longitudinal cohort study. Setting Health and Retirement Study (HRS). Participants HRS respondents aged 65 and older whose survey data were linked with Medicare claims from 1999 to 2008 (N = 16,186). Measurements Transitions in care between home, home with formal services, hospital, and nursing facility care; cognitive function; activities of daily living; and mortality. Results The 3,447 (21.3%) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Of subjects transitioning from a hospital stay, 52.2% returned home without home care services, and 33.8% transitioned to a nursing facility. Of subjects transitioning from a nursing facility, 59.2% transitioned to the hospital, and 25.3% returned home without services. There were 2,139 transitions to death, and 58.7% of HRS subjects with dementia died at home. Even in persons with moderate to severe dementia, multiple transitions in care were documented, including transitions from the hospital to home and back to the hospital. Conclusion In this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in function and cognition.

Original languageEnglish (US)
Pages (from-to)1495-1502
Number of pages8
JournalJournal of the American Geriatrics Society
Issue number8
StatePublished - Aug 1 2015


  • dementia
  • elder care
  • transitions

ASJC Scopus subject areas

  • Geriatrics and Gerontology

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