Association of dementia with early rehospitalization among Medicare beneficiaries

Daiello, Lori A.; Gardner, Rebekah; Epstein‐Lubow, Gary; Butterfield, Kristen; Gravenstein, Stefan

doi:10.1016/j.archger.2014.02.010

Cited by 71 publications

(147 citation statements)

References 33 publications

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“…Facilitating care transitions for cognitively impaired older adult patients is vital for the well being of patients and their caregivers. Cognitively impaired older adults are at higher risk than their counterparts for hospital readmission and negative outcomes during a care transition (Daiello, Gardner, Epstein-Lubow, Butterfield, & Gravenstein, 2014). This is in part due to the unique needs of these patients and the unique challenges of providing transitional care for them.…”

Section: Discussionmentioning

confidence: 99%

Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities

Prusaczyk

Cherney

Carpenter

et al. 2016

Clinical Gerontologist

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Introduction Due to issues related to informed research consent, older adults with cognitive impairments are often excluded from high-quality studies that are not directly related to cognitive impairment, which has led to a dearth of evidence for this population. The challenges to including cognitively impaired older adults in research and the implications of their exclusion are a transdisciplinary issue. Discussion The ethical challenges and logistical barriers to conducting research with cognitively impaired older adults are addressed from the perspectives of three different fields – social work, emergency medicine, and orthopaedic surgery. Issues related to funding, study design, intervention components, and outcomes are discussed through the unique experiences of three different providers. Clinical Implications A fourth perspective – medical research ethics – provides alternatives to exclusion when conducting research with cognitively impaired older adults such as timing, corrective feedback and plain language, and capacity assessment and proxy appointments. Given the increasing aging population and the lack of evidence on cognitively impaired older adults, it is critical that researchers, funders, and institutional review boards not be dissuaded from including this population in research studies.

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Section: Discussionmentioning

confidence: 99%

Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities

Prusaczyk

Cherney

Carpenter

et al. 2016

Clinical Gerontologist

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“…One checklist is for evaluating observational cohort and cross-sectional studies, 14 32 Sixteen studies were observational, that is, one longitudinal, 20 four prospective, 9,21,24,28 and 11 retrospective. 17,27 Studies were conducted at different levels in terms of sample scales, including three national-level, 22,24,25 four state or regional, 8,18,30,31 four multisite, 16,17,19,26 and eight single-site studies. 17,27 Studies were conducted at different levels in terms of sample scales, including three national-level, 22,24,25 four state or regional, 8,18,30,31 four multisite, 16,17,19,26 and eight single-site studies.…”

Section: Quality Appraisal Of Reviewed Studiesmentioning

confidence: 99%

“…8,16,18,19,22,23,25,[29][30][31][32] Three were intervention studies, that is, one randomized controlled trial (RCT) 26 and two quasiexperimental studies. 9,20,21,23,[27][28][29]32 Various data sources were used, including patient medical records (n = 12, 67%), 9,16,17,[19][20][21]23,[26][27][28][29]31,32 billing and/or claims files (n = 6, 33%), 8,16,18,20,22,25 registry data (n = 5, 28%), 9,16,24,30,31 and surveys and/or interviews (n = 9, 50%). 9,20,21,23,[27][28]…”

Section: Quality Appraisal Of Reviewed Studiesmentioning

confidence: 99%

Hospital readmission in persons with dementia: A systematic review

Bao

Dull

et al. 2019

Int J Geriat Psychiatry

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Objective Hospital readmission in persons with dementia is becoming a critical safety and cost issue. The purpose of this review is to systematically assess published evidence on hospital readmissions in persons with dementia, including rate, clinical reasons, risk factors, and prevention programs. Methods A systematic review of relevant literature was conducted. Literature were searched in PubMed, CINAHL, PsycINFO, and Embase as well as hand searching. Quality of reviewed studies were assessed independently by reviewers using quality assessment checklists. Results Nineteen studies met the inclusion criteria and were reviewed. In persons with dementia, all‐cause 30‐day readmission rate was most frequently reported and ranged from 7% to 35%. Compared with those without dementia, persons with dementia had significantly higher rate of readmission. Reported risk factors of readmission varied across studies from patient sociodemographic and clinical status, history of health care utilization, to family caregivers. Reasons for readmission were rarely documented. Programs of home‐based individualized care and interdisciplinary team care were used for preventing readmissions. Findings from some of the studies were limited by small sample sizes, single data source, and other methodologic flaws. Conclusions Persons with dementia are at high risk for hospital readmission, but many of the readmissions are potentially preventable. Multiple strategies such like identifying high‐risk individuals and the clinical reasons for index admission and readmission and implementing home‐based individualized care by interdisciplinary team can reduce preventable hospital readmissions. Future studies should use multiple national data sources and advanced methodology to identify risk factors and clinical reasons of hospital readmissions.

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“…These complications put them at increased risk for hospital-acquired disability (manifest in loss of activities of daily living [ADL] function and mobility), and increased morbidity/mortality [5,6]. During the postacute period, persons with dementia are more likely to experience protracted delirium and increased care dependency [7,8] with lower quality of life for both themselves and their family caregivers (FCGs) [9,10]. Consequently, they utilize more postacute care [1] and are at increased risk for rehospitalizations, transitions to long-term nursing home stays and mortality than persons without dementia [6,8].…”

mentioning

confidence: 99%

Testing Family-Centered, Function-Focused Care in Hospitalized Persons with Dementia

Boltz

Chippendale

Resnick

et al. 2015

Neurodegener. Dis. Manag.

139

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Summary Aim Hospital-acquired disability causes decreased quality of life for patients with dementia and family caregivers, and increased societal costs. Materials & methods A comparative, repeated measures study tested the feasibility and preliminary efficacy of the family-centered, function-focused care intervention (Fam-FFC) in dyads of hospitalized, medical patients with dementia and family caregivers (FCGs). Results The intervention group demonstrated better activities of daily living and walking performance, and less severity/duration of delirium and hospital readmissions, but no significant differences in gait/balance. FCGs showed increased preparedness for caregiving and less anxiety but no significant differences in depression, strain and mutuality. Conclusion Fam-FFC presents a possible pathway to meeting the Triple Aim of improved patient care, improved patient health and reduced costs for persons with dementia.

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Association of dementia with early rehospitalization among Medicare beneficiaries

Cited by 71 publications

References 33 publications

Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities

Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities

Hospital readmission in persons with dementia: A systematic review

Testing Family-Centered, Function-Focused Care in Hospitalized Persons with Dementia

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