Care of community-dwelling older adults with dementia and their caregivers

Warrick, Natalie; Prorok, Jeanette C.; Seitz, Dallas

doi:10.1503/cmaj.170920

Cited by 13 publications

(7 citation statements)

References 55 publications

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“…Regarding the contribution of Andersen’s model predisposing factors to the explanation of forgone care, our study showed, similar to others [ 33 , 35 ], that having lower education was associated with increased forgone care for both caregivers and care-receivers. Although none of the examined enabling factors were associated with forgone care for the person with dementia, participants reporting lower levels of income had an increased likelihood to forgo care for themselves.…”

Section: Discussionsupporting

confidence: 89%

Examining Dementia Family Caregivers’ Forgone Care for General Practitioners and Medical Specialists during a COVID-19 Lockdown

Werner

Tur‐Sinai

AboJabel

2021

IJERPH

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The present study aimed to assess dementia caregivers’ reports of the prevalence and correlates of forgone care regarding visits to a general practitioner (GP) and to a specialist during the COVID-19 lockdown in Israel, using Andersen’s Behavioral Model of Healthcare Utilization. A cross-sectional study using an online survey was conducted with 73 Israeli family caregivers of persons with dementia residing in the community (81% Jews, 86% female, mean age = 54). Overall, one out of two participants reported having to delay seeking needed help from a GP or a specialist for themselves, as well as for their relatives with dementia, during the COVID-19 lockdown period. Among the predisposing factor, education was associated with caregivers’ reports regarding forgone care for themselves as well as for their loved ones. Living with the care-receiver and income level were the enabling factors associated with forgone care for caregivers. Finally, feelings of burden were associated with caregivers’ forgone care and feelings of loneliness and perceptions of the care-receiver’s cognitive functioning were associated with care-receivers’ forgone care. Our findings show that it is essential that this population receive appropriate practical and emotional support at times of distress and crisis to enable them to continue with their caregiving role.

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Section: Discussionsupporting

confidence: 89%

Examining Dementia Family Caregivers’ Forgone Care for General Practitioners and Medical Specialists during a COVID-19 Lockdown

Werner

Tur‐Sinai

AboJabel

2021

IJERPH

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“…For older adults receiving home care on a long-stay basis, a population at high risk of potentially inappropriate care transitions and associated adverse outcomes,2 3 we showed that the likelihood for LTC admission and death (but not urgent hospitalisation) for clients with compared with those without dementia was significantly modified by their frailty status. Given projected increases in the prevalence of both dementia and frailty,1 21 future work should examine the extent to which the quality, appropriateness and outcomes of health and social care services vary for persons with dementia43 and with varying degrees of frailty.…”

Section: Discussionmentioning

confidence: 99%

Joint impact of dementia and frailty on healthcare utilisation and outcomes: a retrospective cohort study of long-stay home care recipients

et al. 2019

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ObjectivesTo examine the associations between dementia and 1-year health outcomes (urgent hospitalisation, long-term care (LTC) admission, mortality) among long-stay home care recipients and the extent to which these associations vary by clients’ frailty level.DesignA retrospective cohort study using linked clinical and health administrative databases.SettingHome care in Ontario, Canada.ParticipantsLong-stay (≥60 days) care clients (n=153 125) aged ≥50 years assessed between April 2014 and March 2015.Main outcome measuresDementia was ascertained with a validated administrative data algorithm and frailty with a 66-item frailty index (FI) based on a previously validated FI derived from the clinical assessment. We examined associations between dementia, FI and their interactions, with 1-year outcomes using multivariable Fine-Gray competing risk (urgent hospitalisation and LTC admission) and Cox proportional hazards (mortality) models.ResultsClients with dementia (vs without) were older (mean±SD, 83.3±7.9 vs 78.9±11.3 years, p<0.001) and more likely to be frail (30.3% vs 24.2%, p<0.001). In models adjusted for FI (as a continuous variable) and other confounders, clients with dementia showed a lower incidence of urgent hospitalisation (adjusted subdistribution HR (sHR)=0.84, 95% CI: 0.83 to 0.86) and mortality rate (adjusted HR=0.87, 95% CI: 0.84 to 0.89) but higher incidence of LTC admission (adjusted sHR=2.60, 95% CI: 2.53 to 2.67). The impact of dementia on LTC admission and mortality was significantly modified by clients’ FI (p<0.001 interaction terms), showing a lower magnitude of association (ie, attenuated positive (for LTC admission) and negative (for mortality) association) with increasing frailty.ConclusionsThe strength of associations between dementia and LTC admission and death (but not urgent hospitalisation) among home care recipients was significantly modified by their frailty status. Understanding the public health impact of dementia requires consideration of frailty levels among older populations, including those with and without dementia and varying degrees of multimorbidity.

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“…In 2015, 46 million people in the world had dementia; this number is expected to double every 20 years as the global population ages, reaching 131.5 million by 2050 [ 1 ]. Up to 70% of older adults with dementia live in private community dwellings [ 2 ] and the majority of their care is provided by primary care physicians (PCPs) [ 3 , 4 ]. Caring for older adults with dementia is complex; most have numerous medical comorbidities and are more likely to experience adverse side effects to commonly prescribed medicines [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Primary care physician volume and quality of care for older adults with dementia: a retrospective cohort study

et al. 2021

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Background Some jurisdictions restrict primary care physicians’ daily patient volume to safeguard quality of care for complex patients. Our objective was to determine whether people with dementia receive lower-quality care if their primary care physician sees many patients daily. Methods Population-based retrospective cohort study using health administrative data from 100,256 community-living adults with dementia aged 66 years or older, and the 8,368 primary care physicians who cared for them in Ontario, Canada. Multivariable Poisson GEE regression models tested whether physicians’ daily patient volume was associated with the adjusted likelihood of people with dementia receiving vaccinations, prescriptions for cholinesterase inhibitors, benzodiazepines, and antipsychotics from their primary care physician. Results People with dementia whose primary care physicians saw ≥ 30 patients daily were 32% (95% CI: 23% to 41%, p < 0.0001) and 25% (95% CI: 17% to 33%, p < 0.0001) more likely to be prescribed benzodiazepines and antipsychotic medications, respectively, than patients of primary care physicians who saw < 20 patients daily. Patients were 3% (95% CI: 0.4% to 6%, p = 0.02) less likely to receive influenza vaccination and 8% (95% CI: 4% to 13%, p = 0.0001) more likely to be prescribed cholinesterase inhibitors if their primary care physician saw ≥ 30 versus < 20 patients daily. Conclusions People with dementia were more likely to receive both potentially harmful and potentially beneficial medications, and slightly less likely to be vaccinated by high-volume primary care physicians.

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Care of community-dwelling older adults with dementia and their caregivers

Cited by 13 publications

References 55 publications

Examining Dementia Family Caregivers’ Forgone Care for General Practitioners and Medical Specialists during a COVID-19 Lockdown

Examining Dementia Family Caregivers’ Forgone Care for General Practitioners and Medical Specialists during a COVID-19 Lockdown

Joint impact of dementia and frailty on healthcare utilisation and outcomes: a retrospective cohort study of long-stay home care recipients

Primary care physician volume and quality of care for older adults with dementia: a retrospective cohort study

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