Health care transitions for persons living with dementia and their caregivers

Abstract

Background Persons with dementia are likely to require care from various health care providers in multiple care settings, necessitating navigation through an often-fragmented care system. This study aimed to create a better understanding of care transition experiences from the perspectives of persons living with dementia and their caregivers in Ontario, Canada, through the development of a theoretical framework. Methods Constructivist grounded theory guided the study. Seventeen individual caregiver interviews, and 12 dyad interviews including persons with dementia and their caregivers, were recorded and transcribed verbatim. The data were coded using NVivo 10 software; analysis occurred iteratively until saturation was reached. Results A theoretical framework outlining the context, processes, and influencing factors of care transitions was developed and refined. Gaining an in-depth understanding of the complex care transitions of individuals with dementia and their caregivers is an important step in improving the quality of care and life for this population. Conclusion The framework developed in this study provides a focal point for efforts to improve the health care transitions of persons living with dementia.

A Systematic Review of the Needs of Dementia Caregivers Across Care Settings

“…58 Furthermore, older persons living with dementia require more frequent medical care across multiple different care settings as compared to those without cognitive impairment, mainly due to the progressive nature of dementia and higher rate of comorbidities. 3,4 Even though many still live at home, they are hospitalized more frequently than those without cognitive impairment and experience transitions between different care settings such as inpatient, skilled nursing facilities, and long-term care, after which they often return back home. 4 For these reasons, it is essential that more research focus on caregivers' needs across the various care settings.…”

“…2 Older persons living with dementia, as compared to those without cognitive impairment, require more frequent care from providers across multiple care settings, such as skilled nursing facilities, long-term care, and at home. 3,4 As a result, older persons living with dementia frequently transition between care settings, due in part to the progressive nature of dementia and the common occurrence of comorbidities. 3 Older persons living with dementia experience more transitions between care settings than those without cognitive impairment, and each transition involves challenges and risks for the older person and their caregiver, such as duplication of services and medical errors.…”

“…3,4 As a result, older persons living with dementia frequently transition between care settings, due in part to the progressive nature of dementia and the common occurrence of comorbidities. 3 Older persons living with dementia experience more transitions between care settings than those without cognitive impairment, and each transition involves challenges and risks for the older person and their caregiver, such as duplication of services and medical errors. 4 Frequent transitions can be problematic for older persons living with dementia, and family and unpaid caregivers must also adapt to transitions between care settings in addition to progression of the disease.…”

Interprofessional collaboration in palliative dementia care through the eyes of informal caregivers

“…Without optimal coordination between the care settings (e.g. referrals, collaboration and information transfer) ( Ashbourne, Boscart, Meyer, Tong, & Stolee, 2021 ), these nursing home transitions are susceptible to adverse outcomes such as miscommunication and medication errors ( Callahan et al, 2012 ). Known effective components for an optimal nursing home transition for persons with dementia include: (1) shared decision-making; (2) preparing and supporting the person with dementia and their informal caregivers for the nursing home transition; (3) collecting all information of the person with dementia; (4) transferring information between the care settings; (5) using this information to prepare the welcome of the person with dementia and their informal caregivers; (6) performing follow-up by healthcare professionals from HC; and (7) assisting in adjusting to a new environment by healthcare professionals from nursing home ( Ashbourne et al, 2021 ; Coleman, 2003 ; Garvelink et al, 2019 ; Groenvynck et al, 2021 ).…”

Sensory Processing Abnormalities in Community-Dwelling Older Adults with Cognitive Impairment: A Mixed Methods Study

“…A person-centered approach toward tailoring environmental adaptation to support behavior may be most advantageous due to the unique complexities involved in the situational contexts of the home environment ( Hung et al, 2016 ; Wang et al, 2019 ). Further, communication of such preference, if relocation to institutional care is warranted, may improve transition and integration into the new living environment ( Ashbourne et al, 2021 ).…”