Interventions to Prevent or Delay Long-Term Nursing Home Placement for Adults with Impairments—a Systematic Review of Reviews

Duan-Porter, Wei; Ullman, Kristen; Rosebush, Christina; McKenzie, Lauren; Ensrud, Kristine E.; Ratner, Edward; Greer, Nancy; Shippee, Tetyana; Gaugler, Joseph E.; Wilt, Timothy J

doi:10.1007/s11606-019-05568-5

Cited by 28 publications

(22 citation statements)

References 136 publications

(197 reference statements)

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“…4 Most recently, the VA launched the Choose Home Initiative to increase support for Veterans with substantial impairments so that they can remain in community settings. 63 Our finding that unpaid caregivers of VHA users provided more hours of care over time relative to non-VHA users is contrary to other studies that have looked at the effect of publicly funded HCBS expansion efforts on unpaid care supply. 11 In the Canadian context, Stabile et al 11 found that increased access to publicly provided home care resulted in a decrease in unpaid care provision.…”

Section: Discussioncontrasting

confidence: 99%

Long‐term care service mix in the Veterans Health Administration after home care expansion

Jacobs

Trivedi

Lorenz

et al. 2021

Health Services Research

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Objective: To determine whether the Veterans Health Administration's (VHA) efforts to expand access to home-and community-based services (HCBS) after the 2001 Millennium Act significantly changed Veterans' utilization of institutional, paid home, and unpaid home care relative to a non-VHA user Medicare population that was not exposed to HCBS expansion efforts.Data Sources: We used linkages between the Health and Retirement Study and VHA administrative data from 1998 until 2012. Study Design:We conducted a retrospective-matched cohort study using coarsened exact matching to ensure balance on observable characteristics for VHA users (n = 943) and nonusers (n = 6106). We used a difference-in-differences approach with a person fixed-effects estimator.Data Collection/Extraction Methods: Individuals were eligible for inclusion in the analysis if they were age 65 or older and indicated that they were covered by Medicare insurance in 1998. Individuals were excluded if they were covered by Medicaid insurance at baseline. Individuals were considered exposed to VHA HCBS expansion efforts if they were enrolled in the VHA and used VHA services.Principal Findings: Theory predicts that an increase in the public allocation of HCBS will decrease the utilization of its substitutes (e.g., institutional care and unpaid caregiving). We found that after the Millennium Act was passed, there were no observed differences between VHA users and nonusers in the probability of using institutional long-term care (0.7% points, 95% CI: À0.009, 0.022) or in receiving paid help with activities of daily living (0.06% points, 95% CI: À0.011, 0.0125). VHA users received more hours of unpaid care post-Millennium Act (1.48, 95% CI: À0.232, 3.187), though this effect was not significant once we introduced controls for mental health.Conclusions: Our findings indicate that mandating access to HCBS services does not necessarily imply that access to these services will follow suit.

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Section: Discussioncontrasting

confidence: 99%

Long‐term care service mix in the Veterans Health Administration after home care expansion

Jacobs

Trivedi

Lorenz

et al. 2021

Health Services Research

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“…On this basis, the implementation of flexible, tailored interventions addressing the specific circumstances of the caregiving situation to delay a transition or assure a well‐timed and well‐organized transition should be a long‐term goal of health politics. Effective strategies exist with intervention programs such as case management, caregiver support and preventive home visits as shown by a recent review of Duan‐Porter et al 7 …”

Section: Discussionmentioning

confidence: 99%

“…In the international literature, determinants of institutionalization were investigated frequently. In the past decade, research was summarized by a number of systematic reviews focusing on determinants of the elderly population in general, 3 of elderly individuals with dementia, 4,5 on frailty as predictor of NH placement (NHP), 6 as well as by an umbrella review on potentially modifiable risk factors of NHP 7 . Key findings showed transition to a NH is mainly based on cognitive and/or functional impairment, a poor health status, a lack of social support, a higher caregivers distress or poor health status.…”

Section: Introductionmentioning

confidence: 99%

Correlates of institutionalization among the oldest old—Evidence from the multicenter AgeCoDe‐AgeQualiDe study

Hajek

Luppa

Brettschneider

et al. 2021

Int J Geriat Psychiatry

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Objectives There is a lack of studies identifying the correlates of institutionalization specifically among the oldest old. Therefore, our aim was to fill this gap in knowledge. Methods Cross‐sectional data (Follow up wave 9; n = 633 observations in the analytical sample) were used from the multicenter prospective cohort study “Needs, health service use, costs and health‐related quality of life in a large sample of oldest‐old primary care patients (85+)” Correlates of institutionalization among the oldest old—Evidence from a multicenter cohort study. The sample consists of primary care patients aged 86 years and over (mean 90.5 years, SD: 2.9 years). Sociodemographic and health‐related independent variables were included in our regression model. Institutionalization was defined as living in a nursing home or an old‐age home (not including assisted living facilities). Results Out of the 633 participants, 502 individuals (79.3%) did not live in an institutionalized setting, whereas 73 individuals (20.7%) lived in an institutionalized setting. Multiple logistic regressions showed that the likelihood of institutionalization increased with being divorced/widowed/single (compared to being married; OR: 5.35 [95% CI: 1.75–16.36]), the presence of social isolation (OR: 2.07 [1.20–3.59]), more depressive symptoms (OR: 1.11 [1.01–1.23]), increased cognitive impairment (OR: 1.67 [1.31–2.15]) and higher levels of frailty (OR: 1.48 [1.07–2.06]). Conclusion The study findings identified various sociodemographic and health‐related factors associated with institutionalization among the oldest old. Longitudinal studies are required to gain further insights into these associations.

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“…Our study showed however that many of the older persons in the PA group still had moderate ADLimpairment and often needs for IADL-assistance as well as mild cognitive impairment. As they were also at risk of institutionalization, interventions designed to avoid early nursing home admission should target persons with similar levels of impairment as well [38,39]. In addition, persons in the lowest levels of ADL, IADL and cognitive impairment could still be in need of help because of loneliness or depressive symptoms..…”

Section: Discussionmentioning

confidence: 99%

Comparing the case-mix of frail older people at home and of those being admitted into residential care: a longitudinal study

Mello¹,

Cès

Vanneste³

et al. 2020

BMC Geriatr

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Background: In order to optimize interventions and services in the community, it is important to identify the profile of persons who are able to stay at home and of those who are being admitted into residential care. Understanding their needs and their use of resources is essential. The main objective of the study is to identify persons who are likely to enter residential care based upon their needs and resource utilization, so that care providers can plan interventions effectively and optimize services and resources to meet the persons' needs. Methods: This is a longitudinal quasi-experimental study. The data consists of primary data from the community setting collected every six months during the period of 2010-2016. Interventions had the goal of keeping older people longer at home. Participants were at least 65 years old and were living in the community. The interRAI Resource Utilization Group system (RUG-III) was used to calculate the case-mix indexes (CMI) of all participants. Comparisons were made between the case-mix of those who were still living at home and those who were admitted into residential care at follow-up. Results: A total of 10,289 older persons participated in the study (81.2 ± 7.1 yrs., 69.1% female). From this population, 853 participants (8.3%) were admitted into residential care. The CMI of the persons receiving night care at home were the highest (1.6 at baseline and 1.7 at the entry point of residential care), followed by persons receiving occupational therapy (1.5 at baseline and 1.6 at the entry point of residential care) and persons enrolled in case management interventions with rehabilitation (1.4 at baseline and 1.6 at the entry point of residential care). The CMIs at follow-up were significantly higher than at baseline and the linear regression model showed that admission to residential care was a significant factor in the model.

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Interventions to Prevent or Delay Long-Term Nursing Home Placement for Adults with Impairments—a Systematic Review of Reviews

Cited by 28 publications

References 136 publications

Long‐term care service mix in the Veterans Health Administration after home care expansion

Long‐term care service mix in the Veterans Health Administration after home care expansion

Correlates of institutionalization among the oldest old—Evidence from the multicenter AgeCoDe‐AgeQualiDe study

Comparing the case-mix of frail older people at home and of those being admitted into residential care: a longitudinal study

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