Skilled Nursing Facility-to-Home Trajectories for Older Adults With Mental Illness or Dementia

The impact of facility-based transitional care programs on function and discharge destination for older adults with cognitive impairment: a systematic review

“…Among the included studies, 14 (64%) were completed in the United States [ 42 , 44 – 48 , 51 , 52 , 54 , 55 , 57 , 58 , 62 , 63 ], two (9%) in Australia [ 38 , 53 ], and one (5%) each in Hong Kong [ 30 ], Italy [ 59 ], Japan [ 56 ], Norway [ 60 ], Singapore [ 61 ], and Taiwan [ 29 ]. Eighteen of the 22 articles (82%) were cohort studies, with 13 (59%) being retrospective cohort studies [ 38 , 42 , 44 , 46 , 48 , 51 , 52 , 55 , 57 – 59 , 61 , 62 ] and five (23%) prospective cohort studies [ 29 , 30 , 45 , 60 , 63 ]. There were also three (14%) cross-sectional studies [ 47 , 53 , 54 ] and one (5%) retrospective study design for data from a cross-sectional survey [ 56 ].…”

“…There were a variety of settings where the TCPs were conducted, with skilled nursing facilities being the most common ( n = 9) [ 42 , 44 , 45 , 51 , 52 , 54 , 58 , 62 , 63 ]. Other settings included nursing homes ( n = 7) [ 38 , 46 – 48 , 55 , 57 , 60 ]; a subacute ward in a hospital ( n = 2) [ 59 , 61 ]; a community hospital-based post-acute care unit ( n = 1) [ 29 ]; a post-acute convalescence unit ( n = 1) [ 30 ]; a transition care facility ( n = 1) [ 53 ] and geriatric intermediate care facilities ( n = 1) [ 56 ].…”

“…One study included both care coordinators and allied health specialists [ 61 ] and one study involved a podiatrist [ 53 ]. Services provided in the TCPs were reported in ten out of the 20 studies [ 29 , 30 , 38 , 46 , 52 , 56 , 57 , 59 – 61 ] and most involved therapies to improve physical function [ 29 , 30 , 38 , 56 , 57 , 60 ]. Services included customised low-intensity therapies to increase physical, cognitive, and psychosocial function [ 38 ]; a physical reablement program through daily physiotherapy and occupational therapy sessions, exercise and ADL assistance, nutrition consultation, medication reconciliation, social worker visit on admission and as needed [ 29 ]; non-pharmacologic and pharmacological approaches to patients with dementia and challenging neuropsychiatric symptoms [ 61 ]; nursing care [ 46 , 56 , 57 , 59 ] or treatment [ 60 ] or post-acute care [ 52 ] and rehabilitation [ 46 , 52 , 56 , 57 , 60 ]; 2 h daily, 5 days per week of mobility and ADL training [ 30 ]; and 180 min of direct nursing care [ 59 ].…”

“…Eight studies reported outcomes for older adults with dementia [ 29 , 38 , 48 , 51 , 52 , 54 , 56 , 61 ]; six studies for older adults with CI [ 44 , 46 , 53 , 58 , 60 , 62 ]; three studies for older adults with CI and dementia [ 30 , 47 , 57 ]; two studies for older adults with delirium [ 42 , 45 ]; two studies for older adults with delirium and dementia [ 55 ]; and one study for older adults with delirium and subsyndromal delirium [ 63 ]. Delirium was most often measured using the Confusion Assessment Method [ 45 , 55 ].…”

“…In comparison, for participants without CI, between 55.1% [ 55 ] and 73% [ 63 ] were discharged home, 13% were discharged to hospital [ 63 ], and 2.7% to 3.5% [ 54 ] were discharged to long-term care. Moreover, participants with dementia in facility-based TCPs were less likely to be discharged to home (adjusted odds ratio (aOR) 0.53 [ 28 ] and aOR 0.4 [ 52 ]) compared to participants without dementia. Finally, participants with CI were less likely to be discharged home (odds ratio (OR) 0.46), more likely to be discharged to the nursing home or be deceased after two months (OR 2.95), and more likely to transfer to another TCP after two months (OR 1.96), compared to those without CI [ 60 ].…”