Predictors of Aged Residential Care Placement in Patients Newly Diagnosed with Dementia at a New Zealand Memory Service (original) (raw)
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Predictors of Residential Care Admission in Community-Dwelling Older People With Dementia
Journal of the American Medical Directors Association, 2020
Objectives: The objectives of this study were to identify variables associated with dementia and entry into aged residential care (ARC) and derive and validate a risk prediction model for dementia and entry into ARC. Design: This was an observational study of prospectively collected Home Care International Residential Assessment Instrument (interRAI-HC) assessment data. Setting and Participants: Participants included all people age ≥65 years who had completed an interRAI-HC assessment between July 1, 2012 and June 30, 2018. Exclusion criteria included death or entry into ARC within 30 days of assessment and not living at home at the time of the assessment. Measures: InterRAI data from 94,202 older New Zealanders were evaluated for presence or absence of dementia. A multivariable competing-risks model for entry into ARC with death as the competing event was used to estimate subdistribution hazard ratios (SHR). Results: In total, there were 18,672 (19.8%) persons with dementia (PWD). PWD were almost twice as likely to enter ARC as persons without dementia [42.8% vs 25.3%; difference 17.5% (95% confidence interval 16.7%-18.2%)]. PWD at highest risk of entering ARC were those where there was a desire to live elsewhere (SHR 1.44), depression (indicated, SHR 1.15), poor cognitive performance (Cognitive Performance Scale minimal SHR 1.32 and severe plus SHR 1.91), and wandering (SHR 1.19). Factors associated with reduced risks of PWD entering ARC were living with a child or relative, alcohol consumption, and comorbidities.
Dementia (London, England), 2018
There is general acknowledgement of the importance of early diagnosis of dementia, yet there are still high rates of undetected dementia internationally. The aim of this cross-sectional study was to determine the sociodemographic characteristics associated with possible undetected dementia in a large sample of community-dwelling older New Zealanders. The sample consisted of older people (age ≥ 65) who had received the homecare version of the international Residential Home Care Assessment version 9.1 over a two-year period and who were screened positive for possible dementia on the international Residential Assessment's Cognitive Performance Scale. People with possible alternative explanations for impaired cognitive performance such as depression and other neurological conditions were excluded from analysis. The 5202 eligible individuals were categorized into two groups: (1) those with a recorded diagnosis of dementia (64%) and (2) those without a recorded diagnosis of dementia (...
Dementia case management and risk of long-term care placement: a systematic review and meta-analysis
International Journal of Geriatric Psychiatry, 2012
The objective of our study is to evaluate the effectiveness of dementia case management compared with usual care on reducing long-term care placement, hospitalization, and emergency department visits for adult patients with dementia. We also sought to evaluate the effectiveness of this intervention on delaying time to long-term care placement and hospitalization. Methods: We searched electronic databases supplemented by bibliographies and conference proceedings for randomized controlled trials testing the effectiveness of dementia case management in reducing resource utilization in a population of caregiver-care recipient dyads living in the community. We meta-analyzed the risk ratio (RR) and weighted mean differences of long-term care placement and the RR of hospital admissions. Pooled estimates were further stratified by study characteristics and measures of study quality. Results: Seventeen studies were included in the meta-analysis. The overall pooled RR of long-term care placement was 0.94 (95% confidence interval [0.85, 1.03]; p = 0.227) for dementia case management compared with usual care. Stratification by follow-up duration indicated a statistically significant reduction in risk of long-term care placement when follow-up duration was less than 18 months (RR 0.61, 95% confidence interval [0.41, 0.91], p = 0.015). There was no effect of dementia case management compared with usual care for the other outcomes. Conclusion: Dementia case management demonstrated a short-term positive effect on reducing the risk of long-term care placement among older people with dementia residing in the community. However, other sources of resource utilization and more extended effects of dementia case management on risk of long-term care placement warrant further investigation.
International Journal of Geriatric Psychiatry, 2020
Objectives: Limited research has shown that people with dementia (PwD) from lower socioeconomic backgrounds can face difficulties in accessing the right care at the right time. This study examined whether socioeconomic status (SES) and rural versus urban living location are associated with the time between diagnosis and care home admission in PwD living in Wales, UK. Methods/Design: This study linked routine health data and an e-cohort of PwD who have been admitted into a care home between 2000 and 2018 living in Wales. Survival analysis explored the effects of SES, living location, living situation, and frailty on the time between diagnosis and care home admission. Results: In 34,514 PwD, the average time between diagnosis and care home admission was 1.5 (�1.4) years. Cox regression analysis showed that increased age, living alone, frailty, and living in less disadvantaged neighbourhoods were associated with faster rate to care home admission. Living in rural regions predicted a slower rate until care home admission. Conclusions: This is one of the first studies to show a link between socioeconomic factors on time to care home admission in dementia. Future research needs to address variations in care needs between PwD from different socioeconomic and geographical backgrounds. K E Y W O R D S care homes, dementia, health inequalities, routine data, socioeconomic status 1 | INTRODUCTION Dementia affects approximately 50 million people worldwide, 1 and 850,000 in the United Kingdom alone. 2 In Wales specifically, the total cost of dementia in 2013 was estimated to have been £1.4 billion per year, of which 46% was accounted for by unpaid care. 2 Besides informal care provided by family and friends, one of the biggest cost factors in dementia is care home residency, which is 1.8 times more expensive than home care. 3 Entering a care home can be a stressful experience, by leaving the familiar home environment and getting adjusted to a new setting. Moreover, it is one of the most cost intensive element of the dementia care pathway, often resulting in people having to sell their homes to be able to afford institutional long-term care. 4 Therefore, This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Setting of care modifies risk of nursing home placement for older adults with dementia
International Journal of Geriatric Psychiatry, 2010
Objective: The purpose of this study was to examine risk of nursing home (NH) placement among older adults receiving publicly funded home and community-based services (HCBS) or assisted living (AL) and to explore whether these settings of care modify the relationship between dementia and risk of NH placement. Methods: The sample consisted of dually eligible Medicare and Medicaid beneficiaries age 65 and older who received HCBS (n ¼ 1630) or resided in AL (n ¼ 836) in Florida between July 1999 and June 2000. Cox proportional hazards regression was used to estimate risk of NH placement over a 5-year study period and to test the interaction of setting of care by dementia status. Results: In all, 15% of HCBS participants were placed in a NH compared to 26% of AL participants. As indicated by a significant interaction term in the regression model, setting of care modified the relationship between dementia and NH placement (HR ¼ 0.45, CI ¼ 0.31-0.66). In post hoc analyses stratified by setting of care, dementia was associated with a 50% increased risk of NH placement from HCBS (HR ¼ 1.50, CI ¼ 1.12-2.02) but was not associated with placement from AL (HR ¼ 0.86, CI ¼ 0.63-1.16). Conclusion: The findings suggest that differences in care provided in HCBS and AL may influence subsequent NH placement for older adults with dementia.
Risk Factors for Nursing Home Placement in Older Adults With and Without Dementia
Journal of Aging and Health, 2007
The authors explored the effect of predisposing, enabling, and need characteristics on risk of nursing home placement (NHP) in participants with and without dementia. Method: Participants were 1,943 newly enrolled Medicare/Medicaid beneficiaries in Florida who were evaluated for health services by the Department of Elder Affairs. They were at least 65 years of age during fiscal year 1998-1999 and were followed for up to 4 years. Results: Cox proportional hazard regressions indicated that baseline characteristics including older age, White race, diabetes, incontinence, stroke, and difficulties with instrumental activities increased risk of NHP in those without dementia. Caregiver, widowed status, arthritis, and heart disease reduced the risk. Only age, race, and marital status were predictive among participants with dementia. Discussion: Dementia plays a central role in risk of NHP. Understanding risk factors for NHP in this relatively vulnerable population has important policy implications.
BMC Public Health
Background Long-term residential care (LTC) supports the most vulnerable and is increasingly relevant with demographic ageing. This study aims to describe entry to LTC and identify predictive factors for older Māori (indigenous people of New Zealand) and non-Māori. Methods LiLACS-NZ cohort project recruited Māori and non-Māori octogenarians resident in a defined geographical area in 2010. This study used multivariable log-binomial regressions to assess factors associated with subsequent entry to LTC including: self-identified ethnicity, demographic characteristics, self-rated health, depressive symptoms and activities of daily living [ADL] as recorded at baseline. LTC entry was identified from: place of residence at LiLACS-NZ interviews, LTC subsidy, needs assessment conducted in LTC, hospital discharge to LTC, and place of death. Results Of 937 surveyed at baseline (421 Māori, 516 non-Māori), 77 already in LTC were excluded, leaving 860 participants (mean age 82.6 +/− 2.71 years Mā...
PloS one, 2016
The Quality and Outcomes Framework, or QOF, rewards primary care doctors (GPs) in the UK for providing certain types of care. Since 2006, GPs have been paid to identify patients with dementia and to conduct an annual review of their mental and physical health. During the review, the GP also assesses the carer's support needs, including impact of caring, and ensures that services are co-ordinated across care settings. In principle, this type of care should reduce the risk of admission to long-term residential care directly from an acute hospital ward, a phenomenon considered to be indicative of poor quality care. However, this potential effect has not previously been tested. Using English data from 2006/07 to 2010/11, we ran multilevel logit models to assess the impact of the QOF review on the risk of care home placement following emergency admission to acute hospital. Emergency admissions were defined for (a) people with a primary diagnosis of dementia and (b) people with dement...
Prediction of general hospital admission in people with dementia: cohort study
The British journal of psychiatry : the journal of mental science, 2014
Background People with dementia are extremely vulnerable in hospital and unscheduled admissions should be avoided if possible. Aims To identify any predictors of general hospital admission in people with dementia in a well-characterised national prospective cohort study. Method A cohort of 730 persons with dementia was drawn from the Scottish Dementia Research Interest Register (47.8% female; mean age 76.3 years, s.d. = 8.2, range 50-94), with a mean follow-up period of 1.2 years. Results In the age- and gender-adjusted multivariable model (n = 681; 251 admitted), Neuropsychiatric Inventory score (hazard ratio per s.d. disadvantage 1.21, 95% CI 1.08-1.36) was identified as an independent predictor of admission to hospital. Conclusions Neuropsychiatric symptoms in dementia, measured using the Neuropsychiatric Inventory, predict non-psychiatric hospital admission of people with dementia. Further studies are merited to test whether interventions to reduce such symptoms might reduce uns...