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Sengupta M, Agree EM. Metro-Nonmetro Differences in Adverse Events in Residential Care Communities: Results From the National Post-Acute and Long-Term Care Study. J Appl Gerontol 2024; 43:413-422. [PMID: 37916406 DOI: 10.1177/07334648231206323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
More than 1 in 5 older Americans live in rural areas (10.6 million of the 46.2 million aged 65 and older). Long-term care for aging rural populations is a growing challenge in the United States. Research on long-term care services in nonmetro areas has focused almost exclusively on nursing home care, despite growth of residential care alternatives. This paper uses unique facility-level data from the 2020 National Post-acute and Long-term Care Study (NPALS) to examine the relationship of residential care community (RCC) features in metro and nonmetro settings with adverse outcomes (emergency department visits, overnight hospital stays, and falls). Nationally, in 2020, about 13.5% of RCC residents made visits to the emergency department, 8.6% had overnight hospital stays, and 21.3% had falls. Controlling for facility characteristics, RCCs in metro areas had higher risks of overnight hospital stays (p < .001) but lower risks of falls (p = .06).
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Albanesi B, Conti A, Politano G, Dimonte V, Gianino MM, Campagna S. Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019. BMC Geriatr 2024; 24:295. [PMID: 38549053 PMCID: PMC10976813 DOI: 10.1186/s12877-024-04912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/21/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Visits to Emergency Departments (ED) can be traumatic for Nursing Home (NH) residents. In Italy, the rate of ED visits by NH residents was recently calculated as 3.3%. The reduction of inappropriate ED visits represents a priority for National Healthcare Systems worldwide. Nevertheless, research on factors associated with ED visits is still under-studied in the Italian setting. This study has two main aims: (i) to describe the baseline characteristics of NH residents visiting ED at regional level; (ii) to assess the characteristics, trends, and factors associated with these visits. METHODS A retrospective study of administrative data for five years was performed in the Piedmont Region. Data from 24,208 NH residents were analysed. Data were obtained by merging two ministerial databases of residential care and ED use. Sociodemographic and clinical characteristics of the residents, trends, and rates of ED visits were collected. A Generalized Linear Model (GLM) regression was used to evaluate the factors associated with ED visits. RESULTS In 5 years, 12,672 residents made 24,609 ED visits. Aspecific symptoms (45%), dyspnea (17%) and trauma (16%) were the most frequent problems reported at ED. 51% of these visits were coded as non-critical, and 58% were discharged to the NH. The regression analysis showed an increased risk of ED visits for men (OR = 1.61, 95% CI 1.51-1.70) and for residents with a stay in NH longer than 400 days (OR = 2.19, 95% CI 2.08-2.31). CONCLUSIONS Our study indicates that more than half of NH residents' ED visits could potentially be prevented by treating residents in NH. Investments in the creation of a structured and effective network within primary care services, promoting the use of health technology and palliative care approaches, could reduce ED visits and help clinicians manage residents on-site and remotely.
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Affiliation(s)
- Beatrice Albanesi
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Alessio Conti
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy.
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Turin, Italy
| | - Valerio Dimonte
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Maria Michela Gianino
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Sara Campagna
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
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3
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Wang J, Mao Y, McGarry B, Cai S, Temkin-Greener H. Assisted living or nursing home: Who is moving in? J Am Geriatr Soc 2023; 71:3480-3488. [PMID: 37449847 PMCID: PMC10787797 DOI: 10.1111/jgs.18503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Despite the rapid growth of assisted living (AL) communities and the increasing similarity between AL and nursing home (NH) populations, little is known about the characteristics of older adults at the time of AL admission and how these characteristics compare to individuals newly admitted to NH from the community. This study examined the individual, facility, and geographic factors associated with new AL admission. METHODS This retrospective descriptive study used data from the national Medicare enrollment and claims datasets, the Minimum Data Set, and the Medicare Provider Analysis and Review. The study cohort included 158,124 Medicare beneficiaries newly admitted to ALs and 715,261 newly admitted to NHs during 10/2017-10/2019. Multinomial logistic regression analysis and logistic regression analysis were conducted to examine factors associated with new admissions. RESULTS Demographic, socioeconomic, and health service use characteristics were associated with new admission to long-term care. Specifically, Medicare fee-for-service beneficiaries, those age 75 years and older, male, having one skilled nursing facility (SNF) stay or any hospital stay in the past 6 months are more likely to be newly admitted to AL, whereas those who are dually eligible, racial/ethnic minorities, and having two or more SNF stays in the past 6 months are more likely to be admitted to an NH. CONCLUSION There are substantial differences between individuals who are newly admitted from the community to AL versus those to NH.
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Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging, University of Rochester School of Nursing, Rochester, NY
| | - Yunjiao Mao
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Brian McGarry
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Shubing Cai
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Helena Temkin-Greener
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
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Goldman AS, Abbott KM, Huang L, Naylor MD, Hirschman KB. Changes in Tangible Social Support Over Time Among Older Adults Receiving Long-Term Services and Supports. J Appl Gerontol 2023; 42:981-991. [PMID: 36650926 PMCID: PMC10081952 DOI: 10.1177/07334648221150966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The purpose of this study was to examine changes in and predictors of perceived tangible social support over a 2-year period among older adults new to LTSS. Linear mixed effects models were used to model repeated measures of tangible social support as a function of LTSS type [NH, AL, HCBS], personal, clinical, and health-related quality of life variables. AL residents reported greater initial tangible social support, but NH and HCBS residents improved more over time. Predictors of increased tangible social support over time included greater positive affect, sense of aesthetics, education, satisfaction with family relationships, and total number of close friends and family. Decreased tangible support over time was associated with greater depressive symptoms. Findings indicate the positive influence of NH and HCBS services on perception of tangible social support, and the importance of addressing depressive symptoms and assisting with the maintenance of important relationships.
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Affiliation(s)
| | - Katherine M Abbott
- Scripps Gerontology Center, Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Liming Huang
- School of Nursing, 16142University of Pennsylvania, Philadelphia, PA, USA
| | - Mary D Naylor
- School of Nursing, 16142University of Pennsylvania, Philadelphia, PA, USA
| | - Karen B Hirschman
- School of Nursing, 16142University of Pennsylvania, Philadelphia, PA, USA
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Egan C, Naughton C, Caples M, Mulcahy H. Shared decision-making with adults transitioning to long-term care: A scoping review. Int J Older People Nurs 2023; 18:e12518. [PMID: 36480119 PMCID: PMC10078233 DOI: 10.1111/opn.12518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/06/2022] [Accepted: 10/29/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transitions to long-term care are challenging for individuals and often associated with a loss of autonomy. Positive experiences are noted, especially when decisions involve the individual in a person-centred way which are respectful of the person's human rights. One approach which facilitates self-determination during a transitional period is shared decision-making, but there is a lack of clarity on the nature and extent of research evidence in this area. OBJECTIVE The purpose of this scoping review is to identify and document research related to shared decision-making and transitioning to long-term care. METHODS A comprehensive search in CINAHL, Medline and Psych-info identified papers which included evidence of shared decision-making during transitions to a long-term care setting. The review following the JBI and PAGER framework for scoping reviews. Data were extracted, charted and analysed according to patterns, advances, gaps, research recommendations and evidence for practice. RESULTS Eighteen papers met the inclusion criteria. A body of knowledge was identified encompassing the pattern advancements in shared decision-making during transitions to long-term care, representing developments in both the evidence base and methodological approaches. Further patterns offer evidence of the facilitators and barriers experienced by the person, their families and the professional's involved. CONCLUSIONS The evidence identified the complexity of such decision-making with efforts to engage in shared decision-making often constrained by the availability of resources, the skills of professionals and time. The findings recognise the need for partnership and person-centred approaches to optimise transitions. The review demonstrates evidence of approaches that can inform future practice and research to support all adult populations who may be faced with a transitional decision to actively participate in decision-making.
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Affiliation(s)
- Caroline Egan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Corina Naughton
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Maria Caples
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Helen Mulcahy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Simpson ML, Oetzel J, Wilson Y, Nock S, Johnston K, Reddy R. Codesigning a Culture-Centered Age-Friendly Community for Māori Kaumātua: Cultural Principles and Practices. J Gerontol B Psychol Sci Soc Sci 2022; 77:2265-2275. [PMID: 35796864 PMCID: PMC9799182 DOI: 10.1093/geronb/gbac092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This study examined a Māori (Indigenous people of Aotearoa New Zealand) age-friendly housing development. Two Māori community groups worked with multiple stakeholders to codesign a culture-centered, kaumātua (older adults) urban housing community. The purpose was to identify codesign and culture-centered principles in the development. METHODS Kaupapa Māori (Māori-centered) and participatory research methodologies guided the culture-centered research design. Data collection included 27 interviews with 19 residents and 12 organizational stakeholders; three focus groups with residents' families, service providers, and nonresident kaumātua (n = 16); and project documents. Data analysis used the framework method. RESULTS Three codesign process themes emerged: (a) Kaumātua-centered vision; (b) realizing the vision; and (c) living the shared vision. DISCUSSION Accounting for cultural practices in codesigning age-friendly and culture-centered housing for and with Indigenous older adults helps meet their cultural, social, health, and economic needs. The research offers a practical pathway to developing age-friendly housing environments for Māori kaumātua, their communities, wider society, and other Indigenous people.
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Affiliation(s)
- Mary Louisa Simpson
- Address correspondence to: Mary Louisa Simpson, PhD, Waikato Management School, University of Waikato, PB 3105, Hamilton 3240, New Zealand. E-mail:
| | - John Oetzel
- Waikato Management School, University of Waikato, Hamilton, New Zealand
| | | | - Sophie Nock
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
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Knopp-Sihota JA, MacGregor T, Reeves JTH, Kennedy M, Saleem A. Management of Chronic Pain in Long-Term Care: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2022; 23:1507-1516.e0. [PMID: 35594944 DOI: 10.1016/j.jamda.2022.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pain, a complex subjective experience, is common in care home residents. Despite advances in pain management, optimal pain control remains a challenge. In this updated systematic review, we examined effectiveness of interventions for treating chronic pain in care home residents. DESIGN A Cochrane-style systematic review and meta-analysis using PRISMA guidelines. SETTING AND PARTICIPANTS Randomized and nonrandomized controlled trials and intervention studies included care home residents aged ≥60 years receiving interventions to reduce chronic pain. METHODS Six databases were searched to identify relevant studies. After duplicate removal, articles were screened by title and abstract. Full-text articles were reviewed and included if they implemented a pain management intervention and measured pain with a standardized quantitative pain scale. Meta-analyses calculated standardized mean differences (SMDs) using random-effect models. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool 2.0. RESULTS We included 42 trials in the meta-analysis and described 13 more studies narratively. Studies included 26 nondrug alternative treatments, 8 education interventions, 7 system modifications, 3 nonanalgesic drug treatments, 2 analgesic treatments, and 9 combined interventions. Pooled results at trial completion revealed that, except for nonanalgesic drugs and health system modification interventions, all interventions were at least moderately effective in reducing pain. Analgesic treatments (SMD -0.80; 95% CI -1.47 to -0.12; P = .02) showed the greatest treatment effect, followed by nondrug alternative treatments (SMD -0.70; 95% CI -0.95 to -0.45; P < .001), combined interventions (SMD -0.37; 95% CI -0.60 to -0.13; P = .002), and education interventions (SMD -0.31; 95% CI -0.48 to -0.15; P < .001). CONCLUSIONS AND IMPLICATIONS Our findings suggest that analgesic drugs and nondrug alternative pain management strategies are the most effective in reducing pain among care home residents. Clinicians should also consider implementing nondrug alternative therapies in care homes, rather than relying solely on analgesic drug options.
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Affiliation(s)
- Jennifer A Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada; Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Tara MacGregor
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Megan Kennedy
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ahsan Saleem
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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8
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Roma M, Sullivan SS, Casucci S. TILE-12 index: an interpretable instrument for identifying older adults at risk for transitions in living environment within the next 12-months. Home Health Care Serv Q 2022; 41:236-254. [PMID: 35392771 DOI: 10.1080/01621424.2022.2052220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Few evidence-based tools exist to support identification of older community dwelling adults at risk for unwanted transitions in living environment leading to missed opportunities to modify care plans to support aging-in-place and/or establish end-of-life care goals. An interpretable and actionable tool for assessing a person's risk of experiencing a transition is introduced. Logistic regression analysis of 14,772 transition opportunities (i.e. 12-month periods) for 4,431 respondents to the National Health and Aging Trends Study (NHATS) rounds 1-7. Results were visualized in a nomogram. Unmarried males of increasing age with chronic disease, greater functional dependence, overnight hospitalizations, not living in a single-family home, and limited social network, have elevated risk of experiencing a transition in living environment in a 12-month period. Homecare nurses are uniquely qualified to identify social determinants of health and can use this evidence-based tool to identify individuals who may benefit from transitional care assistance.
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Affiliation(s)
- Makayla Roma
- Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Suzanne S Sullivan
- School of Nursing, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Sabrina Casucci
- Industrial and Systems Engineering, University at Buffalo, State University of New York, Buffalo, New York, USA
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9
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Wang J, Mao Y, McGarry B, Temkin‐Greener H. Post‐acute care transitions and outcomes among medicare beneficiaries in assisted living communities. J Am Geriatr Soc 2022; 70:1429-1441. [DOI: 10.1111/jgs.17669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/30/2021] [Accepted: 12/19/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Jinjiao Wang
- Elaine Hubbard Center for Nursing Research on Aging University of Rochester School of Nursing Rochester New York USA
| | - Yunjiao Mao
- Department of Public Health Sciences University of Rochester Medical Center Rochester New York USA
| | - Brian McGarry
- Department of Public Health Sciences University of Rochester Medical Center Rochester New York USA
- Division of Geriatrics and Aging, Department of Medicine University of Rochester Medical Center Rochester New York USA
| | - Helena Temkin‐Greener
- Department of Public Health Sciences University of Rochester Medical Center Rochester New York USA
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Su Y, Cochrane BB, Yu SY, Reding K, Herting JR, Zaslavsky O. Fatigue in community-dwelling older adults: A review of definitions, measures, and related factors. Geriatr Nurs 2021; 43:266-279. [PMID: 34963072 DOI: 10.1016/j.gerinurse.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/04/2022]
Abstract
Fatigue is a common age-related symptom among community-dwelling adults aged 65 years and older. Yet, a systematic approach has rarely been applied to review definitions, measures, related factors, and consequences of fatigue in this population. A scoping review was conducted in December 2020 to fill the gap, and 36 articles met the inclusion criteria. Definitions, albeit diverse, included at least one of the following attributes: an early indicator of disablement, subjective, a lack of energy, multidimensional, impaired daily activities, and temporal. A summary of fatigue measures used in this population was provided, including a brief overview, number of items, reliability, and validity. In general, different measures were used with considerable variability in the content. Additionally, most measures had limited information on test-retest reliability and validity. Fatigue-related factors mapped into biological, psychological, social, and behavioral factors. Fatigue consequences were primarily declines in physical and cognitive functions. (100-150 words).
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Affiliation(s)
- Yan Su
- School of Nursing, University of Washington, Seattle, WA, United States.
| | - Barbara B Cochrane
- School of Nursing, University of Washington, Seattle, WA, United States; Fred Hutchinson Cancer Research Center, Public Health Sciences, Seattle, WA, United States
| | - Shih-Yin Yu
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Kerryn Reding
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Jerald R Herting
- Department of Sociology, University of Washington, Seattle, WA, United States
| | - Oleg Zaslavsky
- School of Nursing, University of Washington, Seattle, WA, United States
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11
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Dobarrio-Sanz I, Ruiz-González C, Fernández-Sola C, Roman P, Granero-Molina J, Hernández-Padilla JM. Healthcare Professionals' Perceptions of Loneliness amongst Older Adults: A Qualitative Study. Int J Environ Res Public Health 2021; 18:12071. [PMID: 34831824 DOI: 10.3390/ijerph182212071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Loneliness amongst older adults is linked to poor health outcomes and constitutes a public health issue worldwide. Healthcare professionals' perceptions could influence the strategies they implement in order to prevent, detect and manage loneliness amongst older adults. The aim of this study was to describe and understand healthcare professionals' perceptions of loneliness amongst older adults. METHODS A descriptive qualitative study. Twenty-six Spanish healthcare professionals with experience caring for older adults participated in the study. Data were collected between November 2019 and September 2020 using focus groups and in-depth interviews. Data were analysed following a content analysis method using ATLAS.ti software. RESULTS Healthcare professionals' perceptions of loneliness amongst older adults is represented by three themes: (1) "when one's personal life and social context lead to loneliness"; (2) "from abandonment to personal growth: the two faces of loneliness"; and (3) "loneliness as a health issue that needs to be addressed". CONCLUSIONS Healthcare professionals perceive loneliness as a multifactorial, subjective experience that can trigger different coping mechanisms and negatively affect older people's health. Healthcare professionals consider that a greater involvement of the whole society is needed in order to fight loneliness amongst older adults as a public health issue.
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12
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Kennedy MA, Hatchell KE, DiMilia PR, Kelly SM, Blunt HB, Bagley PJ, LaMantia MA, Reynolds CF, Crow RS, Maden TN, Kelly SL, Kihwele JM, Batsis JA. Community health worker interventions for older adults with complex health needs: A systematic review. J Am Geriatr Soc 2021; 69:1670-1682. [PMID: 33738803 PMCID: PMC8263299 DOI: 10.1111/jgs.17078] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/10/2021] [Accepted: 01/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES The number of older adults with complex health needs is growing, and this population experiences disproportionate morbidity and mortality. Interventions led by community health workers (CHWs) can improve clinical outcomes in the general adult population with multimorbidity, but few studies have investigated CHW-delivered interventions in older adults. DESIGN We systematically reviewed the impact of CHW interventions on health outcomes among older adults with complex health needs. We searched for English-language articles from database inception through April 2020 using seven databases. PROSPERO protocol registration CRD42019118761. SETTING Any U.S. or international setting, including clinical and community-based settings. PARTICIPANTS Adults aged 60 years or older with complex health needs, defined in this review as multimorbidity, frailty, disability, or high-utilization. INTERVENTIONS Interventions led by a CHW or similar role consistent with the American Public Health Association's definition of CHWs. MEASUREMENTS Pre-defined health outcomes (chronic disease measures, general health measures, treatment adherence, quality of life, or functional measures) as well as qualitative findings. RESULTS Of 5671 unique records, nine studies met eligibility criteria, including four randomized controlled trials, three quasi-experimental studies, and two qualitative studies. Target population and intervention characteristics were variable, and studies were generally of low-to-moderate methodological quality. Outcomes included mood, functional status and disability, social support, well-being and quality of life, medication knowledge, and certain health conditions (e.g., falls, cognition). Results were mixed with several studies demonstrating significant effects on mood and function, including one high-quality RCT, while others noted no significant intervention effects on outcomes. CONCLUSION CHW-led interventions may have benefit for older adults with complex health needs, but additional high-quality studies are needed to definitively determine the effectiveness of CHW interventions in this population. Integration of CHWs into geriatric clinical settings may be a strategy to deliver evidence-based interventions and improve clinical outcomes in complex older adults.
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Affiliation(s)
- Meaghan A. Kennedy
- New England Geriatric Research, Education, and Clinical
Center, VA Bedford Healthcare System, Bedford, MA
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kayla E. Hatchell
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Peter R. DiMilia
- Department of Community and Family Medicine, Geisel School
of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | | | - Michael A. LaMantia
- Division of Geriatric Medicine, Department of Medicine,
Larner College of Medicine at The University of Vermont, Burlington, VT
| | | | - Rebecca S. Crow
- Department of Medicine, Geisel School of Medicine at
Dartmouth and Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Geriatrics and Extended Care, Veterans Affairs Medical Center, White River Junction,
White River Junction, VT
| | - Tara N. Maden
- Analytics Institute, Dartmouth-Hitchcock Clinic, Lebanon,
NH
| | | | | | - John A. Batsis
- Division of Geriatric Medicine and Gillings School of
Global Public Health, University of North Carolina, Chapel Hill, NC
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Dys S, Smith L, Tunalilar O, Carder P. Revisiting the Role of Physicians in Assisted Living and Residential Care Settings. Gerontol Geriatr Med 2020; 6:2333721420979840. [PMID: 33354590 PMCID: PMC7734500 DOI: 10.1177/2333721420979840] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/22/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
As the United States population ages, a higher share of adults is likely to use long-term services and supports. This change increases physicians' need for information about assisted living and residential care (AL/RC) settings, which provide supportive care and housing to older adults. Unlike skilled nursing facilities, states regulate AL/RC settings through varying licensure requirements enforced by state agencies, resulting in differences in the availability of medical and nursing services. Where some settings provide limited skilled nursing care, in others, residents rely on resident care coordinators, or their own physicians to oversee chronic conditions, medications, and treatments. The following narrative review describes key processes of care where physicians may interact with AL/RC operators, staff, and residents, including care planning, managing Alzheimer's disease and related conditions, medication management, and end-of-life planning. Communication and collaboration between physicians and AL/RC operators are a crucial component of care management.
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Affiliation(s)
- Sarah Dys
- Oregon Health & Science University-Portland State University, Portland, OR, USA
- Portland State University, Portland, OR, USA
| | - Lindsey Smith
- Oregon Health & Science University-Portland State University, Portland, OR, USA
- Portland State University, Portland, OR, USA
| | | | - Paula Carder
- Oregon Health & Science University-Portland State University, Portland, OR, USA
- Portland State University, Portland, OR, USA
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