Transitions in Care for Older Adults with and without Dementia
Article first published online: 15 MAY 2012
© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 60, Issue 5, pages 813–820, May 2012
How to Cite
Callahan, C. M., Arling, G., Tu, W., Rosenman, M. B., Counsell, S. R., Stump, T. E. and Hendrie, H. C. (2012), Transitions in Care for Older Adults with and without Dementia. Journal of the American Geriatrics Society, 60: 813–820. doi: 10.1111/j.1532-5415.2012.03905.x
- Issue published online: 15 MAY 2012
- Article first published online: 15 MAY 2012
- National Institute on Aging Grants. Grant Numbers: R01 AG031222, K24 AG024078
- Alzheimer's disease;
- transitions in care;
- nursing facilities;
- healthcare utilization
To describe transitions in care of persons with dementia with attention to nursing facility transitions.
Public health system.
Four thousand one hundred ninety-seven community-dwelling older adults.
Participants’ electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Data Set (MDS), and the Outcome and Assessment Information Set (OASIS) from 2001 to 2008 with a mean follow-up of 5.2 years from the time of enrollment.
Older adults with prevalent (n = 524) or incident (n = 999) dementia had greater Medicare (44.7% vs 44.8% vs 11.4%, P < .001) and Medicaid (21.0% vs 16.8% vs 1.4%, P < .001) nursing facility use, greater hospital (76.2% vs 86.0% vs 51.2%, P < .001) and home health (55.7% vs 65.2% vs 27.3%, P < .001) use, more transitions in care per person-year of follow-up (2.6 vs 2.7 vs 1.4, P < .001), and more mean total transitions (11.2 vs 9.2 vs 3.8, P < .001) than those who were never diagnosed (n = 2,674). For the 1,523 participants with dementia, 74.5% of transitions to nursing facilities were transfers from hospitals. For transitions from nursing facilities, the conditional probability was 41.0% for a return home without home health care, 10.7% for home health care, and 39.8% for a hospital transfer. Of participants with dementia with a rehospitalization within 30 days, 45% had been discharged to nursing facilities from the index hospitalization. At time of death, 46% of participants with dementia were at home, 35% were in the hospital, and 19% were in a nursing facility.
Individuals with dementia live and frequently die in community settings. Nursing facilities are part of a dynamic network of care characterized by frequent transitions.