Transitions in Care for Older Adults with and without Dementia

Authors

  • Christopher M. Callahan MD,

    Corresponding author
    1. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
    2. Regenstrief Institute, Inc., Indianapolis, Indiana
    • Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, Indiana
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  • Greg Arling PhD,

    1. Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, Indiana
    2. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
    3. Regenstrief Institute, Inc., Indianapolis, Indiana
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  • Wanzhu Tu PhD,

    1. Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, Indiana
    2. Regenstrief Institute, Inc., Indianapolis, Indiana
    3. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
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  • Marc B. Rosenman MD,

    1. Regenstrief Institute, Inc., Indianapolis, Indiana
    2. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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  • Steven R. Counsell MD,

    1. Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, Indiana
    2. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
    3. Regenstrief Institute, Inc., Indianapolis, Indiana
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  • Timothy E. Stump MA,

    1. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
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  • Hugh C. Hendrie MB, ChB, DSc

    1. Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, Indiana
    2. Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana
    3. Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana
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Address correspondence to Christopher M. Callahan, Indiana University Center for Aging Research, 410 West 10th Street, Suite 2000, Indianapolis, IN 46202. E-mail: ccallaha@iupui.edu

Abstract

Objectives

To describe transitions in care of persons with dementia with attention to nursing facility transitions.

Design

Prospective cohort.

Setting

Public health system.

Participants

Four thousand one hundred ninety-seven community-dwelling older adults.

Measurements

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.

Results

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.

Conclusion

Individuals with dementia live and frequently die in community settings. Nursing facilities are part of a dynamic network of care characterized by frequent transitions.

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