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Diagnosis and Disruption: Population-Level Analysis Identifying Points of Care at Which Transitions Are Highest for People with Dementia and Factors That Contribute to Them.

Abstract：

OBJECTIVES:To examine transitions that individuals with dementia experience longitudinally and to identify points of care when transitions are highest and the factors that contribute to those transitions. DESIGN:Population-based 10-year retrospective cohort study from 2000 to 2011. SETTING:General community. PARTICIPANTS:All individuals aged 65 and older newly diagnosed with dementia in British Columbia, Canada. MEASUREMENTS:The frequency and timing of transitions over 10 years, participant characteristics associated with greater number of transitions, and the influence of recommended dementia care and high-quality primary care on number of transitions. RESULTS:Individuals experience a spike in transitions during the year of diagnosis, driven primarily by hospitalizations, despite accounting for end of life or newly moving to a long-term care facility (LTCF). This occurs regardless of survival time or care location. Regardless of survival time, individuals not in LTCFs experience a marked increase in hospitalizations in the year before and the year of death, often exceeding hospitalizations in the year of diagnosis. Receipt of recommended dementia care and receipt of high-quality primary care were independently associated with fewer transitions across care settings. CONCLUSION:The spike in transitions in the year of diagnosis highlights a distressing period for individuals with dementia during which unwanted or unnecessary transitions might occur and suggests a useful target for interventions. There is an association between recommended dementia care and outcomes and evidence of the continued value of high-quality primary care in a complex population at a critical point when gaps in continuity are especially likely.

journal_name

J Am Geriatr Soc

journal_title

Journal of the American Geriatrics Society

authors

Sivananthan SN,McGrail KM

doi

10.1111/jgs.14033

subject

Has Abstract

pub_date

2016-03-01 00:00:00

pages

569-77

issue

eissn

0002-8614

issn

1532-5415

journal_volume

pub_type

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Diagnosis and Disruption: Population-Level Analysis Identifying Points of Care at Which Transitions Are Highest for People with Dementia and Factors That Contribute to Them.