Objective: To identify the prevalence and characteristics of people living with dementia (PLWD) lost to follow-up (LTFU) from a specialized dementia care clinic and to understand factors influencing patient follow-up status.
Methods:We conducted a retrospective chart review of PLWD seen at a dementia care clinic 2012-2017 who were deceased as of 2018 (n = 746). Participants were evaluated for follow-up status at the time of death. Generalized linear regression was used to analyze demographic and diagnostic characteristics by follow-up status.Text extracted from participant medical records was analyzed using qualitative content analysis to identify reasons patients became LTFU.Results: Among PLWD seen at a dementia care clinic, 42% became LTFU before death, 39% of whom had chart documentation describing reasons for loss to followup. Increased rates of LTFU were associated with female sex (risk ratio 1.27, [95% confidence interval 1.09-1.49]; p = 0.003), educational attainment of high school or less (1.34, [1.13-1.61]; p = 0.001), and death in a long-term care facility (1.46, [1.19-1.80]; p = 0.003). Commonly documented reasons for not returning for care at the clinic included switching care to another provider (42%), logistical difficulty accessing care (26%), patient-family decision to discontinue care (24%), and functional challenges in accessing care (23%).Conclusions: PLWD are LTFU from specialized memory care at high rates. Attention to care coordination, patient-provider communication, and integrated use of alternative care models such as telehealth are potential strategies to improve care.
K E Y W O R D Saccess to care, ambulatory, care coordination, continuity of care, dementia, end-of-life, lost to follow-up, memory care, mixed methods, outpatient
Key points� Among people living with dementia seen at a specialized memory care center, 42% became lost to follow-up (LTFU) before death.� LTFU rates were higher among women and patients with lower educational attainment.
Tobacco settlement money can be allocated to nonprofit organizations or government agencies. Both have advantages and disadvantages. Nonprofit organizations may have relatively (a) more efficiency/flexibility, but less accountability; (b) narrower focus, but less experience; (c) more ability to advocate, but more obligations; (d) more independence from tobacco industry influence, but less funding; and, (e) more public trust, but less visibility. The present case study of the Partnership for a Healthy Mississippi focuses on six interconnected areas: education (school and community), raising awareness, advocacy, service, enforcement, and research. In 1999 and 2000, tobacco use declined in Mississippi, even compared to neighboring states. This unique partnership's multifaceted approach to social change probably facilitated this decline.
Objective:To determine the frequency of and challenges to documentation of advance care planning (ACP) in people with dementia, we conducted a chart review of 746 deceased patients seen at a tertiary memory care center between 2012 and 2017.Methods:The rates of documented Advance Directives (AD), Physician Order for Life Sustaining Treatment (POLST) and Do Not Resuscitate (DNR) status were calculated from review of institutional electronic health records. Regression analysis was used to determine associations between ACP documentation and patient characteristics.Results:At the time of death, approximately half of the patient had a documented AD and/or DNR status and 37% had a documented POLST; 30% of patients did not have any ACP documentation. Whereas the majority of AD were documented more than five years prior to time of death, POLST and DNR status were documented more frequently within two years of time of death. People who presented to clinic at a younger age and who primarily spoke English were more likely to have documented ADs. People living in zip codes with lower household incomes were 2-4.5 times less likely to have a POLST or DNR documentation.Conclusion:ACP is underutilized in people with dementia, even among those seen in a specialty memory care center. ACP should be introduced early on for people with dementia to ensure patients have a voice in their care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.