Association Between Home Health Services and Facility Admission in Older Adults With and Without Alzheimer's Disease

Wang, Jinjiao; Caprio, Thomas V.; Simning, Adam; Shang, Jingjing; Conwell, Yeates; Yu, Fang; Li, Yue

doi:10.1016/j.jamda.2019.11.002

Cited by 25 publications

(28 citation statements)

References 28 publications

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“…This study has limitations. First, the type and amount of received HH services was not controlled for and it may have affected study outcomes 9,10,24 . Second, we used Medicaid eligibility as a proxy measure of socioeconomic status, which should be examined using comprehensive measures.…”

Section: Discussionmentioning

confidence: 99%

“…HH care facilitates early identification of clinical status change, promotes functional improvement, avoids hospitalization and emergency department (ED) visits, and prolongs independent stay at home 8‐10 . HH outcomes are related to multi‐domain factors spanning demographic and socioeconomic status, health conditions, social support, type and amount of HH services, 9‐13 and living situations. As noted in a systematic review, three studies using data from 1 to 15 HH agencies reported that living alone at home was related to both higher and lower risks of hospitalization than patients not living alone, either at home or in AL 11 .…”

Section: Introductionmentioning

confidence: 99%

“…We hypothesized that AL residents would have less ADL improvement and higher risk of hospitalization and ED visit than other HH recipients. This is because (1) HH recipients having more functional limitations 9 and cognitive impairment 10 have less ADL improvement 13 and are at higher risk of hospitalization and ED visits, 9,10 and (2) AL residents have more cognitive and functional impairments than other HH recipients 5 …”

Section: Introductionmentioning

confidence: 99%

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Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations

Wang

Ying

Temkin‐Greener

et al. 2020

J American Geriatrics Society

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BACKGROUND/OBJECTIVES Home health (HH) is a major type of home‐based skilled care available to Medicare beneficiaries. We examined the association between living situation (home alone, home with others, and assisted living (AL) residence) and utilization and functional outcomes among Medicare HH recipients. DESIGN Analysis of national data from the Outcome and Assessment Information Set, HH Compare, Medicare claims, and Area Health Resource Files. SETTING Medicare‐certified HH agencies in the United States. PARTICIPANTS National population of Medicare beneficiaries ≥65 years old who received HH care in CY 2017 (N = 6,637,496). MEASUREMENTS Outcomes included time‐to‐event measures of hospitalization and emergency department (ED) visits, and improvement in activities of daily living (ADL) from the start to the end of the HH admission. RESULTS AL residents (12%) and patients living alone at home (24%) had longer survival time without hospitalization and ED visits than patients living with others at home (64%). Adjusting for covariates and HH agency‐level random effects, and compared with patients living with others, AL residents had lower risk of hospitalization (hazard ratio (HR) = 0.85, P < .001) and ED visit (HR = 0.92, P < .001); however, less ADL improvement (β = 0.29 (29% less of total independence in one ADL)); and patients living alone had lower risk of hospitalization (HR = 0.94, P < .001) and ED visit (HR = 0.93, P < .001), yet more ADL improvement (β = −0.15 (15% more of total independence in one ADL)). CONCLUSION In the national population of Medicare HH recipients, patients living with others at home had the highest risk of hospitalization and ED visits, whereas AL residents had the lowest risk of hospitalization and patients living alone at home had the lowest risk of ED visits, meaning that combined support from HH and AL reduces acute care admissions. Evidence‐based interventions are needed for HH patients living with others at home to avoid unnecessary acute care use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations

Wang

Ying

Temkin‐Greener

et al. 2020

J American Geriatrics Society

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“…Demographics, health status, caregiving support, and intensity of HH service are related to facility admissions, and thus were included as covariates (Lohman et al, 2017;Wang et al, 2019;Wang et al, 2018).…”

Section: Covariatesmentioning

confidence: 99%

Pain Management in Home Health Care: Relationship With Dementia and Facility Admissions

Wang

Monroe

Simning

et al. 2021

Pain Management Nursing

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Background: Pain is common yet under-studied among older Medicare home health (HH) patients with Alzheimer's disease and related dementias (ADRD). Aims: Examine (1) the association between ADRD and severe pain in Medicare HH patients; and (2) the impact of severe pain and ADRD on unplanned facility admissions in this population. Design: Analysis of the Outcome and Assessment Information Set (OASIS) and Medicare claims data. Settings/Participants: 6,153 patients 65 years receiving care from a nonprofit HH agency in 2017. Methods: Study outcomes included presence of severe pain and time-to-event measures of unplanned facility admissions (hospital, nursing home, or rehabilitation facilities). ADRD was identified using ICD-10 diagnosis codes and cognitive impairment symptoms. Logistic regression and Cox proportional hazard models were used to examine, respectively, the association between ADRD and severe pain, and the independent and interaction effects of severe pain and ADRD on unplanned facility admission. Results: Patients with ADRD (n ¼ 1,525, 24.8%) were less likely to have recorded severe pain than others (16.4% vs. 23.6%, p < .001). Adjusting for demographics, comorbidities, mental and physical functional status, and use of HH services, having severe pain was related to a 35% increase (hazard ratio [HR] ¼ 1.35, p ¼ .002) in the risk of unplanned facility admission, but the increase in such risk was the same whether or not the patient had ADRD. Conclusions: HH patients with ADRD may have under-recognized pain. Severe pain is a significant independent predictor of unplanned facility admissions among HH patients.

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“…Factors predicting the amount of time to nursing home (NH) admission may differ between persons assessed for cognitive decline in primary healthcare compared to those assessed in specialist healthcare [7][8][9]. Furthermore, NH admission may depend on the quality and quantity of health and social services provided to persons in their homes [10,11], which may differ among countries.…”

Section: Introductionmentioning

confidence: 99%

Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis

et al. 2020

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Objectives To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times. Design Markov multistate survival analysis and flexible parametric models. Setting Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants’ address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data. Participants 2,938 home-dwelling persons with dementia, ages 40–97 years at time of diagnosis (mean 76.1, SD 8.5). Results During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group. Conclusion Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.

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Association Between Home Health Services and Facility Admission in Older Adults With and Without Alzheimer's Disease

Cited by 25 publications

References 28 publications

Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations

Utilization and Functional Outcomes Among Medicare Home Health Recipients Varied Across Living Situations

Pain Management in Home Health Care: Relationship With Dementia and Facility Admissions

Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis

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