High prevalence of dementia among community dwelling older adults in receipt of state funded home care packages: implications for health care planning

O’Brien, Irene; Smuts, K; Fan, Chie Wei; O’Sullivan, Maria; Warters, Austin

doi:10.1017/ipm.2017.80

Cited by 17 publications

(19 citation statements)

References 16 publications

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“…In the present study, the prevalence of "cognitive dysfunction" was 43.1% consistent with our previous findings among home support recipients. 24 While there is generally a dearth of research on the prevalence of "cognitive dysfunction" among older people in receipt of home support, evidence from other countries (eg, Norway and Canada) suggests that people with "cognitive dysfunction" are relatively high users of home care services 30,31 In the present study, "cognitive dysfunction" was found to be significantly associated with LTC. There is a growing realisation of the importance of providing a rich and varied individualised set of responses to dependent older people with cognitive dysfunction, 11 many of which may be feasible to embed within home support.…”

Section: Discussionmentioning

confidence: 57%

“…There is evidence that reduced activities of daily living (ADL) activity is associated with functional deterioration, LTC, and mortality among older people. 23,24 There have been no studies done on the identification of factors that influence admission to long-stay care in Ireland, or on predictors of mortality among community-dwelling older dependent adults. 20 In a systematic review and meta-analysis, Cepoiu-Martin et al found that increased age, functional impairment, behavioural, and psychological problems and being in the severe stages of dementia were significant predictors of LTC placement for people with dementia.…”

Section: Key Pointsmentioning

confidence: 99%

“…Physical dependency level was assessed using the Barthel index (BI), a simple index based on the scoring of 10 items. The method used for the purposes of this audit has been previously described 24 and is as follows. Its main aim is to establish the degree to which a person is independent from needing any help, physical or verbal, with these items however minor and for whatever reason.…”

Section: Study Variablesmentioning

confidence: 99%

“…22 The older population in receipt of home support represent a vulnerable subgroup, characterised by a high prevalence of "cognitive dysfunction" (46%) and frailty (41%). 23,24 There have been no studies done on the identification of factors that influence admission to long-stay care in Ireland, or on predictors of mortality among community-dwelling older dependent adults. The aim of this paper is to identify factors that predict admission to LTC and mortality during a 1-year period, based on a large cohort of communitydwelling older adults receiving formal home support.…”

Section: Key Pointsmentioning

confidence: 99%

“…"Dementia" and "suspected CI" were based on information on cognitive status recorded on the CSAR form. The method used for the purposes of this audit has been previously described 24 and is as follows. Service users were categorised as having (a) "dementia" if a diagnosis of dementia or cognitive decline with impact on independent living, was documented on the CSAR form by a health professional (geriatrician, public health nurse, general practitioner, occupational therapist) or (b) "suspected CI" where a validated cognitive screening tool was applied, and the documented score was indicative of mild CI.…”

Section: Study Variablesmentioning

confidence: 99%

See 4 more Smart Citations

Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

Aspell

O’Sullivan

O’Shea

et al. 2019

Int J Geriat Psychiatry

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Objective To identify factors that predict admission to long‐term care (LTC) and mortality among community‐based, dependent older people in Ireland, who were in receipt of formal home support. Methods An audit was conducted of all community‐dwelling older adults receiving government funded home support during 2017 in the Dublin North Central, Health Service Executive administrative area. Data were extracted from the Common Summary Assessment Report (CSAR), a mandatory form used in the provision of home support. Multiple logistic regression analysis was used to examine the factors associated with admission to LTC and mortality, with the results presented as odds ratios (OR) and 95% confidence intervals. Results The audit comprised 1597 community‐dwelling older adults with a mean age of 83.3 (SD: 7.2) years. The prevalence of transition to LTC and mortality was 8% and 9%, respectively, during the 12‐month period. Factors significantly associated with admission to LTC were “cognitive dysfunction” [OR 2.10 (1.41‐3.14), P < .001] and the intensity of home support [OR 1.05 (1.01‐1.06), P < .003], as measured by weekly formal care hours. Physical dependency and advanced age (aged 95 years +) were significantly associated with mortality in this population (P < .001). Conclusion “Cognitive dysfunction” and intensity of formal home support were associated with transition to LTC, while physical dependency and advanced age were associated with mortality. Investment in personalised, cognitive‐specific, services and supports are necessary to keep people with dementia and related cognitive impairments living at home for longer.

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Section: Discussionmentioning

confidence: 57%

Section: Key Pointsmentioning

confidence: 99%

Section: Study Variablesmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

Section: Study Variablesmentioning

confidence: 99%

See 3 more Smart Citations

Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

Aspell

O’Sullivan

O’Shea

et al. 2019

Int J Geriat Psychiatry

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Caring for people with dementia in their own homes: homecare workers' experiences of tolerating and mitigating risk

Ruston

Backhouse

2022

Ageing and Society

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Little is known about risk management in homecare for people with dementia. We aimed to gain an understanding of the ways in which homecare workers assess and manage risk whilst caring for people with dementia in their own homes. We conducted a qualitative interview study with 17 homecare workers assisting people with dementia with their personal care. Interviews were face-to-face, semi-structured, recorded and transcribed verbatim. Analysis was inductive and thematic. A key theme of risk was identified, with three main sources: the client as a source of risk to the homecare worker, the clients' home and behaviours as a risk to the client, and the wider health and social care system as a risk to both clients and homecare workers. Three interrelated aspects of risk were found to influence homecare workers' decision making and actions: homecare workers' perception of the level of risk, their perceived ability to control the risk and their tolerability of risk. The higher the perceived risk, the stronger the action taken by the worker or agency to mitigate it and the greater the impact on the client. To support effective development of this workforce there is a need to devise training that incorporates the use of tacit knowledge and experiential learning. Risk management policies for homecare should acknowledge and utilise the expertise, experiences and values of homecare workers.

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Resource allocation in dementia care: comparing the views of people with dementia, carers and health and social care professionals under constrained and unconstrained budget scenarios

Pierse

Keogh

Challis

et al. 2021

Aging & Mental Health

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Case types were developed using the approach adopted by (Challis et al., 2014). As is the case in many jurisdictions, there is no single data set available in Ireland with all the required variables to generate case types, so data from several sources were combined. The case types were developed mainly from an Irish data set of anonymised home care assessments of 277 people with dementia in an urban area (O'Brien et al., 2017). Four variables were used to generate the initial dementia case types: dependency measured by the Barthel Index, falls risk, living alone, communication difficulty (See Table 1). A set of dementia case types with all the possible combinations of the four variables was firstly generated, resulting in 24 case types. A sub-set of six case types, comprising 46 per cent of the dementia case types in the dataset was then selected for the study. The level of cognitive impairment for the case types was derived using a dataset of anonymised InterRai assessments (HSE, 2017) for 453 inpatients over 65 some of whom had been diagnosed with dementia. Further discriminating variables were sourced from the literature, specifically Behavioural and Psychological Symptoms of Dementia (BPSD) and Comorbidities. In previous balance of care studies, the attitudes to care mainly focused on attitudes to nursing home care (Tucker et al., 2016). However, in this study as the research question is more focused on the continuum of care, attitudes to care cover preferences in relation to spending, privacy, day-care attendance, carer preferences and attitudes to nursing home care. Unit CostsUnit costs for these services were calculated based on Irish Health Service Executive staff pay scales and the Irish literature on unit costs (O'Shea & Monaghan 2016). The full service cost, including voluntary, public and private funding, was used irrespective of the funding source, so that service prioritisation could be compared on a like for like basis. The full cost of a Psychiatry of Old Age referral and a carer education programme were included in the budget allocation for the hypothetical month, although in practice this cost may be spread over a longer period.

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High prevalence of dementia among community dwelling older adults in receipt of state funded home care packages: implications for health care planning

Cited by 17 publications

References 16 publications

Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

Predicting admission to long‐term care and mortality among community‐based, dependent older people in Ireland

Caring for people with dementia in their own homes: homecare workers' experiences of tolerating and mitigating risk

Resource allocation in dementia care: comparing the views of people with dementia, carers and health and social care professionals under constrained and unconstrained budget scenarios

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