The Effect of a Comprehensive Dementia Care Management Program on End‐of‐Life Care

Jennings, Lee A.; Turner, Maurice; Keebler, Chandra; Burton, Claire; Romero, Tahmineh; Wenger, Neil S.; Reuben, David B.

doi:10.1111/jgs.15769

Cited by 45 publications

(67 citation statements)

References 29 publications

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“…However, to be able to work in a person-centred way, the staff need to have preparation to do so. In our study, the participants expressed that staff were more focussed on the tasks to be done than on genuinely acknowledging them as in a relationship, which is consistent with previous studies of dementia care (Jennings et al, 2019;Rapaport et al, 2018). Szebehely and Trydegard (2012) explained this by suggesting that staff are pressured into a taskoriented approach by a too tight schedule and found that HCS has become more detail-oriented, leaving minimal time to nurture a relationship with the persons they care for.…”

Section: Discussionsupporting

confidence: 87%

Important aspects of home care service: An interview study of persons with dementia

et al. 2020

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Background and Aim Because of the policy of ‘ageing in place’ and a decreasing number of beds in residential settings, more persons with dementia live at home with support from home care services. However, previous studies have revealed more unmet needs and a lower quality of life in this group than in other groups. Because few qualitative studies are performed in which persons with dementia have the opportunity to tell their own stories and describe what they find important, this study aimed to interview persons with dementia and describe their views on the important aspects of receiving home care service. Methods The study used a qualitative approach, and 14 persons with dementia participated in the interviews. The interviews were analysed using qualitative content analysis. Findings The findings revealed one overarching theme. The importance of being supported as a unique and capable human, that is the persons with dementia stated that despite their dementia diagnoses, it was important to be seen as a person with capabilities, although in need of support. This theme was built on three subthemes: being seen as a person, being informed and involved, and being part of a relationship. Conclusions Our study showed that persons with dementia are able to express, formulate and reflect on their needs and preferences about their daily care as well as what is important to them when receiving home care service. Therefore, their point of view should be taken into consideration when planning, providing and evaluating care.

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Section: Discussionsupporting

confidence: 87%

Important aspects of home care service: An interview study of persons with dementia

et al. 2020

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“…Another important finding was the higher rate of ADC participants receiving hospice services in the last 6 months of life. Using chart review, we previously demonstrated the high rates of hospice use among persons in the program 22 . In this study using a more robust quasi‐experimental design, we were able to confirm that these rates were significantly higher than among persons with dementia receiving usual care, another potential source of cost savings.…”

Section: Discussionsupporting

confidence: 57%

The Effects of Dementia Care Co‐Management on Acute Care, Hospice, and Long‐Term Care Utilization

Jennings

Hollands

Keeler

et al. 2020

J American Geriatrics Society

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See related editorial by Callahan et al. in this issue. BACKGROUND/OBJECTIVES: Although nurse practitioner dementia care co-management has been shown to reduce total cost of care for fee-for-service (FFS) Medicare beneficiaries, the reasons for cost savings are unknown. To further understand the impact of dementia co-management on costs, we examined acute care utilization, long-term care admissions, and hospice use of program enrollees as compared with persons with dementia not in the program using FFS and managed Medicare claims data. DESIGN: Quasi-experimental controlled before-and-after comparison. SETTING: Urban academic medical center.

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“…Previous studies that investigated HHC interventions for similar end-of-life outcomes in people with dementia were mostly in small samples or followed a short period before death [21,22]. Jennings et al reported a longitudinal nurse practitioner dementia care programme in the Los Angeles community that enrolled 322 people and achieved a more than 90% rate of advance care planning (ACP) in decedents.…”

Section: Background/rationalementioning

confidence: 99%

The Association between Home Healthcare and Burdensome Transitions at the End-of-Life in People with Dementia: A 12-Year Nationwide Population-Based Cohort Study

Chen

Liao

et al. 2020

IJERPH

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Background: For people with dementia, burdensome transitions may indicate poorer-quality end-of-life care. Little is known regarding the association between home healthcare (HHC) and these burdensome transitions. We aimed to investigate the impact of HHC on transitions and hospital/intensive care unit (ICU) utilisation nearing the end-of-life for people with dementia at a national level. Methods: A nested case-control analysis was applied in a retrospective cohort study using a nationwide electronic records database. We included people with new dementia diagnoses who died during 2002–2013 in whole population data from the universal healthcare system in Taiwan. Burdensome transitions were defined as multiple hospitalisations in the last 90 days (early transitions, ET) or any hospitalisation or emergency room visit in the last three days of life (late transitions, LT). People with (cases) and without (controls) burdensome transitions were matched on a ratio of 1:2. We performed conditional logistic regression with stratified analyses to estimate the adjusted odds ratio (OR) and 95% confidence interval (CI) of the risks of transitions. Results: Among 150,125 people with new dementia diagnoses, 61,399 died during follow-up, and 31.1% had burdensome transitions (50% were early and 50% late). People with ET had the highest frequency of admissions and longer stays in hospital/ICU during their last year of life, while people with LT had fewer hospital/ICU utilisation than people without end-of-life transitions. Receiving HHC was associated with an increased risk of ET (OR = 1.14, 95 % CI: 1.08–1.21) but a decreased risk of LT (OR = 0.89, 95 % CI 0.83–0.94). In the people receiving HHC, however, those who received longer duration (e.g., OR = 0.50, 95 % CI: 0.42–0.60, >365 versus ≤30 days) or more frequent HHC or HHC delivered closer to the time of death were associated with a remarkably lower risk of ET. Conclusions: HHC has differential effects on early and late transitions. Characteristics of HHC such as better continuity or interdisciplinary coordination may reduce the risk of transitions at the end-of-life. We need further studies to understand the longitudinal effects of HHC and its synergy with palliative care, as well as the key components of HHC that achieve better end-of-life outcomes.

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The Effect of a Comprehensive Dementia Care Management Program on End‐of‐Life Care

Cited by 45 publications

References 29 publications

Important aspects of home care service: An interview study of persons with dementia

Important aspects of home care service: An interview study of persons with dementia

The Effects of Dementia Care Co‐Management on Acute Care, Hospice, and Long‐Term Care Utilization

The Association between Home Healthcare and Burdensome Transitions at the End-of-Life in People with Dementia: A 12-Year Nationwide Population-Based Cohort Study

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