The Nursing Home Effect: A Case Study of Residents With Potential Dementia and Emergency Department Visits

Barreto, Philipe de Souto; Lapeyre‐Mestre, Maryse; Mathieu, Céline; Piau, Christine; Bouget, Catherine; Cayla, Françoise; Vellas, Bruno; Rolland, Yves

doi:10.1016/j.jamda.2013.08.010

Cited by 6 publications

(13 citation statements)

References 22 publications

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“…First, the sample engaged was largely community-based, and as a result, the views of hospital-based staff including specialist clinicians and health service managers were under-represented. Given that a memory clinic has the potential to positively impact hospital service delivery by reducing emergency department presentations, admissions, and inpatient length of stay (due to adequate diagnosis, management, and advance care planning) [10][11][12][13], it is essential that these views are taken into account. This will be addressed in a follow-up Delphi method study that engages an expert panel with equal representation from all stakeholder groups.…”

Section: Discussionmentioning

confidence: 99%

“…Although there is no cure for dementia, there is an emerging body of evidence which demonstrates that early diagnosis is beneficial [7] and cost-effective for the health care system [8]. Timely access to a specialised cognitive assessment service and early diagnosis facilitates: access to treatments which reduce cognitive and neuropsychiatric symptoms [9]; reduces emergency department presentations from residential aged care facilities [10], hospital admissions [11] and length of stay [12,13]; improves medication adherence and monitoring [11], advance care planning [14], and access to community-based services to support activities of daily living (ADLs); and allows people to stay at home for longer [4,15]; results in improved mental health for carers [16] and greater acceptance of the diagnosis for both patients and families [17]. This is particularly relevant during the symptomatic pre-dementia mild cognitive impairment (MCI) phase which confers significantly increased dementia risk [18,19], as its classification as a diagnostic entity has been fraught with difficulty due to the lack of a consensus upon clear clinical and research diagnostic and management guidelines; significant efforts have been made to clarify this in recent times [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

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“We need a one-stop-shop”: co-creating the model of care for a multidisciplinary memory clinic with community members, GPs, aged care workers, service providers, and policy-makers

Steiner

Dubois

et al. 2020

BMC Geriatr

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Background: Timely diagnosis of dementia has a wide range of benefits including reduced hospital emergency department presentations, admissions and inpatient length of stay, and improved quality of life for patients and their carers by facilitating access to treatments that reduce symptoms, and allow time to plan for the future. Memory clinics can provide such services, however there is no 'gold standard' model of care. This study involved the co-creation of a model of care for a new multidisciplinary memory clinic with local community members, General Practitioners (GPs), policy-makers, community aged care workers, and service providers. Methods: Data collection comprised semi-structured interviews (N = 98) with 20 GPs, and three 2-h community forums involving 53 seniors and community/local government representatives, and 25 community healthcare workers. Interviews and community forums were audio-recorded, transcribed verbatim, and coded by thematic analysis using Quirkos.Results: GPs' attitudes towards their role in assessing people with dementia varied. Many GPs reported that they found it useful for patients to have a diagnosis of dementia, but required support from secondary care to make the diagnosis and assist with subsequent management. Community forum participants felt they had a good knowledge of available dementia resources and services, but noted that these were highly fragmented and needed to be easier to navigate for the patient/carer via a 'one-stop-shop' and the provision of a dementia key worker. Expectations for the services and features of a new memory clinic included diagnostic services, rapid referrals, case management, education, legal services, culturally sensitive and appropriate services, allied health, research participation opportunities, and clear communication with GPs. Participants described several barriers to memory clinic utilisation including transportation access, funding, awareness, and costs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“We need a one-stop-shop”: co-creating the model of care for a multidisciplinary memory clinic with community members, GPs, aged care workers, service providers, and policy-makers

Steiner

Dubois

et al. 2020

BMC Geriatr

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“…Of the 23 studies, 13 were from North America, 28e35,37,39,41,42,45 5 from Europe, 16,38,43,46,49 4 from Australia, 36,44,47,48 and 1 from Asia. 40 There were 18 high-, 1 moderate-, 49 and 2 low-quality studies, 37,46 with moderate risk and some concerns of bias identified in the nonrandomized 48 and randomized 47 controlled trials, respectively.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…There was high-strength evidence that increased likelihood of ED attendance was associated with increasing numbers of comorbidities, 28,31,34,38,46 neuropsychiatric symptoms (measured as depression, 16 psychiatric problems, 28 or diagnoses 46 ), and a history of previous hospital transfers, including prior hospitalization 31,34 and ED attendance. 31,36 All other clinical factors were associated with low-strength evidence, including limitations in activities of daily living, 28,46 dementia subtype, 16,36,39 pain, 41,46 medications, 46 specific comorbidities, 28,36,46 undiagnosed dementia, 43 and severity of cognitive impairment (measured using the Mini-Mental State Examination 16 and the Minimum Data Set Cognitive Performance Scale 34,46 ).…”

Section: Clinical Factorsmentioning

confidence: 99%

Factors Associated With Emergency Department Visits by People With Dementia Near the End of Life: A Systematic Review

Williamson

Evans

Cripps

et al. 2021

Journal of the American Medical Directors Association

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Objectives: Emergency department (ED) attendance is common among people with dementia and increases toward the end of life. The aim was to systematically review factors associated with ED attendance among people with dementia approaching the end of life. Design: Systematic search of 6 databases (MEDLINE, EMBASE, ASSIA, CINAHL, PsycINFO, and Web of Science) and gray literature. Quantitative studies of any design were eligible. Newcastle-Ottawa Scales and Cochrane risk-of-bias tools assessed study quality. Extracted data were reported narratively, using a theoretical model. Factors were synthesized based on strength of evidence using vote counting (PROS-PERO registration: CRD42020193271). Setting and Participants: Adults with dementia of any subtype and severity, in the last year of life, or in receipt of services indicative of nearness to end of life. Measurements: The primary outcome was ED attendance, defined as attending a medical facility that provides 24-hour access to emergency care, with full resuscitation resources. Results: After de-duplication, 18,204 titles and abstracts were screened, 367 were selected for full-text review and 23 studies were included. There was high-strength evidence that ethnic minority groups, increasing number of comorbidities, neuropsychiatric symptoms, previous hospital transfers, and rural living were positively associated with ED attendance, whereas higher socioeconomic position, being unmarried, and living in a care home were negatively associated with ED attendance. There was moderatestrength evidence that being a woman and receiving palliative care were negatively associated with ED attendance. There was only low-strength evidence for factors associated with repeat ED attendance. Conclusions and Implications: The review highlights characteristics that could help identify patients at risk of ED attendance near the end of life and potential service-related factors to reduce risks. Better understanding of the mechanisms by which residential facilities and palliative care are associated with reduced ED attendance is needed.

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“…Citation and reference searching of the four reviews and included studies identified a further 120 studies for abstract and title screening, of which 12 were retrieved. [77][78][79][80][81][82][83][84][85][86][87][88] Overall, 72 primary studies and four systematic reviews were retrieved; 30 of these studies used qualitative methods and were considered for inclusion in an accompanying review. 18,19,21,22,[26][27][28][29]31,32,[37][38][39][40][44][45][46]51,[54][55][56][58][59][60][61][66][67][68][69][70] The remaining 42 retrieved primary studies were considered for inclusion in this review.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Factors associated with increased Emergency Department transfer in older long-term care residents: a systematic review

Marincowitz

Preston

Cantrell

et al. 2022

The Lancet Healthy Longevity

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The Nursing Home Effect: A Case Study of Residents With Potential Dementia and Emergency Department Visits

Cited by 6 publications

References 22 publications

“We need a one-stop-shop”: co-creating the model of care for a multidisciplinary memory clinic with community members, GPs, aged care workers, service providers, and policy-makers

“We need a one-stop-shop”: co-creating the model of care for a multidisciplinary memory clinic with community members, GPs, aged care workers, service providers, and policy-makers

Factors Associated With Emergency Department Visits by People With Dementia Near the End of Life: A Systematic Review

Factors associated with increased Emergency Department transfer in older long-term care residents: a systematic review

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