Who Is Providing the Predominant Care for Older Adults With Dementia?

Abstract

Objectives To identify which clinical specialties are most central for care of people with dementia in the community and long term care (LTC) settings. Design Cross-sectional analysis Participants Fee-for-service Medicare beneficiaries aged ≥65 years with dementia Measurements Specialty, categorized into primary care (internal or family medicine, geriatrics, or nurse practitioners (NPs)) versus other specialties, of the predominant provider of care (PPC) for each patient, defined by providing the most ambulatory visits. Results Among 2,598,719 beneficiaries with dementia, 74% lived in the community and 80% had a PPC in primary care. In LTC, 91% had primary care as their PPC compared to 77% in community (p<.001). Cardiology and neurology were most frequent specialists. NPs were PPCs for 19% of dementia patients in LTC versus 7% in the community (p<.001). Conclusion It is unknown whether specialists are aware of their central role for many dementia patients’ care needs. In LTC, NPs play a lead role as PPCs.

The Impact of Nurse Practitioners on Hospitalizations and Discharges from Long-term Nursing Facilities: A Systematic Review

“…Additional facilitator themes identified during the review of the articles were as follows. Increased access to healthcare was mentioned in 14 of 136 occurrences of facilitator themes, or 10.29% [ 18 , 20 , 23 , 24 , 25 , 30 , 32 , 33 , 34 ]. Patient and family education were mentioned in 3 of 136 occurrences of facilitator themes, 2.21% [ 13 , 20 ].…”

“…Reduced healthcare costs were mentioned in 9 of 136 occurrences of facilitator themes, or 6.62% [ 7 , 8 , 9 , 12 , 14 , 23 , 30 ]. Unrestrictive or least restrictive scope of practice for NPs was mentioned in 10 of 136 occurrences of facilitator themes, 7.35% [ 10 , 14 , 16 , 17 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

“…When NPs were utilized, patients experienced increased access to healthcare, patient and family education, and a multidisciplinary approach [ 13 , 18 , 20 , 21 , 23 , 24 , 25 , 29 , 30 , 32 , 33 ]. Increased access to healthcare was mentioned in 14 of 132 occurrences (10.29%) of facilitator themes [ 18 , 20 , 23 , 24 , 25 , 30 , 32 , 33 , 34 ]. Failures in the traditional process of primary care provider referrals negatively impacted quality outcomes of resident care [ 32 ].…”

“…When utilized, NP services adequately filled the gap [ 32 ]. In fact, in long-term care, NPs often played the lead role as primary care providers [ 34 ]. Their ability to communicate and collaborate with other healthcare professionals, patients, and their families about their chronic illnesses, disease trajectories, and their goals of care positively impacted clinical outcomes [ 20 , 21 ].…”

“…Those NPs working at this capacity were well positioned to promote high quality care, multidisciplinary collaboration, communication, education, leadership, advocacy, research, and evidence-informed practice [10,14,16,17,31,33,34,36]. Unrestricted scope of practice for NPs improved health outcomes and reduced the costs [34]. To ensure successful NP practice, both state and organizational policies should be taken into consideration [36].…”