4.7 Article

Reasons for Hospitalization while Receiving Dementia Care Coordination through Maximizing Independence at Home

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ELSEVIER SCIENCE INC
DOI: 10.1016/j.jamda.2021.12.044

关键词

Hospitalization; dementia; care coordination

资金

  1. National Institute on Aging [R01 AG047859, P30 AG06650, K23 AG064036, T35 AG026758]
  2. Centers for Medicare and Medicaid Services (CMS Health Care Innovation Award) [1C1CMS331332]

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This study aims to describe the reasons for hospitalizations among community-living persons with dementia participating in a dementia care coordination study, and how these reasons vary by disease stage. The results show that infections and falls are the most common reasons for hospitalization, and the reasons vary based on the severity of functional impairment.
Objectives: Persons living with dementia (PLWD), particularly those with higher levels of functional impairment, are at increased risk of hospitalization and higher hospital-associated health care costs. Our objective was to provide a nuanced description of reasons for hospitalizations over a 12-month period among community-living persons with dementia taking part in a dementia care coordination study using caregiver-reported data and to describe how reasons varied by disease stage. Design: Retrospective descriptive analysis of pooled data from 2 concurrent studies of PLWD receiving the MIND at Home dementia care coordination program. Setting and Participants: Four hundred ninety-four community-dwelling PLWD with a family caregiver in the Greater Baltimore and Central Maryland region, 2015-2019. Methods: PLWD sociodemographic, clinical, functional, cognitive, and behavioral characteristics were assessed during an in-home baseline visit. Caregiver-reported hospitalizations and primary reasons for events were recorded every 4.5 months by research staff and by memory care coordinators during program delivery for a 12-month period. Hospitalization event data were subsequently reviewed, reconciled, and coded by a trained investigator. Results: One hundred seventy PLWD (34.4%) had at least 1 hospitalization within 12 months of enrollment, with 316 separate events. The most common primary reason for hospitalization according to caregivers was infection (22.4%), falls (16.5%), and cardiovascular/pulmonary (12.4%). Top reasons for hospitalization were falls among persons with mild and moderate functional impairment (17.7% and 21.9% respectively) and infection among PLWD with severe impairment (30.3%). Conclusions: and Implications:Infections and falls were the most common caregiver-reported reasons for hospitalization in PLWD receiving dementia care coordination. Reasons for hospitalization varied based on severity of functional impairment. Greater understanding of reasons for hospitalization among PLWD receiving dementia care management interventions, from multiple important perspectives, may help programs more effectively address and prevent hospitalization. (C) 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

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