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J Am Geriatr Soc. 2016 Mar;64(3):569-77. doi: 10.1111/jgs.14033.

Diagnosis and Disruption: Population-Level Analysis Identifying Points of Care at Which Transitions Are Highest for People with Dementia and Factors That Contribute to Them.

Author information

1
Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada.

Abstract

OBJECTIVES:

To examine transitions that individuals with dementia experience longitudinally and to identify points of care when transitions are highest and the factors that contribute to those transitions.

DESIGN:

Population-based 10-year retrospective cohort study from 2000 to 2011.

SETTING:

General community.

PARTICIPANTS:

All individuals aged 65 and older newly diagnosed with dementia in British Columbia, Canada.

MEASUREMENTS:

The frequency and timing of transitions over 10 years, participant characteristics associated with greater number of transitions, and the influence of recommended dementia care and high-quality primary care on number of transitions.

RESULTS:

Individuals experience a spike in transitions during the year of diagnosis, driven primarily by hospitalizations, despite accounting for end of life or newly moving to a long-term care facility (LTCF). This occurs regardless of survival time or care location. Regardless of survival time, individuals not in LTCFs experience a marked increase in hospitalizations in the year before and the year of death, often exceeding hospitalizations in the year of diagnosis. Receipt of recommended dementia care and receipt of high-quality primary care were independently associated with fewer transitions across care settings.

CONCLUSION:

The spike in transitions in the year of diagnosis highlights a distressing period for individuals with dementia during which unwanted or unnecessary transitions might occur and suggests a useful target for interventions. There is an association between recommended dementia care and outcomes and evidence of the continued value of high-quality primary care in a complex population at a critical point when gaps in continuity are especially likely.

KEYWORDS:

continuity; dementia; elderly; end of life; guidelines; multi-morbidity; population level; primary care; transitions

PMID:
27000330
DOI:
10.1111/jgs.14033
[Indexed for MEDLINE]

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