Variation in Home Healthcare Use by Dementia Status Among a National Cohort of Older Adults.

Autor:	Burgdorf JG; Center for Home Care Policy & Research, VNS Health, New York, New York, USA., Ornstein KA; Center for Equity in Aging, The Johns Hopkins School of Nursing, Baltimore, Maryland, USA., Liu B; Department of Population Health Science and Policy, Icahn School of Medicine at Mt. Sinai, New York, New York, USA., Leff B; The Center for Transformative Geriatric Research, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA., Brody AA; Hartford Institute for Geriatric Nursing, New York University Meyers College of Nursing, New York, New York, USA., McDonough C; Department of Population Health Science and Policy, Icahn School of Medicine at Mt. Sinai, New York, New York, USA., Ritchie CS; Mongan Institute for Aging and Serious Illness, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	The journals of gerontology. Series A, Biological sciences and medical sciences [J Gerontol A Biol Sci Med Sci] 2024 Mar 01; Vol. 79 (3).
DOI:	10.1093/gerona/glad270
Abstrakt:	Background: Medicare-funded home healthcare (HHC) delivers skilled nursing, therapy, and related services through visits to the patient's home. Nearly one-third (31%) of HHC patients have diagnosed dementia, but little is currently known regarding how HHC utilization and care delivery differ for persons living with dementia (PLwD). Methods: We drew on linked 2012-2018 Health and Retirement Study and Medicare claims for a national cohort of 1 940 community-living older adults. We described differences in HHC admission, length of stay, and referral source by patient dementia status and used weighted, multivariable logistic and negative binomial models to estimate the relationship between dementia and HHC visit type and intensity while adjusting for sociodemographic characteristics, health and functional status, and geographic/community factors. Results: PLwD had twice the odds of using HHC during a 2-year observation period, compared to those without dementia (odds ratio [OR]: 2.03; p < .001). They were more likely to be referred to HHC without a preceding hospitalization (49.4% vs 32.1%; p < .001) and incurred a greater number of HHC episodes (1.4 vs 1.0; p < .001) and a longer median HHC length of stay (55.8 days vs 40.0 days; p < .001). Among post-acute HHC patients, PLwD had twice the odds of receiving social work services (unadjusted odds ratio [aOR]: 2.15; p = .008) and 3 times the odds of receiving speech-language pathology services (aOR: 2.92; p = .002). Conclusions: Findings highlight HHC's importance as a care setting for community-living PLwD and indicate the need to identify care delivery patterns associated with positive outcomes for PLwD and design tailored HHC clinical pathways for this patient subpopulation. (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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