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Potentially preventable hospitalizations in dementia: family caregiver experiences

Published online by Cambridge University Press:  28 March 2017

Tatiana Sadak ,
Susan Foster Zdon ,
Emily Ishado ,
Oleg Zaslavsky  and
Soo Borson
Tatiana Sadak*
Affiliation:
Geriatric Mental Health, Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA; Geropsychiatric Nurse Practitioner, Dementia Specialist, Psychiatric Wellness & Dementia Care, Seattle, WA, USA
Susan Foster Zdon
Affiliation:
University of Washington Medical Center, Emergency Department, Seattle, WA, USA
Emily Ishado
Affiliation:
Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA; Geriatric Medical Social Worker. Kline Galland Community Based Services, Seattle, WA, USA
Oleg Zaslavsky
Affiliation:
Department of Biobehavioral Nursing and Health Systems, University of Washington School of Nursing, Seattle, WA, USA
Soo Borson
Affiliation:
University of Washington School of Medicine and Affiliate Professor, University of Washington School of Nursing, Seattle, WA, USA; Adjunct Professor of Neurology and Nursing, University of Minnesota, Minnesota, MN, USA
*
Correspondence should be addressed to: Tatiana Sadak, PhD, PMHNP Assistant Professor of Geriatric Mental Health, Department of Psychosocial and Community Health, Department of Psychosocial & Community Health, School of Nursing, Campus Mailbox 357263, 1959 NE Pacific Street, Seattle, WA 98195, USA. Phone: # (206) 459-1158; Fax # (888) 296-8140. Email: sadakt@uw.edu. Mailing address: 22608 57th Ave W, Mountlake Terrace, WA 98043.
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Abstract

Background:

Health crises in persons living with dementia challenge their caregivers to make pivotal decisions, often under pressure, and to act in new ways on behalf of their care recipient. Disruption of everyday routines and heightened stress are familiar consequences of these events. Hospitalization for acute illness or injury is a familiar health crisis in dementia. The focus of this study is to describe the lived experience of dementia family caregivers whose care recipients had a recent unplanned admission, and to identify potential opportunities for developing preventive interventions.

Methods:

Family caregivers (n = 20) of people with dementia who experienced a recent hospitalization due to an ambulatory care sensitive condition or fall-related injury completed phone interviews. Interviews used semi-structured protocols to elicit caregivers’ reactions to the hospitalization and recollections of the events leading up to it.

Results:

Analysis of interview data identified four major themes: (1) caregiver is uncertain how to interpret and act on the change; (2) caregiver is unable to provide necessary care; (3) caregiver experiences a personal crisis in response to the patient's health event; (4) mitigating factors may prevent caregiver crises.

Conclusions:

This study identifies a need for clinicians and family caregivers to work together to avoid health crises of both caregivers and people with dementia and to enable caregivers to manage the health of their care recipients without sacrificing their own health and wellness.

Keywords

carersadverse eventsprimary carefalls
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 7 , July 2017 , pp. 1201 - 1211
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

AARP Public Policy Institute. (2015). Executive summary: caregiving in the US. Available at: http://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-executive-summary-revised.pdf; last accessed 1 January 2017.Google Scholar
Alzheimer's Disease International (2015). World Alzheimer report 2015: the global impact of dementia. Available at: https://www.alz.co.uk/research/WorldAlzheimerReport2015.pdf; last accessed 1 January 2007.Google Scholar
American Academy of Neurology (2017). Medicare coding changes and values. Available at: https://www.aan.com/uploadedFiles/Website_Library_Assets/Documents/3.Practice_Management/1.Reimbursement/2.Medicare/1.Medicare_Payments/Codingtable-2017FeeSchedule.pdf; last accessed 1 January 2017.Google Scholar
Aneshensel, C. S., Pearlin, L. I., Levy-Storms, L. and Schuler, R. H. (2000). The transition from home to nursing home mortality among people with dementia. The Journal of Gerontology: Psychological Sciences, 55, S152–162. doi: 10.1093/geronb/55.3.S152.CrossRefGoogle ScholarPubMed
Bail, K., Goss, J., Draper, B., Berry, H., Karmel, R. and Gibson, D. (2015). The cost of hospital-acquired complications for older people with and without dementia; a retrospective cohort study. BMC Health Services Research, 15, 91. doi:10.1186/s12913-015-0743-1 CrossRefGoogle ScholarPubMed
Baker, N. L., Cook, M. N., Arrighi, H. M. and Bullock, R. (2011). Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom, 1988–2007. Age Ageing, 40, 49–54. doi: 10.1093/ageing/afq146 Google Scholar
Bloomer, M., Digby, R., Tan, H., Crawford, K. and Williams, A. (2014). The experience of family carers of people with dementia who are hospitalised. Dementia (London). doi:10.1177/1471301214558308 Google Scholar
Boltz, M. (2012). The family caregiver: an untapped resource. Geriatric Nursing, 33, 137–139. doi:10.1016/j.gerinurse.2012.02.004.CrossRefGoogle ScholarPubMed
Boltz, M., Chippendale, T., Resnick, B. and Galvin, J. E. (2015). Anxiety in family caregivers of hospitalized persons with dementia: contributing factors and responses. Alzheimer Disease and Associated Disorders, 29, 236–241. doi:10.1097/WAD.0000000000000072 Google Scholar
Bremer, P. et al. (2015). Informal dementia care: consequences for caregivers’ health and health care use in 8 European countries. Health Policy, 119, 1459–71. doi:10.1016/j.healthpol.2015.09.014 Google Scholar
Bynum, J. P., Rabins, P. V., Weller, W., Niefeld, M., Anderson, G. F. and Wu, A. W. (2004). The relationship between a dementia diagnosis, chronic illness, medicare expenditures, and hospital use. Journal of the American Geriatrics Society, 52, 187–194.Google Scholar
Centers for Medicare & Medicaid Service (CMS) (2015). 2014 measure information about the acute and chronic ambulatory care-sensitive condition composite measures, calculated for the value-based payment modifier program. Available at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2014-ACSC-MIF.pdf; last accessed 1 January 2017.Google Scholar
Chmelik, E., Emtman, R., Borisovskaya, , , A. and Borson, S. (2016). Communication in dementia care. Neurodegernerative Disease Management, 6, 479–490.Google Scholar
Dedoose. Great research made easy (2016). Available at: http://www.dedoose.com/; last accessed 1 January 2017.Google Scholar
Feng, Z., Coots, L. A., Kaganova, Y. and Wiener, J. M. (2014). Hospital and ED use among medicare beneficiaries with dementia varies by setting and proximity to death. Health Affairs (Millwood), 33, 683–690. doi:10.1377/hlthaff.2013.1179.Google Scholar
Hallberg, I. R. et al. (2013). Dementia care in eight European countries: developing a mapping system to explore systems. Journal of Nursing Scholarship, 45, 412–424. doi:10.1111/jnu.12046 Google Scholar
Harlein, J., Dassen, T., Halfens, R. J. and Heinze, C. (2009). Fall risk factors in older people with dementia or cognitive impairment: a systematic review. Journal of Advanced Nursing, 65, 922–933. doi:10.1111/j.1365-2648.2008.04950.x CrossRefGoogle ScholarPubMed
Lin, R. J., Adelman, R. D., Diamond, R. R. and Evans, A. T. (2014). The sentinel hospitalization and the role of palliative care. Journal of Hospital Medicine, 9, 320–323. doi:10.1002/jhm.2160 Google Scholar
MacNeil Vroomen, J., Bosmans, J. E., van Hout, H. P. and de Rooij, S. E. (2013). Reviewing the definition of crisis in dementia care. BMC Geriatrics, 13, 10. doi:10.1186/1471-2318-13-10 Google Scholar
Mark, R. E. (2016). Promote the health of dementia caregivers. American Journal of Alzheimer s Disease and Other Dementias, 31, 181–183. doi:10.1177/1533317515588182 Google Scholar
McClendon, M. J. and Smyth, K. A. (2015). Quality of in-home care, long-term care placement, and the survival of persons with dementia. Aging & Mental Health, 19, 1093–1102. doi:10.1080/13607863.2014.1003284 CrossRefGoogle ScholarPubMed
Phelan, E. A., Borson, S., Grothaus, L., Balch, S. and Larson, E. B. (2012). Association of incident dementia with hospitalizations. The Journal of the American Medical Association, 307, 165–172. doi:10.1001/jama.2011.1964 Google Scholar
Reinhard, S., Levine, C. and Samis, S. (2012). Home alone: family caregivers providing complex chronic care. AARP Public Policy Institute. Available at: http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/home-alone-family-caregivers-providing-complex-chronic-care-rev-AARP-ppi-health.pdf; last accessed 1 January 2017.Google Scholar
Roth, D. L., Fredman, L. and Haley, W. E. (2015). Informal caregiving and its impact on health: a reappraisal from population-based studies. Gerontologist, 55, 309–319. doi:10.1093/geront/gnu177 Google Scholar
Sadak, T., Korpak, A. and Borson, S. (2015). Measuring caregiver activation for health care: validation of PBH-LCI:D. Geriatric Nursing, 36, 284–292. doi:10.1016/j.gerinurse.2015.03.003 Google Scholar
Smith, J., Jarman, M. and Osborn, M. (1999). Doing Interpretive Phenomenological Analysis. London, UK: Saga.Google Scholar
Tinetti, M. E. and Kumar, C. (2010). The patient who falls: “it's always a trade-off”. Journal of the American Medical Association, 303, 258–266. doi:10.1001/jama.2009.2024 Google Scholar
World Health Organization (2012). Dementia: a public health priority. Available at: http://apps.who.int/iris/bitstream/10665/75263/1/9789241564458_eng.pdf?ua=1; last accessed 1 January 2017.Google Scholar
Yardley, L. (2000). Dilemmas in qualitative health research. Psychology and Health, 15, 215–228. doi: 10.1080/08870440008400302.Google Scholar
Zekry, D. et al. (2009). Does dementia predict adverse hospitalization outcomes? a prospective study in aged inpatients. International Journal of Geriatric Psychiatry, 24, 283–291. doi:10.1002/gps.2104 Google Scholar
Zhu, C. W., Cosentino, S., Ornstein, K., Gu, Y., Andrews, H. and Stern, Y. (2015). Use and cost of hospitalization in dementia: longitudinal results from a community-based study. International Journal of Geriatric Psychiatry, 30, 833–841. doi:10.1002/gps. 4222 Google Scholar