Hours Of Care Research Articles

THE ROLE OF DEMENTIA AND SERIOUS ILLNESS IN RECEIPT OF PAID CARE

Abstract Little is known about receipt of paid care for individuals living at home with dementia and other non-dementia serious illnesses. This retrospective cohort study sought to characterize receipt of paid care among individuals with impairment in self-care activities and/or other manifestations of serious illness in the context of family caregiving and socioeconomic status. Data from participants ≥65 years enrolled in the Health and Retirement Study between 1998-2018 with new-onset need for help in ≥1 self-care task was linked to fee-for-service Medicare claims (sample n=2,521). We found that those who received paid care experienced higher healthcare utilization than those without paid care. Receipt of paid care was highest among those with multiple manifestations of serious illness: 41.7% of those with self-care impairment, dementia, and non-dementia serious illness received ≥40 hours of paid care per week. When present, paid care accounted for 54% of total caregiving hours. In multivariable models, those with Medicaid were more likely to receive paid care (p<0.001), but those in the highest income quartile received more hours of paid care (p=0.05.) Those with non-dementia serious illness were more likely to receive paid care (p<0.001), but those with dementia received more hours of paid care (p<0.001). The role of paid caregivers grows as people experience multiple manifestations of serious illness and high care hours are common among those with dementia. Future work should explore how paid caregivers can collaborate with families and healthcare teams to improve the health and well-being of the seriously ill living at home.

CAREGIVER AND VETERAN PERCEPTIONS OF THE REFINING ELDER CARE IN AMERICA PROGRAM (RECAP)

Abstract In 2021, the Veterans Health Administration (VHA) piloted the Redefining Elder Care in America Program (RECAP) at two Department of Veterans Affairs (VA) health care centers. RECAP identifies Veterans at risk for nursing home placement, and coordinators conduct a phone assessment with Veterans or their caregivers to link Veterans to VA services. To identify benefits and challenges of RECAP from Veterans’ and caregivers’ perspectives, we conducted phone interviews (N=32) from October 2021- May 2022. We analyzed data using a thematic approach, finding that participants appreciated the proactive nature of RECAP, felt supported by RECAP coordinators, and felt the VA cared about them. Caregivers cited RECAP’s benefits, such as learning about VA services and having the RECAP coordinator as a point of contact to help them navigate the VA. Caregivers of Veterans who received services reported improvements in caregiver mental health, decreases in caregiver burden, and improvements in Veterans’ abilities to remain at home. A few caregivers were uncertain if they could trust the RECAP phone assessment, thinking it was a scam, and two reported challenges contacting the coordinator after the assessment. Several caregivers expressed uncertainty about the timeline for service delivery and next steps to obtain services following the assessment. Caregivers described challenges related to receiving services including Veterans not being eligible for the chosen service and receiving fewer hours of home health care than desired. Overall, participants were satisfied with RECAP. Challenges identified should be addressed to best meet the needs of Veterans and Caregivers.

HEALTH INFORMATION–SEEKING BEHAVIORS, CONFIDENCE, AND CHALLENGES AMONG FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA

Abstract Family caregivers play a significant role in providing care for their loved ones with dementia, including communication with healthcare providers (HCP), treatment decision-making, and care coordination. These tasks require family caregivers’ ability to seek, manage, and interpret health information they have found or received during and outside clinical encounters. This study examined which sources family caregivers use for seeking dementia care information, how trustworthy and reliable they find these sources, and information seeking confidence and challenges. A survey designed to understand family caregivers’ information seeking was completed by 36 participants who provided at least 10 hours of dementia care weekly (mean age 63.4; 83% female). About 80% reported using the Internet to look for dementia information, and less than 20% used a smartphone app to exchange their loved one’s medical information with HCP through a protected portal. While family caregivers entrusted HCP, pharmacists, and dementia-related organizations as sources of dementia information, they were skeptical of radio and TV as sources of credible information. Other information sources were identified, including Alzheimer’s Association, support groups, books/documentaries, and research journals. Approximately 50% reported concerns about the quality of dementia-related information; 45% experienced difficulties accessing the information they needed; 44% sensed frustration while searching for dementia-related information; and 40% had difficulty understanding the information found. There should be efforts to develop strategies that help dementia caregivers better identify credible information sources to increase confidence and reduce the stress and burden of acquiring reliable information necessary to care for their loved ones.

DEMENTIA-FRIENDLY ENVIRONMENTS IN THE COMMUNITY – AN INTERNATIONAL PERSPECTIVE ON CONCEPTS AND INTERVENTIONS

Abstract Dementia is one of the major age-related societal challenges and causes enormous demands for persons living with dementia (PlwD). Although dementia is one of the major reasons for relocation into a nursing home, most PlwD want to live as long as possible in a familiar domesticity. Therefore, innovative care concepts for community-dwelling PlwD are being developed worldwide as alternative to traditional long-term care settings. Efforts are made to learn more about dementia-friendly environments in order to improve quality of care and quality of life of PlwD. This international symposium will therefore provide four presentations as well as a concluding discussion addressing new concepts for innovative care environments and measuring dementia-friendliness of the built environment as well as nonpharmacological interventions to support high quality person-centred care. The first presentation explores the functions of 24-hour green care farms as alternative to nursing homes and how these can be transferred to other care settings. The second presentation discusses the impact of moving from traditional care environments to innovative care settings for residents and staff. The third presentation presents results of a cluster randomized controlled trial in German shared housing arrangements where a complex nonpharmacological intervention led to significantly less hospital admissions for PlwD. And the final presentation describes an innovative approach to evaluate the wayfinding infrastructure in urban areas for PlwD and to promote dementia-friendliness in urban living structures. The discussant will synthesize the research findings and lead a discussion of research implications and future directions for policy and practice.

A Comparative Gender Analysis of Injury Characteristics, Treatments and Outcomes among Persons Seeking Emergency Care in Kigali, Rwanda

In high-income nations, gender has been associated with injury characteristics. This study evaluated injury epidemiology and care based on gender at the Centre Hospitalier Universitaire de Kigali in Rwanda. Patients presenting to the emergency department with acute injuries were prospectively enrolled from 27 January–28 June 2020, and descriptive statistics were performed with comparisons between males and females. Of 601 patients, 25.6% were female and 74.4% were male. There were gender differences in the mechanism of injury, with females more likely to be injured in falls (43.5% versus 23.0%, p = 0.001); meanwhile, males were more likely to suffer road traffic accidents (52.6% versus 39.6%, p = 0.006). The severity of injury was similar between genders based on the mean Kampala Trauma Score (14.4 versus 14.7, p = 0.09). Females were more likely to have been transported by prehospital services (87.7% versus 72.9%, p = 0.001), and less likely to receive acute treatment during the first six hours of care (67.5% versus 78.1%, p = 0.009). There was no significant difference in mortality between females and males (2.0% versus 1.3%, p = 0.568). This study highlights differences in the epidemiology and care between males and females presenting for emergency injury care in Rwanda. These findings can inform future research and developments in gender-centered healthcare delivery.

Use of Digital Health Resources by Sexual and Gender Minority Caregivers of Older Adults: Findings From the 2020 Caregiving in the U.S. Survey.

We applied Andersen's Behavioral Model of Health Services Use to investigate the health needs and use of digital health resources among sexual and/or gender minority (SGM) caregivers. Data were from the Caregiving in the U.S. 2020 survey. Regression analyses were used to describe associations between predisposing, enabling, and need factors and usage of digital health resources. SGM caregivers provided more hours of care per week, reported higher levels of care intensity, and reported higher physical, emotional, and financial strain compared with non-SGM caregivers. Regression analyses indicated SGM status was a significant predictor of overall use of digital health resources. Younger caregivers, racial minority caregivers, those providing higher levels of care, and those reporting a poorer health status were more likely to use digital health resources. Digital health resources may be useful tools for SGM caregivers of older adults. More research is needed to investigate the reasons SGM caregivers use these resources.

Profile of Older Dual-Enrollees Living in Areas with Managed Long-Term Services and Supports

ObjectivesNearly half of all state Medicaid agencies in the United States have implemented managed long-term services and supports (MLTSS). Data gaps have inhibited our understanding of MLTSS experiences to date. We draw on a national survey with novel data linkages to develop a profile of older dual-enrollees with significant LTSS needs by MLTSS program presence. DesignCross-sectional observational study using the 2015 round of the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally representative sample of Medicare beneficiaries aged 65 years and older. Setting and ParticipantsThe sample comprised 275 participants who self-reported Medicaid enrollment and met our definition of significant LTSS need as defined by receiving help with 2 or more self-care or mobility activities (eating, bathing, toileting, dressing, bed transfer, indoor mobility). MethodsBivariate analyses were used to comparatively examine differences in demographic, health, and care circumstances by MLTSS, as defined by living in a county with MLTSS program presence. ResultsAmong approximately 1 million (weighted sample) older dual-enrollees with significant LTSS needs, 56.2% (weighted percentage) lived in counties with MLTSS and 43.7% lived in counties with mandatory MLTSS enrollment in 2015. Those living in areas with MLTSS were much more likely to be of Hispanic or other race and ethnicity (50.5% vs 15.1%, P < .001) yet less likely to live in a rural location (8.7% vs 31.4%, P < .05) or in a residential care facility or nursing home (18.4% vs 34.7%, P < .05). The majority (78.5%) received assistance from 2 or more helpers and received more than 70 hours of care per week. Conclusions and ImplicationsOur findings reinforce the growing reach of MLTSS programs and importance of filling evidence gaps about who these programs are serving.

“Qualitative evaluation of a digital software solution for documentation and training in 24-hour home care”

ABSTRACT Owing to its cost-efficiency, 24-hour home care is increasing and represents a cornerstone in the care of elder people in Austria. A software solution to support 24-hour caregivers in their daily routine was developed facilitating a user-centered design process. It includes electronic documentation, an e-learning platform, emergency management, and a communication tool. To evaluate the usability and acceptance of the developed software solution, a qualitative survey including focus groups (FG), a group interview (GI), and a usability walkthrough (UW) were conducted. This paper describes the findings of the qualitative survey which indicate that the e-learning platform as well as the e-documentation support 24-hour caregivers in their daily work with their clients. Participants with less technical affinity needed support to use the tool proficiently. 24-hour caregivers appreciate the fact that the solution unites all the needed information in one place.

Palliative care in Autosomal Dominant Alzheimer’s disease due to PSEN1‐E280A genetic variant in Colombia

AbstractBackgroundAutosomal Dominant Alzheimer’s disease (ADAD) is a subtype of AD in which the symptoms begin before age 65. ADAD is an important subtype of AD as it affects people at productive and reproductive age, has a genetic origin in most of the cases and is one of the 10 causes of years lost to disability (YDLs) (1). Colombia has the largest kindred family with ADAD due to PSEN1‐E280A genetic variant, we aimed to characterize the palliative care need in a subsample of individuals from these families.MethodsWe performed an analytical observational study with one year follow‐up, data obtained from visit 1 (V1) is shown in this first report. Carriers of PSEN1‐E280A variant and GDS/FAST score above 4 were included. NECPAL and Edmonton surveys were conducted to the main carer to assess the need for palliative care and the frequency of symptoms. A complete medical evaluation was also performed.Results36 patients were included in V1. Median age was 53, most of the individuals were women (63.89%), lived in urban areas (88.89%) and the most common level of education was elementary‐middle school (47.22%). Clinical variables are listed in Table 2. Results of the poisson regression showed that dysphagia, pressure ulcers, asthenia perceived by the main carer, not being surprised if the patient died in the following 12 months (Surprise question of NECPAL scale), functional decline, use of medical services (2 visits in the past year), PAINAD scale and GDS/FAST scale were associated with the need for palliative care when adjusted by number of persons involved in caring, type of carer, hours of care per week and caregiver training.ConclusionADAD is a neurodegenerative disease that requires follow‐up by palliative care services. The health perception of the main carer should be taken into consideration when deciding the need for palliative care in these patients.

Dementia Caregiver Burden associated with COVID‐19 quarantine: A South American Cohort Study

AbstractBackgroundIn December 2019, a new virus, Coronavirus disease (COVID‐19/SARS‐CoV‐2), burst into the world. Social distancing reduces its transmission and delays the spread peak. However, because of the late arrival of vaccines to our region, Argentina had a rigorous mandatory preventive social isolation (MPSI) policy that extended beyond global record. As a result, MPSI had a disruptive impact on the actions associated with the well‐being of dementia patients, and caregivers. In addition, MPSI added to the well‐known caregiver burden already present in many dementia patients’ caregivers. This study aims to investigate the impact of MPSI on dementia patients’ caregivers’ mental health and to identify predictors of caregivers’ burden.MethodA sample of 112 caregivers (75.89% female; age 58.65 ± 14.30) of patients with dementia answered a survey with the following questionnaires: Zarit Burden Interview (ZBI), Weekly hourly load dedicated to dementia care, time spent on leisure activities (activity diary provided by Argentine National Institute of Statistics and Census), the Caregiver Activities Survey (CAS) and the Depression, Anxiety and Stress Scale (DASS‐21). These questionnaires evaluate caregiving characteristics and their impact on the caregiver. Additionally, history of COVID‐19 was recorded for patients, caregivers and people living with either of them.ResultMost caregivers were women (75.89%). This difference hindered direct comparison between men and women. A regularized L2 regression was performed and the number of caregiving hours (β = 0.090), depression (β = 0.085), anxiety (β = 0.099), stress (β = 0.164), and fear of COVID‐19 (β = 0.141), were identified as predictors of caregiver burden. Finally, a mediation analysis was also performed, and hours of care (CAS; r = 0.254), being the primary caregiver, and fear of COVID‐19 (r = 0.335) were identified as mediators of the effect between anxiety, depression, stress (DASS) and burden (ZBI).ConclusionCaregivers of dementia patients show sequelaes of anxiety, stress, depression, and caregivers’ burden in the context of COVID‐19 spread and during MPSI. Being a primary caregiver, dedicating more hours to caregiving, and fear of COVID‐19 are factors that contribute significantly to caregiver burden and mediate between this burden and mood variables. Relief of caregivers' burden could be aided by the design of public health policies that specifically address the mediators identified in this study.

The ability of Psychosocial Care Centers specialized in Alcohol and Drugs to handle crises.

(1) To our knowledge, this is the first study to evaluate CAPSAD's ability to handle crises. (2) The ability to handle crises of the CAPSAD from downtown São Paulo was86.6%. (3) Of the nine users referred to other services, only one evolved to hospitalization. to assess the ability of 24-hour Psychosocial Care Centers specialized in Alcohol and Other Drugs to handle the users' crises in comprehensive care. a quantitative, evaluative, and longitudinal study was conducted from February to November2019. The initial sample consisted of 121users, who were part of the comprehensibly care in crises by two 24-hour Psychosocial Care Centers specialized in Alcohol and other Drugs in downtown São Paulo. These users were re-evaluated 14days after admission. The ability to handle the crisis was assessed using a validated indicator. The data were analyzed using descriptive statistics and regression of mixed-effects models. 67users(54.9%) finished the follow-up period. During crises, nine users (13.4%; p=0.470) were referred to other services from the health network: seven due to clinical complications, one due to a suicide attempt, and another for psychiatric hospitalization. The ability to handle the crisis in the services was 86.6%, which was evaluated as positive. both of the services analyzed were able to handle crises in their territory, avoiding hospitalizations and enjoying network support when necessary, thus achieving the de-institutionalization objectives.

Capacidade de manejo de situações de crise por Centros de Atenção Psicossocial Álcool e Drogas

Objective: to assess the ability of 24-hour Psychosocial Care Centers specialized in Alcohol and Other Drugs to handle the users’ crises in comprehensive care. Method: a quantitative, evaluative, and longitudinal study was conducted from February to November 2019. The initial sample consisted of 121 users, who were part of the comprehensibly care in crises by two 24-hour Psychosocial Care Centers specialized in Alcohol and other Drugs in downtown São Paulo. These users were re-evaluated 14 days after admission. The ability to handle the crisis was assessed using a validated indicator. The data were analyzed using descriptive statistics and regression of mixed-effects models. Results: 67 users (54.9%) finished the follow-up period. During crises, nine users (13.4%; p=0.470) were referred to other services from the health network: seven due to clinical complications, one due to a suicide attempt, and another for psychiatric hospitalization. The ability to handle the crisis in the services was 86.6%, which was evaluated as positive. Conclusion: both of the services analyzed were able to handle crises in their territory, avoiding hospitalizations and enjoying network support when necessary, thus achieving the de-institutionalization objectives.

Cost of informal dementia care by US state, 2010‐2019

AbstractBackgroundThere are significant costs associated with dementia care throughout the world. These are expected to rise as populations age. Informal (unpaid) care represents a large fraction of these costs, although it is challenging to measure. In the United States, estimates of the cost of informal dementia care are dated and measured only at the national level. To fill this gap, we estimated the cost of informal care attributable to dementia through 2019 for each US state.MethodThe value of informal care is estimated as the replacement cost (cost of an equivalent number of hours of paid care) and opportunity cost (expected cost of forgone wages of the caregivers). We combine data from the Behavioral Risk Factor Surveillance System, the National Health and Aging Trends Study (NHATS), and the Health and Retirement Study to estimate caregiving hours at the state level from 2010‐2019. NHATS data are used to estimate the fraction of caregiving hours attributable to dementia.ResultIn 2019, the average annual per‐patient cost of informal care attributable to dementia was $42,271 ($37,338‐$47,898) using the replacement cost method and $19,769 ($15,711‐$25,029) using the opportunity cost method. These estimates imply a national cost of $207.2B ($183.1B‐$234.8B) or $96.9B ($77.0B‐$122.7B) per year, respectively. State‐level estimates show significant variation in informal caregiving hours per prevalent case of dementia. In 2019, the annual replacement cost of informal care provided per patient ranged from $15,885 ($13,941 ‐$17,979) in Nebraska to $71,438 ($63,155 ‐$80,316) in New Mexico. The opportunity cost had a larger spread in relative terms, ranging from $6,653 ($5,233‐$8,417) in Nebraska to $36,831 ($29,071‐$46,833) in Missouri. Co‐occurrence of diabetes mellitus prevalence is associated with more informal care hours for the average adult living with dementia, while average years of education of the caregiver is associated with fewer informal care hours.ConclusionThe hours spent on informal care per prevalent case of dementia vary dramatically by state. This work adds to our understanding of health and demographic factors that are associated with hours of informal care, which can help policymakers plan for future increases in dementia prevalence and assess policy to support caregivers.

Dementia caregiver burden and its toll on caregiver health

AbstractBackgroundIn 2019, more than 16 million U.S. family members and friends provided 18.6 billion hours of unpaid care to people with cognitive impairment. Mexican Americans (MAs) make up two thirds of the Latinx population and research shows that MA caregivers report more caregiver burden compared to non‐Hispanic Whites (NHW). The purpose of this study is to examine the underlying mechanisms influencing caregiver burden on the physical and mental health of caregivers by ethnicity and familism.MethodWe recruited adults 65 and older with cognitive impairment (Montreal Cognitive Assessment score&gt;25), and their caregivers living in Nueces County, Texas. Caregiver burden was measured using the Zarit Burden Interview. Familism was measured using a 18‐item scale. Caregiver’s mental and physical health were derived from the 36‐Item Short Form Survey. Covariates included caregiver’s age, sex, ethnicity, education and care recipient’s cognitive function and physical impairment, including the ability to eat, dress or go to the toilet without assistance. We used weighted path analysis to test effects of ethnicity, familism and caregiver burden on caregiver’s mental and physical health. Covariates with p‐values&gt;0.15 were excluded to attain a parsimonious reduced model.ResultWe included data from 516 caregivers and those they cared for. MA caregivers were younger, female, had less education and scored higher on the familism scale compared to NHW (Table 1). Figure 1 includes results from our reduced weighted path model which presented a good model fit. Increased caregiver burden was associated with worse mental (B = ‐0.53;p&lt;0.001) and physical health (B = ‐0.14;p = 0.003). Familism had indirect positive effects on mental and physical health outcomes mediated by lowering caregiver burden (B = ‐0.15;p = 0.001). Being a MA caregiver was associated with a stronger level of familism (B = 0.49;p&lt;0.001). Findings indicate that MA caregivers have better physical and mental health due to reduced caregiver burden because of stronger family relations.ConclusionResults show that increased caregiver burden is associated with worse caregiver’s mental and physical health. However, among MA, familism can be a protective factor against caregiver burden. Findings can contribute to early identification, intervention and coordination of services to help reduce caregiver burden, particularly in the growing MA informal caregiver population.

Critical Nurses’ Views And Experiences Of Caring Unconscious Patients: A Qualitative Study

Nurses who care for patients in critical rooms, especially unconscious patients, feel greater pressure and burden of responsibility when caring for patients. This study further explores the nurses’ perceptions as 24-hour care providers for unconscious patients and their experiences observing patients and family interactions during the critical phase of unconsciousness. Data were collected with Descriptive Qualitative Research Approach through a focus group discussion process consisting of 12 critical care nurses as participants. The results show four main themes and seven subthemes, including the nurses’ responses when they first met unconscious patients, family involvement in patient care, the role of family stimulation activities, and the patient’s responses when they woke up. This study concludes that nurses attempt to function effectively according to the nursing process procedures, although psychologically, they experience stress when caring for unconscious patients, and active family involvement s essential to support and enhance the patient’s recovery process. Furthermore, critical nurses need to get interventions for solving their psychological problems and the need to actively involve families in the care of unconscious patients.

Predicting high-intensity resuscitation needs in injured patients in the post-hemostasis phase of care following intervention.

Best resuscitation practices in the posthemostasis phase of care are poorly defined; this phase of care is characterized by a range of physiologic derangements and multiple therapeutic modalities used to address them. Using a cohort of injured patients who required an immediate intervention in the operating room or angiography suite following arrival to the emergency department, we sought to define high-intensity resuscitation (HIR) in this posthemostasis phase of care; we hypothesized that those who would require HIR could be identified, using only data available at intensive care unit (ICU) admission. Clinical data were extracted for consecutive injured patients (2016-2019) admitted to the ICU following an immediate procedure in the operating room or angiography suite. High-intensity resuscitation thresholds were defined as the top decile of blood product (≥3 units) and/or crystalloid (≥4 L) use in the initial 12 hours of ICU care and/or vasoactive medication use between ICU hours 2 and 12. The primary outcome, HIR, was a composite of any of these modalities. Predictive modeling of HIR was performed using logistic regression with predictor variables selected using Least Absolute Shrinkage and Selection Operator (LASSO) estimation. Model was trained using 70% of the cohort and tested on the remaining 30%; model predictive ability was evaluated using area under receiver operator curves. Six hundred five patients were included. Patients were 79% male, young (median age, 39 years), severely injured (median Injury Severity Score, 26), and an approximately 3:2 ratio of blunt to penetrating mechanisms of injury. A total of 215 (36%) required HIR. Predictors selected by LASSO included: shock index, lactate, base deficit, hematocrit, and INR. The area under receiver operator curve for the LASSO-derived HIR prediction model was 0.82. Intensive care unit admission data can identify subsequent HIR in the posthemostasis phase of care. Use of this model may facilitate triage, nursing ratio determination, and resource allocation. Therapeutic/Care Management; Level IV.

Clinical Update of Thermal Burns Injury

The initial 48 hours following a thermal burn injury present the most significant window of opportunity to influence a patient's life expectancy. This review was aimed to describe clinical update of thermal burn injury. Burns are categorized according to their size, severity, the age of the patient, and any related medical conditions or injuries. A precise assessment of the magnitude and extent of the burn injury is essential for quantifying resuscitation parameters. Smoke inhalation, trauma, and electrical injuries are frequently present with burns. Severe burns, regardless of their origin, can lead to comparable complications such as infection, difficulty breathing, dysfunction of multiple organs, blood clot formation in veins, and gastrointestinal issues. In conclusion, the treatment plan of thermal burns will be determined based on the expected location, size, and depth of the burn. The initial 48 hours of burn care have the most significant influence on the morbidity and death of burn victims.

The consequences of caring on health during early adulthood in Spain

The consequences of caring on health during early adulthood in Spain

Reduction of Mental Health-Related Emergency Department Admissions for Youth and Young Adults Following a Remote Intensive Outpatient Program: Quality Improvement Analysis.

Pediatric mental health emergency department (ED) visits are increasing at 6% to 10% per year, at substantial cost, while 13% of youth with psychiatric hospitalizations are readmitted in the following weeks. Hospitals do not have the resources to meet escalating youth's mental health needs. Intensive outpatient (IOP) programs, which provide multiple hours of care each week, have the power to reduce the number of patients in need of hospitalized care and provide a step-down option for patients discharging from ED's in order to prevent readmissions. The purpose of this program evaluation was to assess (1) whether youth and young adult ED admission rates decreased following participation in a remote IOP program and (2) whether there were differences in readmission rates between youth and young adults by gender identity, sexual orientation, race, or ethnicity. Data were collected from intake and 3-month postdischarge surveys for 735 clients who attended at least 6 sessions of a remote IOP program for youth and young adults. Patients reported if they had been admitted to an ED within the previous 30 days and the admission reason. Over half (407/707, 57.6%) of clients were adolescents and the rest were young adults (300/707, 42.4%; mean age 18.25, SD 4.94 years). The sample was diverse in gender identity (329/687, 47.9% female; 196/687, 28.5% male; and 65/669, 9.7% nonbinary) and sexual orientation (248/635, 39.1% heterosexual; 137/635, 21.6% bisexual; 80/635, 10.9% pansexual; and 170/635, 26.8% other sexual orientation) and represented several racial (9/481, 1.9% Asian; 48/481, 10% Black; 9/481, 1.9% Indigenous; 380/481, 79% White; and 35/481, 7.2% other) and ethnic identities (112/455, 24.6% Hispanic and 28/455, 6.2% other ethnic identity). Mental health-related ED admissions significantly decreased between intake and 3 months after discharge, such that 94% (65/69) of clients with a recent history of mental health-related ED admissions at IOP intake reported no mental health-related ED admissions at 3 months after discharge from treatment (χ21=38.8, P<.001). There were no differences in ED admissions at intake or in improvement at 3 months after discharge by age, gender, sexuality, race, or ethnicity. This study documents a decrease in ED admissions between intake and 3 months after discharge among both youth and young adults who engage in IOP care following ED visits. The similar outcomes across demographic groups indicate that youth and young adults experience similar decreases after the current tracks of programming. Future research could conduct a full return-on-investment analysis for intensive mental health services for youth and young adults.

The Impact of Educational Attainment and Income on Long-Term Care for Persons with Alzheimer's Disease and Other Dementias: A Swedish Nationwide Study.

Long-term care improves independence and quality of life of persons with dementia (PWD). The influence of socioeconomic status on access to long-term care was understudied. To explore the socioeconomic disparity in long-term care for PWD. This registry-based study included 14,786 PWD, registered in the Swedish registry for cognitive and dementia disorders (2014-2016). Education and income, two traditional socioeconomic indicators, were the main exposure. Outcomes were any kind of long-term care, specific types of long-term care (home care, institutional care), and the monthly average hours of home care. The association between outcomes and socioeconomic status was examined with zero-inflated negative binomial regression and binary logistic regression. PWD with compulsory education had lower likelihood of receiving any kind of long-term care (OR 0.80, 95% CI 0.68-0.93), or home care (OR 0.83, 95% CI 0.70-0.97), compared to individuals with university degrees. Their monthly average hours of home care were 0.70 times (95% CI 0.59-0.82) lower than those of persons with university degrees. There was no significant association between education and the receipt of institutional care. Stratifying on persons with Alzheimer's disease showed significant association between lower education and any kind of long-term care, and between income and the hours of home care. Socioeconomic inequalities in long-term care existed in this study population. Lower-educated PWD were less likely to acquire general long-term care, home care and had lower hours of home care, compared to their higher-educated counterparts. Income was not significantly associated with the receipt of long-term care.