Primary Diagnosis Of Dementia Research Articles

Variation in Hospice Experiences by Care Setting for Patients With Dementia.

Use of hospice care among patients with dementia has been steadily increasing. Our objectives were to characterize quality of hospice care experiences among decedents who had a primary diagnosis of dementia and their caregivers and investigate differences across settings of hospice care. We analyzed Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey data from caregiver respondents whose family members received hospice care. Data from 96,845 caregiver respondents whose family members had a primary diagnosis of dementia and died in 2017 or 2018 while receiving hospice care in 2829 hospices. We calculated quality measure scores overall and stratified by setting, adjusting for mode of survey administration and differences in case mix, and examined variability in hospice-level scores among decedents with dementia. Mean quality measure scores ranged from 69.0 (Getting Hospice Care Training) to 90.9 (Getting Emotional Support). Measure scores varied significantly across settings, with caregivers of decedents who received care in a nursing home (NH), acute care hospital (ACH), or assisted living facility (ALF) consistently reporting poorer quality of care. Hospice-level scores varied substantially, with a wide range between the 10th and 90th percentiles of hospice performance (eg, 25 points). There are important opportunities to improve hospice care for patients with dementia and their caregivers, particularly with respect to caregiver training, symptom management, and across all dimensions within the NH, ACH, and ALF settings. Variability in care experiences across hospices, as well as long lengths of stay for those with dementia, highlight the importance of informed and timely hospice referral.

Inpatients With Dementia Referred for Palliative Care Consultation: A Multicenter Analysis.

Specialty palliative care (PC) may benefit patients with dementia by aligning treatment with goals and relieving symptoms. We aimed to compare demographics and processes and outcomes of PC for inpatients with dementia with those with systemic illnesses or cancer. This multicenter cohort study included standardized data for hospitalized patients with a primary diagnosis of dementia, systemic illnesses (cardiovascular, pulmonary, hepatic, or renal disease), or cancer among the 98 PC teams submitting data to the Palliative Care Quality Network from 2013 to 2019. Of 155,356 patients, 4.5% (n = 6,925) had a primary diagnosis of dementia, 32.5% (n = 50,501) systemic illness, and 29.2% (n = 45,386) cancer. Patients with dementia were older (mean 85.5 years, 95% confidence interval [CI] 85.3-85.6) than those with systemic illnesses (mean 73.2, 95% CI 73.0-73.3) or cancer (mean 66.6, 95% CI 66.4-66.7; p < 0.0001). Patients with dementia were more likely to receive a PC consult within 24 hours of admission (52.3% vs systemic illnesses 37.4%; cancer 45.3%; p < 0.0001), more likely to be bed-bound (vs systemic illnesses odds ratio (OR) 2.23, 95% CI 2.09-2.39, p < 0.0001; vs cancer OR 3.45, 95% CI 3.21-3.72, p < 0.0001), and more likely to be discharged alive (vs systemic illnesses OR 2.22, 95% CI 2.03-2.43, p < 0.0001; vs cancer OR 1.51, 95% CI 1.36-1.67, p < 0.0001). Advance care planning/goals of care (GOC) was the primary reason for consultation for all groups. Few patients overall had advance directives or Physician Orders for Life-Sustaining Treatment before consultation. At the time of referral and at discharge, patients with dementia were more likely to have a code status of do not resuscitate/do not intubate (DNR/DNI) (62.6% and 81.0% vs 38.7 and 64.2% for patients with systemic illnesses and 33.4% and 60.5% for patients with cancer; p < 0.0001). Among the minority of patients with dementia that could self-report, moderate-to-severe symptoms were uncommon (pain 6.4%, anxiety 5.8%, nausea 0.4%, and dyspnea 3.5%). Inpatients with a primary diagnosis of dementia receiving PC consultation were older and more functionally impaired than those with other illnesses. They were more likely to have a code status of DNR/DNI at discharge. Few reported distressing symptoms. These results highlight the need for routine clarification of GOC for patients with dementia.

Hospice Care Inequities in Individuals With Alzheimer's Disease and Related Dementias

Despite known benefits of hospice, inequities exist. Using data from a multi-site pragmatic trial in a representative groups of hospices, we examined inequities in length of stay (LOS) and general inpatient use (GIU) for 12,153 patients with dementia (primary and secondary diagnosis) using descriptive statistics and association tests. There were significant associations between race/ethnicity and GIU and LOS (p< 0.001). In those with primary diagnosis of dementia, Asian (31%) and Black/AA (24%) individuals had significantly greater utilization of GIU than Hispanic (19%) and white individuals (21%). Greater inequities were found in those with a secondary diagnosis. LOS amongst Asians were shortest with 78% having an LOS ≦14 vs 50-59% in other groups. Differences in long-stay >60 days (7%) vs 14-22% in other groups were found. There were similar differences examining by primary vs. secondary diagnosis. These inequities point to cultural and systems factors that require further study and intervention.

Effect of multimodal non‐pharmacologic interventions on cognitive function for people with dementia: Systematic review

AbstractIntroductionDementia is a progressive brain degeneration characterized by a progressive deterioration in cognition and independent living capacity (Sobral, Pestana, &amp; Paúl, 2015). Fifty million people are living with dementia globally. This number will be projected to grow to 82 million by 2030 and 152 million by 2050 (Alzheimer's Disease International, 2020. Since dementia is complex syndrome, multimodal non‐pharmacologic interventions (MNPIs) are highly recommended (Dannhauser et al., 2014; Graessel et al., 2011; Han et al., 2017; Yang et al., 2019). Currently, there is little available evidence to determine which multimodal interventions are effective for cognitive function improvement.MethodA comprehensive search was done in PubMed, EMBASE, CINHAL, Web of Science and Medline international databases. The inclusion criteria of this review were; concerned adults with primary diagnosis of dementia, measured cognitive function outcome, used two or more type of interventions, published in English language and employed controlled trial study design. The quality appraisal of the studies was done by Cochrane risk of bias assessment tools for randomized controlled trail and non‐randomized controlled trial studies (Sterne et al., 2016; Sterne et al., 2016).ResultsFourteen RCTs and five non‐RCT studies were included in the systematic review. Nearly ninety percent of studies resulted in an improvement or maintenance of cognitive function among people with dementia. Integrated, multicomponent and dyadic based interventions implemented for longer duration resulted in improve cognitive function of people with dementia. The combination of three modes of non‐pharmacologic intervention that includes exercise, music, and cognitive training with intervention design of more than three sessions per week for at least 12 ‐ 48 weeks is recommended.ConclusionThis study showed that multimodal non‐pharmacologic interventions might improve cognitive functions among people with dementia. Future high quality randomized controlled trail studies with repeated‐measured design on the combined effect of physical exercise, music and cognitive training on cognitive function for people with dementia is recommended.

Association between ambient temperature and dementia‐related hospital admissions in England

AbstractBackgroundThe impacts of a changing climate on dementia burdens have not been widely explored, despite the increasing pressures associated with dementia on the public health and social care systems. This study explores the association between ambient temperature and the dementia‐related emergency hospital admission, using the national hospital inpatient dataset for England. We also examine important modifiers of the heat‐risk, including separate results for each Government region of the country.MethodsDaily counts of emergency admissions with a primary diagnosis of dementia (ICD codes F00‐F03) and daily ambient temperature data from Met Office land surface stations were obtained for the period 2000‐2009 in England. Poisson regression was used to detect short‐term associations between daily mean temperature and daily counts of dementia admissions, adjusting for overdispersion and day‐of‐week effects, and including spline functions to model any underlying trends and seasonal patterns in the series. Distributed lag non‐linear models employing cross‐basis functions were used to characterise the exposure‐response relationship, at both national and regional levels at different lags of temperature; a 7‐day lag structure was used to explore potential delayed effects of temperature on the week leading up to admission. The modifying effects of age‐group, urban/rural residence, and quintiles of area‐level deprivation were also examined.ResultThere was some suggestion of seasonality in dementia admissions, with numbers peaking in the summer and winter months each year. After seasonal adjustment, there was an increase in the risk of dementia‐related hospital admission associated with high temperature, with adverse effects becoming apparent once daily mean temperatures rose above 15.0°C. At the national level, we estimated an approximately 10% increase in the risk of dementia admission for every 5°C increase in temperature above 15.0°C. When disaggregated by regions, the risk was highest in London. Separate results by age‐group, deprivation and urban/rural residence will be presented.ConclusionThe findings are likely to have important public health implications for priority settings, such as for hospital emergency department planning during hot seasons. The dangers of heat‐induced symptoms among dementia sufferers can be anticipated by caregivers whenever hot weather is forecast.

An exploratory study of caregiver burden amongst urban upper class adults in India during COVID‐19

BackgroundThe COVID pandemic has impacted caregivers of older adults globally and families have been wary of approaching hospitals due to increased risk of exposure. We explored reasons for help seeking and caregiver burden amongst a sample of consecutive urban upper class adults who approached a non‐hospital based organization providing elderly support in Delhi, India.MethodsA detailed assessment was carried out by trained care specialists using a clinical interview, Hindi Mental Status examination, evaluation of independence in activities of daily living and caregiver burden using the Zarit Burden Interview (ZBI). The assessment was conducted online or in person depending on comfort of the family. Descriptive analysis was carried out to understand the caregiver profile and reasons for seeking help.ResultsOf the 39 adults assessed, majority had a primary diagnosis of dementia (80%). 10% had other psychiatric illness and 10% other neurological illness. 87% families preferred an in person assessment, stating that an online assessment would not be possible with their family member. Primary caregivers were mostly female (80%) and older adults (46%). The main reason for seeking help was inability to manage challenging behaviors at home (97%), followed by concerns about increased cognitive impairments during COIVD (80%), mood related disturbances (41%) and difficulties with activities of daily living (41%). Assessment using ZBI revealed 82% primary caregivers experienced mild to moderate caregiver burden, however, they felt that they were doing their duty and none spontaneously reported a need to seek any form of support for themselves.ConclusionCurrently India does not have a public health system that supports dementia care and public awareness about management is limited. Our findings highlight that caregivers experience significant stress particularly managing challenging behaviors. Most caregivers are female older adults in whom caregiver burden may be more due to factors like role‐strain and limited independence. In absence of a supportive public health system, our findings also highlight the important role that non‐hospital based organizations play in bridging a gap for dementia care delivery, particularly during these COIVD times.

Impact of Comorbid Dementia on Patterns of Hospice Use.

Background: The evidence base for understanding hospice use among persons with dementia is almost exclusively based on individuals with a primary terminal diagnosis of dementia. Little is known about whether comorbid dementia influences hospice use patterns. Objective: To estimate the prevalence of comorbid dementia among hospice enrollees and its association with hospice use patterns. Design: Pooled cross-sectional analysis of the nationally representative Health and Retirement Study (HRS) linked to Medicare claims. Subjects: Fee-for-service Medicare beneficiaries in the United States who enrolled with hospice and died between 2004 and 2016. Measurements: Dementia was assessed using a validated survey-based algorithm. Hospice use patterns were enrollment less than or equal to three days, enrollment greater than six months, hospice disenrollment, and hospice disenrollment after six months. Results: Of 3123 decedents, 465 (14.9%) had a primary hospice diagnosis of dementia and 943 (30.2%) had comorbid dementia and died of another illness. In fully adjusted models, comorbid dementia was associated with increased odds of hospice enrollment greater than six months (adjusted odds ratio [AOR] = 1.52, 95% confidence interval [CI]: 1.11-2.09) and hospice disenrollment following six months of hospice (AOR = 2.55, 95% CI: 1.43-4.553). Having a primary diagnosis of dementia was associated with increased odds of hospice enrollment greater than six months (AOR = 2.62, 95% CI: 1.86-3.68), hospice disenrollment (AOR = 1.82, 95% CI: 1.32-2.51), and hospice disenrollment following six months of hospice (AOR = 4.31, 95% CI: 2.37-7.82). Conclusion: Approximately 45% of the hospice population has primary or comorbid dementia and are at increased risk for long hospice enrollment periods and hospice disenrollment. Consideration of the high prevalence of comorbid dementia should be inherent in hospice staff training, quality metrics, and Medicare Hospice Benefit policies.

A Systematic Review of Expressive and Receptive Prosody in People With Dementia.

Purpose This review was designed to provide a systematic overview of prosody in people with a primary diagnosis of dementia (PwD) and evaluate the potential use of prosodic features for diagnosis of dementia. Method A systematic search of five databases was conducted using Medical Subject Headings and keywords. Studies included in the review were evaluated for their methodological quality using the modified Joanna Briggs Institute checklist. Results A total of 14 articles were identified as being relevant for this review. Among the 14 articles, the methodological quality ranged, with eight rated as weak, four rated as moderate, and two rated as strong. Ten of the 14 articles had people with Alzheimer's disease (AD) as participants, and the remaining four had people with frontotemporal dementia as participants. Four articles focused on receptive prosody, another six focused on expressive prosody, and the remaining four articles were investigations into both. The 14 articles presented inconsistent findings, and various tasks were used to measure prosodic features in PwD in the articles. Prosody was studied as a diagnostic tool for dementia in four of the articles, all of which were based on expressive prosody in individuals with AD. Among the four articles, three proposed the use of automatic speech analysis for diagnosis of AD. Conclusions This review demonstrates that prosody in PwD is an underinvestigated area. In particular, it was concerning that most articles were of weak methodological quality. Nevertheless, it was found that prosody may be a potential diagnostic tool for assessing dementia. More studies that replicate the existing studies and those with stronger methodology are needed to confirm that receptive and/or expressive prosody can be used for dementia diagnosis.

Factors Associated With Home-Hospice Utilization.

Utilization of hospice for end-of-life care is known to be lower among racial and ethnic minority groups than among White populations when controlling for other socioeconomic factors. Certain patient, provider, and community characteristics may influence home-hospice use. We sought to identify patient, provider, and community factors associated with home-hospice use. Our final analytic sample included 1,208,700 hospice patients who received home-hospice from 2,148 Medicare-certified hospice providers in 2016. We found that an increase in the proportion of hospice patients with a primary diagnosis of dementia decreased the odds that home-hospice was provided (OR = 1.42, 95% CI = 1.36-1.48). Patients who received hospice care from a provider with a higher proportion of dually enrolled patients were less likely to receive home-hospice (OR = 1.42, 95% CI = 1.36-1.48) and hospices located in ZIP-codes with higher proportion of Hispanic resident were less likely to provide home-hospice (OR = 1.00, 95% CI = 0.99-0.99). Additional research is needed to clarify the mechanisms underlying these associations.

Characteristics of Decedents in Home Settings Using Medicare Place of Hospice Service Codes.

Very little is known about the characteristics of the Medicare beneficiaries receiving hospice at home, defined using the Medicare Healthcare Common Procedure Coding System codes, as a traditional home, an assisted living facility, or a nursing home. A secondary analysis of 2015 Medicare data using regression to describe the characteristics of decedents (n = 675 782) in hospice residing in a traditional home, an assisted living facility, and a nursing home was completed. Results suggest that the proportion of Medicare decedents in hospice with more than 180 lifetime days in hospice was highest among those who resided in an assisted living facility (25.03%) compared with those who resided in a nursing home (18.87%) or in a traditional home (13.04%). Regression findings suggest that, compared with decedents in hospice without dementia who resided in a traditional home, decedents in hospice with a primary diagnosis of dementia were more likely to reside in an assisted living facility (adjusted odds ratio, 2.29; P < .0001) when controlling for other factors. In summary, decedents in hospice who resided in a traditional home have different characteristics than decedents who resided in an assisted living facility or a nursing home. Interdisciplinary providers should consider these differences when managing hospice interventions.

The Impact of Home Health Physical Therapy on Medicare Beneficiaries With a Primary Diagnosis of Dementia

Dementia is a leading cause of disability for adults older than 65 years. Exercise intervention slows functional decline and improves balance; however, the efficacy of physical therapy (PT) services for persons with dementia is unknown. The purpose of this study is to assess the effect of home health PT services on physical function for Medicare beneficiaries with a primary diagnosis of dementia. Observational cohort study using a combined Medicare data set of home health beneficiaries; we performed augmented inverse probability weighted regression with demographic, comorbidity, and symptom-level characteristics analyzed as covariates. Home healthcare, United States, 2012. Medicare beneficiaries who had a primary diagnosis of dementia and home health function evaluations at discharge (n = 1477). PT treatment, examined by (1) any PT and (2) PT visit number. Improvement in composite activity of daily living (ADL) scores from home health admit to discharge. Any PT increased the probability of improvement in ADLs by 15.2% (P < .001). Compared to 1 to 5 PT visits, 6 to 13 visits increased the probability of ADL improvement by 11.6% (P < .001). PT intervention is beneficial for ADL function improvement in Medicare home health beneficiaries with a primary diagnosis of dementia. J Am Geriatr Soc 68:867-871, 2020.

Race, Ethnicity, and Other Risks for Live Discharge Among Hospice Patients with Dementia.

The end-of-life trajectory for persons with dementia is often protracted and difficult to predict, placing these individuals at heightened risk of live discharge from hospice. Risks for live discharge due to condition stabilization or failure to decline among patients with dementia are not well established. Our aim was to identify demographic, health, and hospice service factors associated with live discharge due to condition stabilization or failure to decline among hospice patients with dementia. Retrospective cohort study. A large not-for-profit agency in New York City. A total of 2629 hospice patients with dementia age 65 years and older. Primary outcome was live discharge from hospice due to condition stabilization or failure to decline (vs death). Measures include demographic factors (race/ethnicity, Medicaid, sex, age, marital status, parental status), health characteristics (primary dementia diagnosis, comorbidities, functional status, prior hospitalization), and hospice service (location, length of service, number and timing of nurse visits). Logistic regression models indicated that compared with white hospice patients with dementia, African American and Hispanic hospice patients with dementia experienced increased risk of live discharge (African American: adjusted odds ratio [aOR] = 2.42; 95% confidence interval [CI] = 1.34-4.38; Hispanic: aOR = 2.99; 95% CI = 1.81-4.94). Home hospice (aOR = 7.57; 95% CI = 4.04-14.18), longer length of service (aOR = 1.04; 95% CI = 1.04-1.05), and more days between nurse visits and discharge (aOR = 1.86; 95% CI = 1.56-2.21) were also associated with live discharge. To avoid burdensome and disruptive transitions out of hospice in patients with dementia, interventions to reduce live discharge due to condition stabilization or failure to decline should be tailored to meet the needs of African American, Hispanic, and home hospice patients. Policies regarding sustained hospice eligibility should account for the variable and protracted end-of-life trajectory of patients with dementia. J Am Geriatr Soc 68:551-558, 2020.

RISK FACTORS FOR DISENROLLMENT AMONG HOME HOSPICE PATIENTS WITH DEMENTIA

Hospice delivers care to a substantial and growing number of individuals with primary and comorbid dementia diagnoses. Dementia diagnosis and racial/ethnic minority status are risk factors for hospice disenrollment. However, little research examines racial/ethnic disparities and other risk factors for hospice disenrollment among hospice patients with dementia. This paper uses multinomial logistic regression to explore sociodemographic and functional status risk factors for hospice disenrollment among 3,949 home hospice recipients with primary or comorbid dementia. Results indicate that patients with a primary dementia diagnosis, racial/ethnic minority groups, and those higher functional status have elevated risk of disenrollment due to hospitalization, disqualification, and electively leaving hospice care. Additional research is needed to understand why primary dementia diagnosis and underrepresented racial/ethnic status are associated with multiple kinds of hospice disenrollment so that hospice practice can be tailored to respond to the needs of these individuals.

THE IMPACT OF ALIVIADO DEMENTIA CARE HOSPICE EDITION TRAINING PROGRAM ON HOSPICE STAFF’S DEMENTIA SYMPTOM KNOWLEDGE

A lack of high quality dementia training for healthcare workers is a key barrier to effective care for persons with dementia (PWD), a vulnerable and increasing population across the care continuum. Hospice agencies in particular are underprepared to care for this population, although annually about 17% of hospice patients have a primary diagnosis of dementia and an additional 28% as a comorbidity. Aliviado Dementia Care-Hospice Edition is an interdisciplinary, evidence-based quality improvement program developed to assist hospice interdisciplinary teams in caring for PWD and their caregivers. Interdisciplinary hospice team members in two agencies were enrolled in online training modules, which addressed multiple areas including pain, behavioral and psychological symptoms of dementia (BPSD), and working with caregivers. They were also provided a toolkit to integrate training in daily practice. Changes in knowledge, confidence and attitudes were tested before and after training and paired t-tests were utilized to evaluate the program’s effect. Thirty-five individuals completed the program and pre/post tests. Paired t-tests showed clinically and statistically significant increases in knowledge, attitudes and confidence in five of 10 domains including depression knowledge and confidence and BPSD knowledge, confidence and interventions. The greatest increase was in using BPSD interventions (18.5% increase, p-value: 0.0002), depression confidence (15.9% increase, p-value: 0.006) and BPSD confidence (12.6% increase, p-value: 0.02). Aliviado is an evidence-based, systems-level intervention shown to improve clinical knowledge, attitudes and confidence in treating pain and BPSD in PWD. This training could be used to produce systems-level practice change for hospice interdisciplinary team members serving PWD.

Filling the Behavior Tool Kit With Innovative Resources for Dementia Symptom Management

Filling the Behavior Tool Kit With Innovative Resources for Dementia Symptom Management

Anticholinergic Burden in Hospice Patients With Dementia.

End-of-life (EOL) patients with dementia have an increased risk for anticholinergic toxicities due to age-related pharmacokinetic and physiologic changes in conjunction with an increased susceptibility to drug-induced cognitive impairments. Despite this well-documented risk, the use of drugs with anticholinergic properties (DAPs) remains prevalent in EOL patients with dementia. The aims of this study were to describe prescribing patterns and characterize anticholinergic burden among hospice patients with dementia, as measured by the Anticholinergic Cognitive Burden (ACB) scale. This was a retrospective review of a national hospice patient information database. Patients included were admitted on January 1, 2016, discharged by death by December 31, 2016, and had a primary diagnosis of dementia. Patients' anticholinergic burden was calculated using ACB scores. A total of 1283 patients met the inclusion criteria. Of those, 37.1% (n = 476) were prescribed at least 1 DAP. Specifically, 28.9% (n = 371) were prescribed 1 DAP, 6.6% (n = 84) were prescribed 2 DAPs, 1.6% (n = 20) were prescribed 3 DAPs, and 0.08% (n = 1) were prescribed 4 DAPs. The majority of patients prescribed a DAP had an ACB score of 3 (n = 359, 75.4%) and an average ACB score of 3.8. The most common DAPs prescribed in patients with an ACB score of 2 or higher were quetiapine (n = 202, 42.4%), atropine (n = 155, 32.6%), hyoscyamine (n = 61, 12.8%), olanzapine (n = 46, 9.6%), and scopolamine (n = 35, 7.4%). Due to the limited benefit and increased harms with the use of DAPs, providers should aim to maximize nonpharmacologic options. By reducing the use of the top 5 DAPs identified in this study, the quality of life and care for EOL patients with dementia can potentially be improved.

A mixed methods systematic review of multimodal non-pharmacological interventions to improve cognition for people with dementia

ObjectiveMultimodal non-pharmacological interventions have been argued to have the potential to complement current pharmacological approaches to improving quality of life for people living with dementia. The aim of this review was to identify, synthesise and appraise the evidence for the effectiveness of multimodal non-pharmacological interventions for improving cognitive function specifically.MethodAfter a comprehensive search strategy including grey literature, 26 studies were reviewed. The inclusion criteria concerned adults with a primary diagnosis of dementia. Studies used two or more different modes of intervention, and measured a cognitive outcome. Due to differences in the conceptualisations of the term ‘multimodal’, a typology of modes and methods was developed to facilitate classification of candidate studies.ResultsTwenty-one group studies and five case studies were found. Group studies used two or three modes of intervention and multiple methods to implement them. Interventions utilised were cognitive, physical, psychological and psychosocial, nutrition, fasting, gut health, sleep hygiene, stress reduction, detoxification, hormonal health and oxygen therapy. Five individual case studies were found in two separate papers. Each personalised patient treatment utilised in-depth assessments and prescribed up to nine different modes. In 19 (90%) of the 21 group comparisons, participants were reported to have cognitive improvements, stability with their dementia or a delay in their decline. The extent of these improvements in terms of meaningful clinical change was variable.ConclusionMultimodal non-pharmacological interventions have the potential to complement singular therapeutic approaches by addressing multiple modifiable risk factors currently understood to contribute towards cognitive decline.

Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study

BackgroundPatients with dementia form an increasing proportion of those entering hospice care. Little is known about the types of hospices serving patients with dementia and the patterns of hospice use, including timing of hospice disenrollment between patients with and without dementia. ObjectivesTo characterize the hospices that serve patients with dementia, to compare patterns of hospice disenrollment for patients with dementia and without dementia, and to evaluate patient-level and hospice-level characteristics associated with hospice disenrollment. MethodsWe used data from a longitudinal cohort study (2008–2011) of Medicare beneficiaries (n = 149,814) newly enrolled in a national random sample of hospices (n = 577) from the National Hospice Survey and followed until death (84% response rate). ResultsA total of 7328 patients (4.9%) had a primary diagnosis of dementia. Hospices caring for patients with dementia were more likely to be for-profit, larger sized, provide care for more than 5 years, and serve a large (>30%) percentage of nursing home patients. Patients with dementia were less likely to disenroll from hospice in conjunction with an acute hospitalization or emergency department visit and more likely to disenroll from hospice after long enrollment periods (more than 165 days) as compared with patients without dementia. No significant difference was found between patients with and without dementia for disenrollment after shorter enrollment periods (less than 165 days). In the multivariable analyses, patients were more likely to be disenrolled after 165 days if they were served by smaller hospices and hospices that served a small percentage of nursing home patients. ConclusionPatients with dementia are significantly more likely to be disenrolled from hospice following a long enrollment period compared with patients without dementia. As the number of individuals with dementia choosing hospice care continues to grow, it is critical to address potential barriers to the provision of quality palliative care for this population near the end of life.

Prevalence of Dementia in a Geriatric Palliative Care Unit.

To determine the prevalence of dementia in a palliative care unit (PCU) and to determine whether there is a difference between length of stay (LOS) and Palliative Performance Scale (PPS) score in individuals admitted with a primary diagnosis of dementia compared to individuals admitted with other noncancer and cancer diagnoses. Descriptive retrospective chart review. Geriatric PCU in an academic community geriatric hospital. All individuals admitted to the Baycrest Health Sciences PCU from January 1, 2014, to September 1, 2016. Individuals with an admission diagnosis of cancer, noncancer, and dementia and their corresponding PPS scores were identified. Data were analyzed using descriptive statistics. A total of 780 patients were admitted to the PCU during the study period: 32 (4.1%) individuals had advanced dementia, 121 (15.5%) had a noncancer diagnosis, and 627 (80.4%) had cancer as the primary reason for admission. In the cancer and noncancer groups, 113 patients had a comorbid dementia diagnosis. The mean admission PPS score in patients with cancer was 36%, noncancer was 32.6%, and dementia was 23.8% ( P < .001). Mean LOS in patients with cancer was 32 days, noncancer patients was 34.3 days, and patients with advanced dementia was 33.3 days ( P = .90). Individuals with an admission diagnosis of advanced dementia had a lower mean PPS score than individuals admitted with other noncancer and cancer diagnoses. There was no difference in the mean LOS between the 3 groups. Individuals with an admission diagnosis of advanced dementia should not be refused admission because of fear of outliving their prognosis.

The Role of Home Nursing Visits in Supporting People Living with Dementia in Japan and Australia: Cross-National Learnings and Future System Reform

Japan and Australia are two western Pacific countries with divergent cultures and histories but they share a common public health concern of providing services for their increasing number of people living with dementia. Age is the greatest risk factor for developing dementia, and Japan is leading the world in aging populations. In 2016 in Japan 27.2% of the total population were over 65, while in Australia 15% were over 65. Both countries have responded to social preferences for community aged care. As a result, in Japan the Visiting Nurse Service Stations (VNSS) and in Australia community aged care service providers such as the Royal District Nursing Service (RDNS) are increasingly addressing the needs of people with dementia and their families.This article presents three sets of data to compare developments in the two health systems and to describe the scope of nursing services for people with dementia in the community. For Japan we analyzed an annual survey of VNSS activities, checked the number of people with a primary diagnosis of dementia, and collected data on presenting conditions on 2012. For Australia we analyzed a sample of two Home and Community Care cohorts of RDNS clients. Results indicated that both generalist service systems include tailored person-centered care for people with dementia. The Japanese system has introduced Dementia Support Doctors while in Australia access to psychogeriatric care is still sparse. As the Asia Pacific region experiences aging populations, community services for people with dementia can use these two systems as models.