Urinary tract infection-related hospitalization among older adults receiving home health care

Abstract Background: Urinary tract infection (UTI) is a complication often experienced during a home health care (HHC) episode, yet related hospitalization risk factors are unclear. Objectives: This study use multiple data sources to identify risk factors for UTI related hospitalization or emergency department (ED) visits among HHC patients.Method: We performed a multivariable logistic regression to identify risk factors for UTI-related hospitalization or ED visits using merged data from the Outcome and Assessment Information Set, electronic health record from a large HHC agency, and Center for Medicare and Medicaid claims. Results: Of 48,336 cases, 1,689 patients (3.5%) had a UTI-related hospitalization/ED visits. Being a female (OR = 1.31; 95% CI: 1.16–1.46), the presence of a urinary catheter (OR = 5.7; 95% CI: 4.54–7.14), treatment with general antibacterial and antiseptics (OR = 2.75; 95% CI: 1.02–7.38), dependency in instrumental activities of daily living (e.g., meal preparation [OR=1.72; 95% CI: 1.25-2.37]), and no available caregivers (OR = 1.79; 95% CI: 1.2–2.68) increased the odds of a UTI related event among HHC patients. Discussion/conclusion: We identified notable risk factors for UTI related hospitalization/ER visit, filling a knowledge gap on the currently understudied HHC population. Risk factors identified in this study can be used to proactively identify HHC patients at risk for UTI related hospitalization and target them for preventive interventions. Further research is needed in HHC to develop tailored interventions for at-risk patients.

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Caregivers’ Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting

Journal of Patient Experience ◽

10.1177/2374373519869156 ◽

2019 ◽

Vol 7 (4) ◽

pp. 561-569

Author(s):

Jo-Ana D Chase ◽

David Russell ◽

Meridith Rice ◽

Carmen Abbott ◽

Kathryn H Bowles ◽

...

Keyword(s):

Older Adults ◽

Health Care ◽

Family Caregivers ◽

Learning Strategies ◽

Home Health Care ◽

Home Health ◽

Barriers To Learning ◽

Telephone Interviews ◽

Qualitative Descriptive ◽

Training And Support

Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.

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The Benefits and Harms of Antibiotic Prophylaxis for Urinary Tract Infection in Older Adults

Clinical Infectious Diseases ◽

10.1093/cid/ciab116 ◽

2021 ◽

Author(s):

Bradley J Langford ◽

Kevin A Brown ◽

Christina Diong ◽

Alex Marchand-Austin ◽

Kwaku Adomako ◽

...

Keyword(s):

Older Adults ◽

Urinary Tract Infection ◽

Antibiotic Resistance ◽

Urinary Tract ◽

Tract Infection ◽

Antibiotic Prophylaxis ◽

Bloodstream Infection ◽

Antibiotic Treatment ◽

Positive Culture ◽

Clostridioides Difficile

Abstract Background The role of antibiotics in preventing urinary tract infection (UTI) in older adults is unknown. We sought to quantify the benefits and risks of antibiotic prophylaxis among older adults. Methods We conducted a matched cohort study comparing older adults (≥66 years) receiving antibiotic prophylaxis, defined as antibiotic treatment for ≥30 days starting within 30 days of a positive culture, with patients with positive urine cultures who received antibiotic treatment but did not receive prophylaxis. We matched each prophylaxis recipient to 10 nonrecipients based on organism, number of positive cultures, and propensity score. Outcomes included (1) emergency department (ED) visit or hospitalization for UTI, sepsis, or bloodstream infection within 1 year; (2) acquisition of antibiotic resistance in urinary tract pathogens; and (3) antibiotic-related complications. Results Overall, 4.7% (151/3190) of UTI prophylaxis patients and 3.6% (n = 1092/30 542) of controls required an ED visit or hospitalization for UTI, sepsis, or bloodstream infection (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.12–1.57). Acquisition of antibiotic resistance to any urinary antibiotic (HR, 1.31; 95% CI, 1.18–1.44) and to the specific prophylaxis agent (HR, 2.01; 95% CI, 1.80–2.24) was higher in patients receiving prophylaxis. While the overall risk of antibiotic-related complications was similar between groups (HR, 1.08; 95% CI, .94–1.22), the risk of Clostridioides difficile and general medication adverse events was higher in prophylaxis recipients (HR [95% CI], 1.56 [1.05–2.23] and 1.62 [1.11–2.29], respectively). Conclusions Among older adults with UTI, the harms of long-term antibiotic prophylaxis may outweigh their benefits.

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