Patterns of Home Health and Hospice Service Use in the Last Year of Life among Community-Dwelling Older Adults with and without Dementia (GP774)

ABSTRACTBackground: To ascertain gender-specific determinants of antidepressant and mental health (MH) service use associated with suicidal ideation.Methods: Data used in this study came from the ESA (Enquête sur la Santé des Aînés) survey carried out in 2005–2008 on a large sample of community-dwelling older adults (n = 2,004). Multivariate logistic regression analyses were carried out.Results: The two-year prevalence of suicidal ideation was 8.4% and 20.3% had persistent suicidal thoughts at one-year follow-up. In males, the prevalence of antidepressant and MH service use in respondents with suicidal ideation reached 32.2% and 48.9%, respectively. In females, the corresponding rates were 42.6% and 65.6%. Males were less likely to consult MH services than females when their MH was judged poorly. Male respondents with higher income and education were less likely to use antidepressant and MH services. However, males using benzodiazepines were more likely than females to be dispensed an antidepressant. Among respondents with suicidal ideation, gender was not associated with service use. Younger age, however, was associated with antidepressant use.Conclusions: Increased promotion campaigns sensitizing men to the prodromal symptoms of depression and the need to foster access to MH care when the disorder is manageable may be needed.

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Self-management program versus usual care for community-dwelling older adults with multimorbidity: A pragmatic randomized controlled trial in Ontario, Canada

Journal of Comorbidity ◽

10.1177/2235042x20963390 ◽

2020 ◽

Vol 10 ◽

pp. 2235042X2096339

Author(s):

Kathryn Fisher ◽

Maureen Markle-Reid ◽

Jenny Ploeg ◽

Amy Bartholomew ◽

Lauren E Griffith ◽

...

Keyword(s):

Older Adults ◽

Home Care ◽

Service Use ◽

Primary Outcome ◽

Controlled Trial ◽

Home Care Services ◽

Community Dwelling ◽

Care Services ◽

And Control ◽

Community Dwelling Older Adults

Background: Multimorbidity, the co-existence of 2+ (or 3+) chronic diseases in an individual, is an increasingly common global phenomenon leading to reduced quality of life and functional status, and higher healthcare service use and mortality. There is an urgent need to develop and test new models of care that incorporate the components of multimorbidity interventions recommended by international organizations, including care coordination, interdisciplinary teams, and care plans developed with patients that are tailored to their needs and preferences. Purpose: To determine the effectiveness of a 6-month, community-based, multimorbidity intervention compared to usual home care services for community-dwelling older adults (age 65+ years) with multimorbidity (3+ chronic conditions) that were newly referred to and receiving home care services. Methods: A pragmatic, parallel, two-arm randomized controlled trial evaluated the intervention, which included in-home visits by an interdisciplinary team, personal support worker visits, and monthly case conferences. The study took place in two sites in central Ontario, Canada. Eligible and consenting participants were randomly allocated to the intervention and control group using a 1:1 ratio. The participants, statistician/analyst, and research assistants collecting assessment data were blinded. The primary outcome was the Physical Component Summary (PCS) score of the 12-Item Short-Form health survey (SF-12). Secondary outcomes included the SF-12 Mental Component Summary (MCS) score, Center for Epidemiological Studies of Depression (CESD-10), Generalized Anxiety Disorder (GAD-7), Self-Efficacy for Managing Chronic Disease, and service use and costs. Analysis of covariance (ANCOVA) tested group differences using multiple imputation to address missing data, and non-parametric methods explored service use and cost differences. Results: 59 older adults were randomized into the intervention (n = 30) and control (n = 29) groups. At baseline, groups were similar for the primary outcome and number of chronic conditions (mean of 8.6), but the intervention group had lower mental health status. The intervention was cost neutral and no significant group differences were observed for the primary outcome of PCS from SF-12 (mean difference: −4.94; 95% CI: −12.53 to 2.66; p = 0.20) or secondary outcomes. Conclusion: We evaluated a 6-month, self-management intervention for older adults with multimorbidity. While the intervention was cost neutral in comparison to usual care, it was not found to improve the PCS from SF-12 or secondary health outcomes. Recruitment and retention challenges were significant obstacles limiting our ability to assess intervention effectiveness. Yet, the intervention was grounded in internationally-endorsed recommendations and implemented in a practice setting (home care) viewed as a key upstream resource fostering independence in older adults. These features collectively support the identification of ways to recruit/retain older adults and test alternative implementation strategies for interventions that are based on sound principles of multimorbidity management.

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Urban Expansion of the SAFE-Home Opioid Management Education (SAFE-HOME) Naloxone Awareness Initiative for Home Health Workers and Older Adults

Pharmacy ◽

10.3390/pharmacy9040200 ◽

2021 ◽

Vol 9 (4) ◽

pp. 200

Author(s):

Abigail T. Elmes ◽

Brianna M. McQuade ◽

Michael Koronkowski ◽

Erin Emery-Tiburcio ◽

Jennie B. Jarrett

Keyword(s):

Older Adults ◽

Management Education ◽

Health Workers ◽

Urban Expansion ◽

Knowledge Score ◽

Home Health ◽

Community Dwelling ◽

Repeated Measure ◽

Opioid Overdose ◽

Community Dwelling Older Adults

The SAFE-Home Opioid Management Education (SAFE-HOME) Naloxone Awareness pilot program utilized home health workers (HHWs) in rural settings to educate older adults prescribed opioids on naloxone access and use. This work expands the SAFE-HOME program to urban settings to prepare HHWs to educate community-dwelling older adults on opioid risks and life-saving naloxone. This prospective, interventional cohort study evaluated 60-min synchronous, virtual HHW educational training sessions describing opioid risks in older adults, opioid overdose signs and symptoms, and naloxone access and use. Knowledge assessments were conducted pre- and post-intervention via a pre-developed assessment tool in a repeated measure model. Outcomes included change in total opioid and naloxone knowledge, and baseline total and individual opioid and naloxone knowledge. Six educational sessions were held (n = 154). The average pre- and post-education scores were 62.7% (n = 108) and 83.5% (n = 82), respectively (p < 0.001). Of the 69 participants who completed both pre- and post-education assessments, the average change in total score was +19.6% (p < 0.001), opioid knowledge score −0.4% (p = 0.901), and naloxone knowledge score +32.9% (p < 0.001). At baseline, HHWs were knowledgeable on opioid risks, but lacked familiarity with naloxone access and use. Targeting HHWs with opioid and naloxone training positions them to effectively educate at-risk community-dwelling older adults.

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FAMILY CAREGIVER CONTRIBUTIONS TO HOME HEALTH FOR OLDER ADULTS: PREDICTORS OF ADEQUATE SUPPORT

Innovation in Aging ◽

10.1093/geroni/igz038.748 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S206-S206

Author(s):

Julia Burgdorf ◽

Judith D Kasper ◽

Jennifer L Wolff

Keyword(s):

Older Adults ◽

Older Adult ◽

Medication Management ◽

Home Health ◽

Community Dwelling ◽

Assessment Data ◽

Caregiver Support ◽

Factors Affecting ◽

Nationally Representative ◽

Community Dwelling Older Adults

Abstract Family caregivers play a crucial role in supporting older adults through home health (HH) episodes; yet no prior research examines factors affecting the adequacy of caregiver support during HH. We use a novel dataset linking nationally-representative survey data with HH assessment data for community-dwelling older adults (n=2,128) to identify older adult characteristics associated with adequate caregiver support in four task categories (Activities of Daily Living, medication management, medical tasks, and safety/oversight) during a subsequent HH episode. Weighted, multivariable logistic regression is used to model the likelihood of adequate caregiver support in each category. Multiple older adult characteristics prior to the HH episode were associated with greater likelihood of adequate caregiver support during HH, including: prior caregiver assistance with mobility, self-care, and health care tasks, living with others, and cognitive impairment. These findings reveal new risk factors for consideration in risk assessment and payment adjustments related to social determinants of health.

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Skin Conditions in Community-Living Older Adults

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2013.13102 ◽

2014 ◽

Vol 18 (3) ◽

pp. 186-194 ◽

Cited By ~ 3

Author(s):

Samantha Gontijo Guerra ◽

Helen-Maria Vasiliadis ◽

Michel Préville ◽

Djamal Berbiche

Keyword(s):

Older Adults ◽

Service Use ◽

Care Service ◽

Community Dwelling ◽

Self Report ◽

Data Sources ◽

Geriatric Population ◽

Global Epidemiology ◽

Skin Conditions ◽

Community Dwelling Older Adults

Background: There are considerable gaps in the knowledge of the global epidemiology of skin conditions in the geriatric population. Objective: This study attempted to (1) determine the frequency of skin conditions, (2) evaluate the agreement between two different data sources of information (self-report versus administrative), and (3) document medical care service use for skin conditions in a representative sample of community-dwelling older adults. Methods: A secondary analysis using data from a longitudinal population-based health survey conducted in Quebec (2005–2008) within a sample of 2,811 community-dwelling older adults. Results: Our results highlighted a high prevalence rate of self-reported (13%) and diagnosed skin conditions (21%). Agreement between data sources was low (kappa < 0.20). Most dermatologic-related medical visits were made to dermatologists (almost 60%). Conclusion: The epidemiology of skin conditions in the geriatric population is an underresearched field, despite its important prevalence and relevance as a source of information for assessing the health care needs of older adults.

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EXPLORING PALLIATIVE CARE DISPARITIES IN RACIALLY AND ETHNICALLY DIVERSE COMMUNITY-DWELLING OLDER ADULTS

Innovation in Aging ◽

10.1093/geroni/igz038.2734 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S746-S746

Author(s):

Daniel S Gardner ◽

Meredith Doherty

Keyword(s):

Older Adults ◽

Palliative Care ◽

Service Use ◽

Ethnic Disparities ◽

Community Dwelling ◽

Medically Underserved ◽

Care Needs ◽

Serious Illness ◽

Diverse Community ◽

Community Dwelling Older Adults

Abstract Despite the growth and recognized benefits of palliative care for people with serious illness and their families, there are significant racial and ethnic disparities in access to and utilization of services, particularly among older adults living in impoverished, medically-underserved communities. This paper presents preliminary findings from a mixed-method, CBPR study exploring the experiences, supportive care needs, and service use of diverse older adults living with serious illness in an urban, medically-underserved community in the U.S. Systematic analyses of focused, semi-structured interviews with 45 older adults identified cultural, environmental, financial, and structural barriers to palliative care, and identified the critical importance of familial, social, spiritual, and formal networks of support in coping with serious illness and associated symptoms. The investigators describe implications for practice and policy that addresses palliative care disparities, and strategies for engaging with communities to extend culturally-sensitive palliative care to diverse, community-dwelling older adults and their social networks.

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Indicators of paramedic service use by community dwelling older adults

Irish Journal of Paramedicine ◽

10.32378/ijp.v4i1.74 ◽

2019 ◽

Vol 4 (1) ◽

Author(s):

Matthew S Leyenaar ◽

Walter Tavares ◽

Gina Agarwal ◽

Andrew P Costa

Keyword(s):

Older Adults ◽

Emergency Department ◽

Home Care ◽

Service Use ◽

Community Dwelling ◽

Care Providers ◽

Community Paramedicine ◽

Care Assessment ◽

Ed Visits ◽

Community Dwelling Older Adults

Introduction: Home care clients represent a patient group that may be served through community paramedicine (CP) programs. The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale was recently validated to identify levels of risk for use of emergency care among this population. This study investigates whether frail home care clients that were identified as being at higher risk based on their DIVERT scores were more likely to use paramedic services to access the emergency department within 90 days of assessment when compared to clients that had lower DIVERT scores.Methods: A retrospective cohort study was conducted using regularly collected administrative data. Home care assessment data were supplemented with data on emergency department (ED) visits. Arrival by ambulance was modelled to control for DIVERT scores as well as several social and demographic variables.Results: Within the cohort, approximately 40% of individuals visited an ED within 90 days of a home care assessment and almost half of all individuals visited an ED more than once within a year. About two-thirds of clients that visited an ED in the 90 days following assessment used an ambulance for transportation. DIVERT scores were predictive of this use with highest scores indicating 4.15 times higher odds of paramedic service use (95% CI 3.60-4.78Conclusion: DIVERT was not developed to consider means of transportation to the ED. The results indicate that it can be used to identify frail community dwelling older adults that are likely to use paramedic services to take them to the ED. Further investigation of aspects of social isolation, carer resiliency, time of use, and characteristics associated with ED discharge are warranted. Frequent ambulance use among this population suggests that collaboration between care providers may provide opportunities to prevent unnecessary ED visits by these individuals.

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