The Effectiveness of Transition Interventions to Support Older Patients From Hospital to Home: A Systematic Scoping Review

2020 ◽  
pp. 073346482096871
Author(s):  
Renee O’Donnell ◽  
Melissa Savaglio ◽  
Helen Skouteris ◽  
Jane Banaszak-Holl ◽  
Chris Moran ◽  
...  
Keyword(s):  
Older Adults ◽  
Hospital Readmissions ◽  
Well Being ◽  
Evidence Base ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Hospital To Home ◽  
The Impact ◽  
Health And Well Being

Background: Interventions supporting older adults’ transition from hospital to home can address geriatric needs. Yet this evidence base is fragmented. This review describes transitional interventions that provide pre- and post-discharge support for older adults and evaluates their implementation and effectiveness in improving health and well-being. Method: Articles were included if they examined the extent to which transitional interventions were effective in improving health and well-being outcomes and reducing hospital readmission rates among older adults. Results: Twenty studies met the inclusion criteria. Four types of interventions were identified: education-based (10/20); goal-oriented (4/20); exercise (4/20); and social support interventions (2/20). Education and goal-oriented interventions were effective in improving health and well-being outcomes. The impact of interventions on mitigating hospital readmissions was inconclusive. Only five studies examined implementation. Discussion: Older adults transitioning from hospital to home would benefit from tailored education and goal-oriented interventions that promote their capacity for self-care.

scholarly journals SOCIAL NETWORKS, HEALTH, AND WELL-BEING AMONG PEOPLE LIVING WITH DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S71-S71
Author(s):  
Eleanor S McConnell ◽  
Kirsten Corazzini ◽  
T Robert Konrad
Keyword(s):  
Older Adults ◽  
Social Networks ◽  
Well Being ◽  
Sensor Technology ◽  
Web Based ◽  
Use Of Technology ◽  
Care Partners ◽  
The Impact ◽  
The Relationship ◽  
Health And Well Being

Abstract Although the impact of dementia on the health and well-being of those living with Alzheimer’s Disease and related Disorders (ADRD) and their care partners has been widely studied, less attention has been paid to how the disease impacts individuals within the context of their larger social networks. This symposium presents findings from a series of integrated studies aimed at strengthening measurement of health and well-being among older adults with living with dementia and well-being among members of their social networks. Findings will be presented from five studies: (1) a scoping review of social network measurement in older adults in chronic illness, including dementia, that emphasizes the use of technology in measuring older adults’ social networks; (2) a simulation study to evaluate the feasibility and reliability of sensor technology to measure social interaction among a person living with dementia and others in their immediate surroundings; (3) development of a web-based application that allows older adults to map and activate their social networks; (4) a qualitative analysis of interviews from persons living with dementia, their unpaid caregivers, and paid caregivers from an adult day health program concerning well-being focused outcomes; and (5) a mixed methods analysis of the feasibility of using both traditional and novel measures of health and well-being deployed among networks of people living with dementia. Emerging technologies for measuring social networks health and well-being hold promise for advancing the study of the relationship-based nature of care for people living with dementia.

Abstract 14996: Healthcare Resource Utilization and Costs in Congestive Heart Failure 90-day Episodes Within the Bundled Payment for Care Initiative (BPCI) Model 2, 2016-2018

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Xian Shen ◽  
Gabriel Sullivan ◽  
Mark Adelsberg ◽  
Martins Francis ◽  
Taylor T Schwartz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Hospital Stay ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Angiotensin Receptor ◽  
Post Discharge ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Initial Hospital

Introduction: Congestive heart failure (HF) is the fourth most commonly selected clinical episode among Model 2 participants of the Medicare Bundled Payments for Care Improvement (BPCI) Initiative. This study describes utilization of pharmacologic therapies, hospital readmission rates, and HF episode costs within the BPCI framework. Methods: The 100% sample of Medicare FFS enrollment/claims were used to identify acute hospital stays with a MS-DRG 291/292/293 between 1JAN2016 and 31DEC2018. A HF episode consisted of the initial hospital stay and all Part A & B covered services up to 90-days post-discharge. Prescription fills for angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or angiotensin receptor-neprilysin inhibitors (ARNI) during the 90 days post-discharge were captured. Rates of all-cause and HF readmissions were reported per 10,000 episodes during the 30-, 60-, and 90-days post-discharge period. Total episode costs were defined as the sum of Medicare payments for the initial hospital stay plus all Part A & B covered medical services in the 90-day post-discharge. Results: The sample included 634,307 HF episodes. Patients received ARNIs in 3%, ACEIs/ARBs in 45%, and neither in 52% of the episodes, respectively. All-cause hospital readmission rates were 2,503, 4,465, and 6,368 per 10,000 episodes during the 30-, 60-, and 90-day periods. The 30-, 60-, and 90-day HF readmission rates were 958, 1,696, and 2,394 per 10,000 episodes. Total mean 90-day episode cost was $20,122, of which $8,002 was attributable to hospital readmissions. Conclusions: Hospital readmissions are frequent for HF patients and contribute a notable proportion of overall HF BPCI episode costs. BPCI participants may consider improving utilization of guideline directed medical therapies for HF, including ACEIs/ARBs and ARNI, as a strategy for reducing hospital readmissions and associated costs.

Coping with Loneliness

2019 ◽  
pp. 216-227 ◽  
Author(s):  
Dawn Joosten-Hagye ◽  
Anne Katz
Keyword(s):  
Older Adults ◽  
Transnational Feminism ◽  
Well Being ◽  
The United States ◽  
Research Attention ◽  
Recent Developments ◽  
Major Predictor ◽  
The Impact ◽  
Health And Well Being ◽  
Global Growth

This chapter examines loneliness and how it affects health and well-being. It discusses how loneliness may lead to ill health but also how ill health may lead to feelings of loneliness. It reviews the evidence suggesting that loneliness is not only linked to overall morbidity and mortality in older adults but also a major predictor of psychological distress. With the global growth of the aging population, considerable research attention focuses on these issues in Europe, the United States, and Australia. The proportion of Australians aged 65 years or older is growing, with prevalence rates of loneliness among older adults as high as 30%. The impact of this is discussed in this chapter, as are recent developments, current conditions, historical trends, transnational feminism and advocacy, and how loneliness impacts the health and well-being of older women in Australia.

scholarly journals Contextualizing the COVID-19 Era in Puerto Rico: Compounding Disasters and Parallel Pandemics

2020 ◽  
Author(s):  
Catherine García ◽  
Fernando I Rivera ◽  
Marc A Garcia ◽  
Giovani Burgos ◽  
María P Aranda
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Puerto Rico ◽  
Puerto Rican ◽  
Debt Crisis ◽  
Wealth Inequality ◽  
Well Being ◽  
Research Report ◽  
The Impact ◽  
Health And Well Being

Abstract Objectives The COVID-19 outbreak has worsened the ongoing economic crisis in Puerto Rico by creating “parallel pandemics” that exacerbate socioeconomic and health inequalities experienced by its most vulnerable residents. Unfortunately, conditions on the island have been largely overlooked by national media outlets and the mainland U.S. population. Thus, this research report aims to draw attention to the disparate burden multiple and compounding disasters have on older island-dwelling Puerto Rican adults’ health and well-being. Methods We characterize the lived experiences of the older population in Puerto Rico by incorporating data from multiple sources and contextualizing the effects of compounding disasters, the fiscal pandemic, and health care challenges to provide a more nuanced portrait of existing compounding factors that negatively affect the health and well-being of older adults in the era of COVID-19. Results We highlight 2 main factors that exacerbate pre-pandemic inequities experienced by the older adult population amid the COVID-19 pandemic in Puerto Rico: (a) the impact of multiple and compounding disasters; and (b) health care challenges. Discussion The human suffering of the Puerto Rican population is compounded by the consequences of fiscal austerity, increasing levels of income and wealth inequality, the debt crisis, significant emigration, and a dysfunctional health care system. Future governmental actions are required to lessen the burden of parallel pandemics on older adults in Puerto Rico.

scholarly journals A TRIAL TO IMPROVE MEDICATION SAFETY IN OLDER ADULTS: RECRUITMENT CHALLENGES HAVE GENERALIZABILITY IMPLICATIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S711-S711
Author(s):  
Kathryn Anzuoni ◽  
Terry Field ◽  
Kathleen Mazor ◽  
Yanhua Zhou ◽  
Timothy Konola ◽  
...  
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Odds Ratio ◽  
Adverse Drug Events ◽  
Functional Decline ◽  
Post Discharge ◽  
Recruitment Challenges ◽  
Hospital To Home ◽  
The Impact ◽  
Visiting Nurse

Abstract For older adults, the transition from hospital to home is a high-risk period for adverse drug events, functional decline, and hospital readmission. Randomized trials of interventions to improve this transition must recruit potential subjects immediately after hospital discharge, when people are recovering and tired. Within a randomized trial assessing the impact of a pharmacist home visit to provide medication assistance immediately post-discharge, we determined whether individuals who enrolled were comparable to those who were invited but did not enroll, and described reasons for not enrolling. Individuals ≥50 years of age discharged from the hospital and prescribed a high-risk medication were eligible. We attempted to recruit individuals by phone within 3 days of discharge, and recorded reasons for not enrolling. Of 3,606 eligible individuals reached, 3,147 (87%) declined, 361 (10%) were enrolled, and 98 (3%) were initially recruited but did not complete a consent form. Individuals ≥80 years of age (odds ratio 0.45, CI 0.25, 0.78) and those with an assigned visiting nurse (odds ratio 0.64, CI 0.48, 0.85) were least likely to enroll. Among those who provided a reason for declining (2,473) the most common reason given was the belief they did not need medication assistance (22%). An additional 332 (13%) declined because they were receiving visiting nurse services. Recruiting older adults recently discharged from the hospital is difficult and may under-enroll the oldest individuals, limiting the ability to generalize findings across older patient populations. Researchers planning RCTs among newly discharged older adults may need creative approaches to overcome resistance.

The Impact of a Short-Term Iyengar Yoga Program on the Health and Well-Being of Physically Inactive Older Adults

2011 ◽  
Vol 21 (1) ◽  
pp. 61-72 ◽  
Author(s):  
Juliane Vogler ◽  
Lily O'Hara ◽  
Jane Gregg ◽  
Fiona Burnell
Keyword(s):  
Older Adults ◽  
Muscle Strength ◽  
Range Of Motion ◽  
Well Being ◽  
Holistic Health ◽  
Control Group ◽  
Active Range Of Motion ◽  
The Impact ◽  
Health And Well Being ◽  
Physically Inactive

Background: With the current challenge of rapidly aging populations, practices such as yoga may help older adults stay physically active, healthy, and fulfilled. Methods: The impact of an 8-week Iyengar yoga program on the holistic health and well-being of physically inactive people aged 55 years and over was assessed. Thirty-eight older adults (mean age 73.21 ± 8.38 years; 19 intervention, 19 control) engaged in either twice-weekly yoga classes or continued their usual daily routines. Physical health measures were muscle strength, active range of motion, respiratory function (FEV1), resting blood pressure, and immune function (salivary IgA and lysozyme). Self-perceived general,physical, mental, spiritual, and social health and well-being were assessed with the Life's Odyssey Questionnaire and the SF12v2™ Health Survey. Results: Muscle strength, active range of motion, physical well-being, and aspects of mental well-being (emotional well-being and self-care) improved significantly in the yoga group (p < .05). Median changes in most of these variables were also significantly different from those in the control group. Conclusions:Participation in Iyengar yoga programs by older people is beneficial for health and well-being, and greater availability of such programs could improve quality of life.

scholarly journals Successful hospital readmission reduction initiatives: Top five strategies to consider implementing today

2018 ◽  
Vol 7 (5) ◽  
pp. 16 ◽  
Author(s):  
Bita A. Kash ◽  
Juha Baek ◽  
Ohbet Cheon ◽  
Nana E. Coleman ◽  
Stephen L. Jones
Keyword(s):  
Hospital Readmission ◽  
Discharge Planning ◽  
Hospital Readmissions ◽  
Post Discharge ◽  
Readmission Rates ◽  
Effective Interventions ◽  
Hospital Readmission Rates ◽  
Weighted Means ◽  
Pubmed Database

Only one quarter of U.S. hospitals demonstrated low enough levels of 30 day readmission rates to avoid penalties imposed by the Hospital Readmissions Reduction Program (HRRP) in 2016. Previous work describes interventions for reducing hospital readmission rates; however, without a comprehensive analysis of these interventions, healthcare leaders cannot prioritize strategies for implementation within their healthcare environment. This comparative study identifies the most effective interventions to reduce unplanned 30-day readmissions. The MEDLINE-PubMed database was used to conduct a systematic review of existing literature about interventions for 30-day readmission reduction published from 2006 through 2017. Data were extracted on hospital type, setting, disease type, intervention type, study sample, and impact level. Of 4,886 citations, 508 articles were reviewed in full-text, and 90 articles met the inclusion criteria. Based on the three analytic methodologies of means, weighted means, and pooled estimated impact level, the most effective interventions to reduce unplanned 30-day admissions were identified as collaboration with clinical teams and/or community providers, post-discharge home visits, telephone follow-up calls, patient/family education, and discharge planning. Commonly, all five interventions identify patient level engagement for success. The findings reveal the need for shared accountability towards desired outcomes among health systems, providers, and patients while providing hospital leaders with actionable strategies that can effectively reduce 30-day readmission rates.

scholarly journals “Conviv\^{e}ncia” Groups: Building Active and Healthy Communities of Older Adults in Brazil

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Tânia R. Bertoldo Benedetti ◽  
Eleonora d'Orsi ◽  
Andiara Schwingel ◽  
Wojtek J. Chodzko-Zajko
Keyword(s):  
Older Adults ◽  
Adult Population ◽  
Social Groups ◽  
Well Being ◽  
Social Programs ◽  
Crucial Component ◽  
Older Adult Population ◽  
The Impact ◽  
Health And Well Being

In old age, social groups can be a crucial component for health and well-being. In 2009-2010, a follow-up survey was carried out in Florianópolis, Brazil to understand the impact of a variety of programs established since 2002 that were designed to enhance social activities among the older adult population. This study employed two surveys within the population of older adults in Florianópolis. The first survey interviewed a total of 875 older adults in 2002, and the second survey involved 1,705 older adults between 2009 and 2010. By 2010, many new programs were offered in the community and the enrollment of older adults in social programs followed similar trends. “Convivência” groups stood out as extremely popular social groups among this population. This paper discusses some of the potential outcomes associated with participation in “convivência” groups.

A Multi-Component Transition of Care Improvement Project to Reduce Hospital Readmissions Following Ischemic Stroke

2021 ◽  
pp. 194187442110366
Author(s):  
Ann M. Leonhardt-Caprio ◽  
Craig R. Sellers ◽  
Elizabeth Palermo ◽  
Thomas V. Caprio ◽  
Robert G. Holloway
Keyword(s):  
Ischemic Stroke ◽  
Hospital Readmission ◽  
Hospital Readmissions ◽  
Cost Of Care ◽  
Post Discharge ◽  
Readmission Rates ◽  
Improvement Project ◽  
Risk Of Death ◽  
Hospital Readmission Rates ◽  
Number Of Patients

Background: Ischemic stroke (IS) is a common cause of hospitalization which carries a significant economic burden and leads to high rates of death and disability. Readmission in the first 30 days after hospitalization is associated with increased healthcare costs and higher risk of death and disability. Efforts to decrease the number of patients returning to the hospital after IS may improve quality and cost of care. Methods: Improving care transitions to reduce readmissions is amenable to quality improvement (QI) initiatives. A multi-component QI intervention directed at IS patients being discharged to home from a stroke unit at an academic comprehensive stroke center using IS diagnosis-driven home care referrals, improved post-discharge telephone calls, and timely completion of discharge summaries was developed. The improvement project was implemented on July 1, 2019, and evaluated for the 6 months following initiation in comparison to the same 6-month period pre-intervention in 2018. Results: Following implementation, a statistically significant decrease in 30-day all-cause same-hospital readmission rates from 7.4% to 2.8% ( p = .031, d = 1.61) in the project population and from 6.6% to 3% ( p = .010, d = 1.43) in the overall IS population was observed. Improvement was seen in all process measures as well as in patient satisfaction scores. Conclusions: An evidence-based bundled process improvement intervention for IS patients discharged to home was associated with decreased hospital readmission rates following IS.

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