scholarly journals A comprehensive profile of the sociodemographic, psychosocial and health characteristics of Ontario home care clients with dementia

2014 ◽  
Vol 34 (2/3) ◽  
pp. 132-144 ◽  
Author(s):  
M Vu ◽  
DB Hogan ◽  
SB Patten ◽  
N Jetté ◽  
SE Bronskill ◽  
...  
Keyword(s):  
Home Care ◽  
Service Use ◽  
Large Population ◽  
Home Care Services ◽  
Population Based ◽  
Assessment Instrument ◽  
Assistance Programs ◽  
Comparison Groups ◽  
Diagnosis Of Dementia ◽  
Neurological Conditions

Introduction This study provides a comprehensive summary of the sociodemographic, psychosocial and health characteristics of a large population-based cohort of Ontario home care clients (aged 50 years and over) with dementia and examines the variation in these characteristics in those with co-existing neurological conditions. Methods Clients were assessed with the Resident Assessment Instrument-Home Care (RAI-HC) between January 2003 and December 2010. Descriptive analyses examined the distribution of these characteristics among clients with dementia relative to several comparison groups, as well as clients with other recorded neurological conditions. Results Approximately 22% of clients (n = 104 802) had a diagnosis of dementia (average age 83 years, 64% female) and about one in four within this group had a co-existing neurological condition (most commonly stroke or Parkinson disease). About 43% of those with dementia did not live with their primary caregiver. Relative to several comparison groups, clients with dementia showed considerably higher levels of cognitive and functional impairment, aggression, anxiety, wandering, hallucinations/delusions, caregiver distress and a greater risk for institutionalization. Conversely, they showed a lower prevalence of several chronic conditions and lower levels of recent health service use. Depressive symptoms were relatively common in the dementia and other neurological groups. Conclusion Clients with co-existing neurological conditions exhibited unique clinical profiles illustrating the need for tailored and flexible home care services and enhanced caregiver assistance programs.

scholarly journals Predictors of Home Care Costs Among Persons With Dementia, Amyotrophic Lateral Sclerosis, and Multiple Sclerosis in Ontario

2020 ◽  
Vol 13 ◽  
pp. 117863292090373 ◽  
Author(s):  
Clare Cheng ◽  
John P Hirdes ◽  
George Heckman ◽  
Jeff Poss
Keyword(s):  
Multiple Sclerosis ◽  
Amyotrophic Lateral Sclerosis ◽  
Home Care ◽  
Home Care Services ◽  
Assessment Instrument ◽  
Case Mix ◽  
Care Services ◽  
Neurological Conditions ◽  
Care Costs ◽  
Lateral Sclerosis

Home care is an important service for persons with neurological conditions, but little is known about factors affecting health care costs in this setting. Using administrative data collected with the Resident Assessment Instrument for Home Care (RAI-HC), this study identified factors associated with home care costs for recipients of home care services with Alzheimer disease or related dementias, multiple sclerosis, and/or amyotrophic lateral sclerosis. As part of this study, the effectiveness of the Resource Utilization Groups for Home Care (RUG-III/HC), a case-mix classification system developed for the RAI-HC, in predicting care costs for this population, was also tested. Clinical characteristics indicative of greater disease severity had high levels of significance in predicting home care costs. In particular, the RUG-III/HC was highly predictive of home care costs for 3 neurological conditions, indicating the validity of this case-mix system for this population. With the increasing prevalence of neurological conditions and demand for home care services, future studies should continue to focus on identifying specific predictors care costs for those with neurological conditions in this care setting.

scholarly journals A profile of older community-dwelling home care clients with heart failure in Ontario

2011 ◽  
Vol 31 (2) ◽  
pp. 49-57 ◽  
Author(s):  
AD Foebel ◽  
JP Hirdes ◽  
GA Heckman ◽  
SL Tyas ◽  
EY Tjam
Keyword(s):  
Heart Failure ◽  
Home Care ◽  
Clinical Characteristics ◽  
Service Use ◽  
Self Care ◽  
Home Care Services ◽  
Community Dwelling ◽  
Emergency Department Visits ◽  
Assessment Instrument ◽  
At Home

Introduction The aging of the Canadian population is associated with a rising burden of heart failure (HF), a condition associated with significant morbidity, mortality and health service use. Methods We used data from the Ontario Resident Assessment Instrument-Home Care database for all long-stay home care clients aged 65 years or older to (1) describe the demographic and clinical characteristics of home care clients with HF and (2) examine service use among home care clients with HF to promote management at home with appropriate services. Results Compared with other home care clients, HF clients exhibit more health instability, take more medications, experience more comorbid conditions and receive significantly more nursing, homemaking and meal services. They are hospitalized more frequently, have significantly more emergency department visits and use more emergent care. Discussion HF clients are a more complex group than home care clients in general. Patient self-care must be tailored to the clinical characteristics, patterns of service use and barriers to self-care of the client. This is particularly true for older, frail and medically complex HF patients, many of whom require home care services. This work provides a background upon which to base initiatives to help these higher-needs clients manage their HF at home with appropriate support and services.

A Profile of Older Adults With a History of Stroke Receiving Home Care in Ontario, Canada

2019 ◽  
Vol 31 (3) ◽  
pp. 162-171
Author(s):  
Michael J. Zoratti ◽  
Kathryn Fisher ◽  
Dawn Guthrie ◽  
Lauren E. Griffith
Keyword(s):  
Sex Differences ◽  
Health Status ◽  
Home Care ◽  
Population Level ◽  
Home Care Services ◽  
Community Dwelling ◽  
Assessment Instrument ◽  
Cross Sectional ◽  
Stroke Diagnosis ◽  
History Of

The demand for home care services is increasing, yet the literature describing the clinical characteristics of community-dwelling individuals with a history of stroke who receive home care is limited. In this retrospective, cross-sectional, population-level study, data were sourced from home care recipients aged 65+ who had a routine assessment using the Resident Assessment Instrument for Home Care (RAI-HC) in Ontario between January 2007 and December 2011. The RAI-HC contains several health status indicators and validated health index scales. The association of a history of stroke on health status was assessed through a series of logistic regression models, adjusted for age, sex, and number of comorbidities. Sex differences were also explored. A change in odds of ≥25% was considered to indicate a clinically important finding. From the home care data ( N = 319,694), 56,909 individuals had a stroke diagnosis, with approximately 86% diagnosed with ≥3 chronic conditions. A stroke diagnosis was associated with a higher risk of limitations or impairments with communication, locomotion, continence, activities of daily living, and cognitive performance. A clinically meaningful difference was not observed for symptoms of depression. Few sex differences were observed. In an effort to support the development of effective home and community-based care programs, research is needed to understand differences in community-dwelling versus institutional populations. Community-dwelling individuals with a history of stroke show higher levels of impairment and limitations compared with those without, suggesting areas where home care resources could be improved to help manage the chronic effects of stroke.

Dying of amyotrophic lateral sclerosis

Neurology ◽  
2019 ◽  
Vol 93 (23) ◽  
pp. e2083-e2093 ◽  
Author(s):  
Jocelyn Zwicker ◽  
Danial Qureshi ◽  
Robert Talarico ◽  
Pierre Bourque ◽  
Mary Scott ◽  
...  
Keyword(s):  
Health Care ◽  
Amyotrophic Lateral Sclerosis ◽  
Home Care ◽  
Home Visit ◽  
Care Service ◽  
Health Care Service ◽  
Large Population ◽  
Population Based ◽  
Cost Of Care ◽  
Lateral Sclerosis

ObjectiveTo describe health care service utilization and cost for decedents with and without amyotrophic lateral sclerosis (ALS) in the last year of life.MethodsUsing linked health administrative data, we conducted a retrospective, population-based cohort study of Ontario, Canada, decedents from 2013 to 2015. We examined demographic data, rate of utilization, and cost of health care services in the last year of life.ResultsWe identified 283,096 decedents in Ontario, of whom 1,212 (0.42%) had ALS. Decedents with ALS spent 3 times as many days in an intensive care unit (ICU) (mean 6.3 vs 2.1, p < 0.001), and twice as many days using complex continuing care (mean 12.7 vs 6.0, p < 0.001) and home care (mean 99.1 vs 41.3, p < 0.001). A greater percentage of decedents with ALS received palliative home care (44% vs 20%, p < 0.001) and palliative physician home visits (40% vs 18%, p < 0.001) than decedents without ALS. Among decedents with ALS, a palliative physician home visit in the last year of life was associated with reduced adjusted odds of dying in hospital (odds ratio 0.65, 95% confidence interval 0.48–0.89) and fewer days spent in the ICU. Mean cost of care in the last year of life was greater for those with ALS ($68,311.98 vs $55,773.48, p < 0.001).ConclusionsIn this large population-based cohort of decedents, individuals with ALS spent more days in the ICU, received more community-based services, and incurred higher costs of care in the last year of life. A palliative care physician home visit was associated with improved end of life outcomes; however, the majority of patients with ALS did not access such services.

scholarly journals Generalised anxiety disorder and hospital admissions: findings from a large, population cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e018539 ◽  
Author(s):  
Olivia Remes ◽  
Nicholas Wainwright ◽  
Paul Surtees ◽  
Louise Lafortune ◽  
Kay-Tee Khaw ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Service Use ◽  
Hospital Admissions ◽  
Late Onset ◽  
Large Population ◽  
Population Based ◽  
Generalised Anxiety Disorder ◽  
Increased Risk ◽  
Using Data ◽  
Administrative Health Databases

ObjectiveGeneralised anxiety disorder (GAD) is the most common anxiety disorder in the general population and has been associated with high economic and human burden. However, it has been neglected in the health services literature. The objective of this study is to assess whether GAD leads to hospital admissions using data from the European Prospective Investigation of Cancer-Norfolk. Other aims include determining whether early-onset or late-onset forms of the disorder, episode chronicity and frequency, and comorbidity with major depressive disorder (MDD) contribute to hospital admissions.DesignLarge, population study.SettingUK population-based cohort.Participants30 445 British participants were recruited through general practice registers in England. Of these, 20 919 completed a structured psychosocial questionnaire used to identify presence of GAD. Anxiety was assessed in 1996–2000, and health service use was captured between 1999/2000 and 2009 through record linkage with large, administrative health databases. 17 939 participants had complete data on covariates.Main outcome measurePast-year GAD defined according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.ResultsIn this study, there were 2.2% (393/17 939) of respondents with GAD. Anxiety was not independently associated with hospital admissions (incidence rate ratio (IRR)=1.04, 95% CI 0.90 to 1.20) over 9 years. However, those whose anxiety was comorbid with depression showed a statistically significantly increased risk for hospital admissions (IRR=1.23, 95% CI 1.02 to 1.49).ConclusionPeople with GAD and MDD comorbidity were at an increased risk for hospital admissions. Clinicians should consider that meeting criteria for a pure or individual disorder at one point in time, such as past-year GAD, does not necessarily predict deleterious health outcomes; rather different forms of the disorder, such as comorbid cases, might be of greater importance.

scholarly journals Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study

2020 ◽  
Author(s):  
Derek R. Manis ◽  
Caitlin McArthur ◽  
Andrew P. Costa
Keyword(s):  
Home Care ◽  
Negative Binomial ◽  
Population Based ◽  
Cross Sectional Study ◽  
Assessment Instrument ◽  
Health Conditions ◽  
Assistive Device ◽  
Sectional Study ◽  
Functional Characteristics ◽  
Cross Sectional

Abstract Background Accidental falls among older adults are a leading cause of injury-related hospitalizations. Reducing falls is an ongoing quality improvement priority for home care, given that many home care clients experience falls. In this study, we identify factors associated with the rate of falls among home care clients.Methods We conducted a population-based, cross-sectional study using secondary data from the Hamilton, Niagara, Haldimand, and Brant health region of Ontario, Canada from January 1 – March 31, 2018. We captured person-level characteristics with falls from the Resident Assessment Instrument – Home Care (RAI-HC). Negative binomial regression was used to model the rate of falls.Results Functional characteristics of home care clients had strong, statistically significant associations with the rate of falls. Declines in activities of daily living, assistive device use for locomotion indoors, polypharmacy, and health conditions, such as dizziness or lightheadedness, and parkinsonism, were associated with a higher rate of falls. Males who used assistive devices had a higher rate of falls compared to females; however, males with neurological and cardiovascular health conditions had a decrease in the rate of falls compared to females. Home care clients with parkinsonism who used a cane and took eight or more drugs had stronger associations with an increased rate of falls compared to those who do not have parkinsonism.Conclusions Functional characteristics, polypharmacy, and health conditions are associated with increased rates of falls among home care clients. Home care clients who are at a greater risk of falls may require environmental adjustments in their home to reduce or eliminate the possibility of falling.

Active identification of patients appropriate for palliative care: Impact on use of palliative care and home care resources.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 101-101
Author(s):  
Nicole Mittmann ◽  
Ning Liu ◽  
Marnie MacKinnon ◽  
Soo Jin Seung ◽  
Nicole Look Hong ◽  
...  
Keyword(s):  
Palliative Care ◽  
Home Care ◽  
Service Use ◽  
Intervention Group ◽  
Home Care Services ◽  
Control Group ◽  
Palliative Approach ◽  
Active Identification ◽  
Care Services ◽  
Primary Care Teams

101 Background: This research evaluates whether active identification of patients who may benefit from a palliative approach to care changes the use of palliative care and home care services. Methods: Between 2014 and 2017, Cancer Care Ontario implemented the INTEGRATE project at 4 cancer centres and 4 primary care teams. Physicians in participating sites were encouraged to systematically identify patients who were likely to die within 1 year and would benefit from a palliative approach to care. Patients in the INTEGRATE intervention group were 1:1 matched to non-intervention controls selected from provincial healthcare administrative data based on a publicly funded health system using the propensity score-matching. Palliative care and home care services utilization was evaluated within 1 year after the date of identification (index date), censoring on death, or March 31, 2017, the study end date. Cumulative incidence function was used to estimate the probability of having used care services, with death as a competing event. Rate of service use per 360 patient-days was calculated. Analyses were done separately for palliative care and home care. Results: Of the 1,187 patients in the INTEGRATE project, 1,185 were matched to a control. The intervention and the control groups were well-balanced on demographics, diagnosis, comorbidities, and death status. The probability of using palliative services in the intervention group was 80.3%, which was significantly higher than that in the control group (62.4%) with more palliative care visits in the intervention group [29.7 (95%CI: 29.4 to 30.1] per 360 patient-days) than in the control group [19.6 (95%CI: 19.3 to 19.9) per 360 patient-days]. The intervention group had a greater probability of receiving home care (81.4%) than the control group (55.2%) with more homecare visits per 360 patient-days [64.7 (95%CI: 64.2 to 65.3) vs. 35.3 (95%CI: 34.9 to 35.7)] The intervention group also had higher physician home visits as compared to the control group (36.5% vs. 23.7%). Conclusions: Physicians actively identifying patients that would benefit from palliative care resulted in increased use of palliative care and home care services.

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

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.

scholarly journals Population-based home care services in breast cancer: utilization and costs

2012 ◽  
Vol 19 (6) ◽  
Author(s):  
N. Mittmann ◽  
P.K. Isogai ◽  
R. Saskin ◽  
N. Liu ◽  
J.M. Porter ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Home Care ◽  
Home Care Services ◽  
Population Based ◽  
Care Services

scholarly journals Symptom trajectories of non-cancer patients in the last six months of life: Identifying needs in a population-based home care cohort

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252814
Author(s):  
Katrin Conen ◽  
Dawn M. Guthrie ◽  
Tara Stevens ◽  
Samantha Winemaker ◽  
Hsien Seow
Keyword(s):  
Home Care ◽  
End Of Life ◽  
Cancer Patients ◽  
Severe Pain ◽  
Home Care Services ◽  
Population Based ◽  
Caregiver Distress ◽  
Shortness Of Breath ◽  
Symptom Trajectories ◽  
Care Services

Introduction The end-of-life symptom prevalence of non-cancer patients have been described mostly in hospital and institutional settings. This study aims to describe the average symptom trajectories among non-cancer patients who are community-dwelling and used home care services at the end of life. Materials and methods This is a retrospective, population-based cohort study of non-cancer patients who used home care services in the last 6 months of life in Ontario, Canada, between 2007 and 2014. We linked the Resident Assessment Instrument for Home Care (RAI-HC) (standardized home care assessment tool) and the Discharge Abstract Databases (for hospital deaths). Patients were grouped into four non-cancer disease groups: cardiovascular, neurological, respiratory, and renal (not mutually exclusive). Our outcomes were the average prevalence of these outcomes, each week, across the last 6 months of life: uncontrolled moderate-severe pain as per the Pain Scale, presence of shortness of breath, mild-severe cognitive impairment as per the Cognitive Performance Scale, and presence of caregiver distress. We conducted a multivariate logistic regression to identify factors associated with having each outcome respectively, in the last 6 months. Results A total of 20,773 non-cancer patient were included in our study, which were analyzed by disease groups: cardiovascular (n = 12,923); neurological (n = 6,935); respiratory (n = 6,357); and renal (n = 3,062). Roughly 80% of patients were > 75 years and half were female. In the last 6 months of life, moderate to severe pain was frequent in the cardiovascular (57.2%), neurological (42.7%), renal (61.0%) and respiratory (58.3%) patients. Patients with renal disease had significantly higher odds for reporting uncontrolled moderate to severe pain (odds ratio [OR] = 1.21; 95% CI: 1.08 to 1.34) than those who did not. Patients with respiratory disease reported significantly higher odds for shortness of breath (5.37; 95% CI, 5.00 to 5.80) versus those who did not. Patients with neurological disease compared to those without were 9.65 times more likely to experience impaired cognitive performance and had 56% higher odds of caregiver distress (OR = 1.56; 95% CI: 1.43 to 1.71). Discussion In our cohort of non-cancer patients dying in the community, pain, shortness of breath, impaired cognitive function and caregiver distress are important symptoms to manage near the end of life even in non-institutional settings.

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