scholarly journals Functional and Cognitive Impairments Increased Risks of Outcomes of Healthcare Utilization in Patients With Stroke Receiving Home and Community-Based Care in Taiwan

2021 ◽  
Vol 9 ◽  
Author(s):  
Li-Fan Liu ◽  
Wei-Ming Wang ◽  
Jung-Der Wang
Keyword(s):  
Healthcare Utilization ◽  
Cognitive Impairments ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Functional Impairments ◽  
Term Care ◽  
Stroke Population ◽  
National Mortality ◽  
Aged Society

Aim: Stroke is a leading cause of disability; however, little is known about the outcomes of the utilization of long-term care (LTC) recipients in Taiwan. This study aimed to quantify the burdens of disease of stroke survivors receiving LTC by evaluating the outcomes of their utilization including mortality, readmissions, and re-emergency within 1 year after diagnoses of strokes.Methods: By interlinkages among the national mortality registry, LTC dataset (LTC-CM), and the National Health Insurance Research Dataset (NHIRD), the outcomes and the factors associated with receiving LTC up to 1 year were explored. Patients were aged 50 years and over with an inpatient claim of the first diagnosis of stroke of intracerebral hemorrhage (ICH) and ischemic stroke during 2011–2016. Outcomes of the healthcare utilization include rehospitalization and re-emergency.Results: There were 15,662 patients with stroke who utilized the LTC services in the dataset among the stroke population in NHIRD. Stroke survivors receiving LTC showed no difference in clinical characteristics and their expected years of life loss (EYLL = 7.4 years) among those encountered in NHIRD. The LTC recipients showed high possibilities to be rehospitalized and resent to emergency service within 1 year after diagnosis. Apart from the comorbidity and stroke severity, both the physical and mental functional disabilities and caregiving resources predicted the outcomes of the utilization.Conclusions: For stroke survivors, both severe functional impairments and cognitive impairments were found as important factors for healthcare utilizations. These results regarding reserving functional abilities deserve our consideration in making the decision on the ongoing LTC policy reform in the aged society of Taiwan.

scholarly journals Person-Centered Health Care: An Approach That Integrates Acute and Long-Term Care

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 704-704
Author(s):  
Yuchi Young ◽  
Barbara Resnick
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Systems ◽  
Long Term Care ◽  
The United States ◽  
World Population ◽  
Term Care ◽  
The Usa ◽  
Aged Society

Abstract The world population is aging. The proportion of the population over 60 will nearly double from 12% in 2015 to 22% in 2050. Global life expectancy has more than doubled from 31 years in 1900 to 72.6 years in 2019. The need for long-term care (LTC) services is expanding with the same rapidity. A comprehensive response is needed to address the needs of older adults. Learning from health systems in other countries enables health systems to incorporate best long-term care practices to fit each country and its culture. This symposium aims to compare long-term care policies and services in Taiwan, Singapore, and the USA where significant growth in aging populations is evidenced. In 2025, the aging population will be 20% in Taiwan, 20% in Singapore and 18 % in the USA. In the case of Taiwan, it has moved from aging society status to aged society, and to super-aged society in 27 years. Such accelerated rate of aging in Taiwan is unparalleled when compared to European countries and the United States. In response to this dramatic change, Taiwan has passed long-term care legislation that expands services to care for older adults, and developed person-centered health care that integrates acute and long-term care services. Some preliminary results related to access, care and patterns of utilization will be shared in the symposium. International Comparisons of Healthy Aging Interest Group Sponsored Symposium.

scholarly journals Return to Work Among Stroke Survivors

2019 ◽  
Vol 67 (2) ◽  
pp. 87-94 ◽  
Author(s):  
Kristin D. Ashley ◽  
Loretta T. Lee ◽  
Karen Heaton
Keyword(s):  
Occupational Health ◽  
Return To Work ◽  
Quantitative Research ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Factors Affecting ◽  
Work And Employment ◽  
Subsequent Failure

Despite improvements in the treatment of stroke, many individuals still face cognitive, emotional, and physical impairments. Stroke is a leading cause of serious long-term disability and subsequent failure to return to work (RTW). The purpose of this literature review was to synthesize and discuss the literature relevant to factors affecting RTW for stroke survivors, summarize the identified gaps, and discuss steps occupational health nurses can take to facilitate RTW among stroke survivors. A literature search was conducted using the keywords: “stroke,” “cerebrovascular disease,” “return to work,” and “employment.” After excluding articles based on inclusion/exclusion criteria, 19 quantitative research articles were reviewed. Consistent themes found in the literature affecting RTW following stroke included physical, social, and cognitive factors. One of the most consistent predictors of RTW found was stroke severity. Individuals who experienced a mild to moderate stroke, those of Caucasian ethnicity, and higher socioeconomic levels were more likely to RTW. Findings suggest the importance of future studies to examine factors among African American stroke survivors that predict RTW and the role of occupational health nurses.

scholarly journals The Limits of Dwelling and the Unwitnessed Death

2019 ◽  
Vol 34 (2) ◽  
pp. 213-239 ◽  
Author(s):  
Jason Danely
Keyword(s):  
First Century ◽  
Family Welfare ◽  
Potential Zone ◽  
Urban Centers ◽  
Community Based ◽  
Term Care ◽  
The Family ◽  
Long Term Care Insurance ◽  
Aged Society

Demographic and policy changes in Japan during the first decades of the twenty-first century have resulted in significantly more people growing older and dying alone, especially in densely populated urban centers. As the national Long-Term Care Insurance system continues to promote community-based elder care despite weakened family and neighborhood bonds, the home has become an intensified space of care as well as a potential zone of abandonment. This article considers these divergent potentials of home and their implications for thinking about the material, ethical, and aesthetic limits of dwelling as embodied in the specter and spectacle of the lonely death (kodokushi). Such deaths and the empty houses they leave behind index other forms of loss emerging from intertwined histories of the family, welfare, and housing and construction policy. I argue that the connection between local experiences of aging and death and national policies can be found in mediating images and narratives of mourning, which seek to locate and make sense of the inability to dwell. Approaching unwitnessed deaths as specters at the limits of dwelling allows us to move beyond the shock of lonely death and draws our attention instead to the links between caring, mourning, and the home in an aged society. 要約 21世紀前半の20年間における日本の人口動態と政策の変化の結果、特に人口密集した都心部で、一人で老後を過ごし、亡くなっていく人々の数が著しく増大した。家族や近隣共同体の絆が弱まっているにもかかわらず、国の介護保険制度が地域を基盤とした在宅高齢者介護を促進し続けているため、居宅は介護の場となるだけでなく、潜在的な放棄の場ともなっている。この記事では、これらの居宅の多様な可能性を検討する中で、孤独死の幻影(spectacle)と光景(spectacle)が具現化した場としての住まい(dwelling)の物質的、倫理的、そして美的な限界について考察する。孤独死と残された空家は、家族や福祉、住宅、そして建設政策などが絡み合った歴史から生じる社会的な喪失を写し出すのだ。ここで議論されるのは、地域における高齢化および死の経験と国家政策との関係が、居住(dwell)不可能性を見定め、理解しようと努める哀悼のイメージや物語を仲介することで見出しうるということである。誰にも目撃されることのなかった死を、住まいの限界に現れた幻影としてアプローチすることで、孤独死のショックを乗り越え、高齢化社会における思いやりと、哀悼、そして居宅との関連性に注目することが可能となる。

Memory Development: An Approach to the Mentally Impaired Elderly in the Long-Term Care Setting

1981 ◽  
Vol 13 (1) ◽  
pp. 15-35 ◽  
Author(s):  
Kathleen Carroll ◽  
Katherine Gray
Keyword(s):  
Care Setting ◽  
Cognitive Impairments ◽  
Memory Function ◽  
Nursing Home Residents ◽  
Memory Development ◽  
Review Of The Literature ◽  
Term Care ◽  
Mentally Impaired ◽  
Reality Orientation

Based upon a review of the literature on memory and cognitive impairments a number of procedures were implemented to improve memory function among nursing home residents. This paper describes the conceptual basis for the program called Memory Development (MD), and delineates procedures and techniques involving the use of cues, practice, and motivation. MD is compared to the traditional Reality Orientation (RO) approach.

The epistemological complexity of ideal care: long-term care professionals’ perspectives

2022 ◽  
Author(s):  
Antti Hämäläinen
Keyword(s):  
Long Term Care ◽  
Cognitive Impairments ◽  
Care Work ◽  
Structured Interviews ◽  
Term Care ◽  
Care Workers ◽  
Care Practices ◽  
Epistemological Basis ◽  
Epistemological Complexity

The article elaborates what aspects of knowledge eldercare workers describe concerning everyday long-term care practices. The article utilises a thematic analysis of Finnish long-term care workers’ semi-structured interviews (n = 25), and in doing so, it contributes to the discussion concerning the epistemological basis of care. The analysis specifies four aspects of knowledge in long-term care work: objective/objectifying, particular, corporeal and tacit. In line with existing literature on knowledge and care, the findings indicate that rational-technical epistemological approaches are insufficient when complex and fluid care relations are concerned. Moreover, cognitive impairments and other particularities of eldercare provide previously under-researched epistemological perspectives for consideration.

Longitudinal Healthcare Utilization and Costs in Parkinson’s Disease: Pre-Diagnosis to 9 Years After

2021 ◽  
pp. 1-10
Author(s):  
Ming Li Emily Soh ◽  
Xiumin Shermyn Neo ◽  
Seyed Ehsan Saffari ◽  
Sheng Yong Aidan Wong ◽  
Ganga Ganesan ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Movement Disorder ◽  
Healthcare Utilization ◽  
Hospital Admissions ◽  
Emergency Department Visits ◽  
Administrative Databases ◽  
Charlson Comorbidity Index Score ◽  
Term Care

Background: There is currently insufficient long-term data on costs of treatment in patients with Parkinson’s disease (PD), which is chronic and progressive, and associated with substantial healthcare costs. Identifying patterns in healthcare utilization and cost may illuminate further discussion on early intervention. Objective: To characterize long-term healthcare utilization and costs of PD in newly diagnosed patients managed by movement disorder specialists. Methods: Using a longitudinal matched-cohort study of linked data from the National Neuroscience Institute Parkinson’s disease and Movement Disorder and healthcare administrative databases in Singapore from 2008–2017, we compared healthcare utilization and costs between patients and controls matched on age, sex, race, and Charlson Comorbidity Index score. Results: 1,162 patients met study inclusion criteria and 1,157 matched controls were identified. The total mean annual healthcare cost (at 2017 costs) was significantly increased in patients compared to controls from years 1–9 post-diagnosis. The increased cost was observed 2 years before diagnosis (USD2322 vs. 2052; p <  0.001). Mean annual cost attributable to PD increased from USD1854 at 1-year post-diagnosis to USD2652 at 9 years. Over 9 years, average costs were significantly higher across all domains of healthcare utilization except primary care—cost of intermediate and long-term care was increased by a factor of 2.5, specialist care by 2.3, emergency department visits by 1.6, and hospital admissions by 1.3. Conclusion: PD results in higher healthcare utilization and costs. Pre-diagnosis increase in healthcare utilization observed in patients supports the presence of prodromal PD symptoms and may present an opportunity for early diagnosis.

Abstract W MP106: Clinical Effectiveness of Anticoagulation with Warfarin among Ischemic Stroke Patients with Atrial Fibrillation: Findings from the Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ying Xian ◽  
Jingjing Wu ◽  
Emily C O’Brien ◽  
Gregg C Fonarow ◽  
DaiWai M Olson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Warfarin Therapy ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Warfarin Treatment

Background: Oral anticoagulation is recommended for ischemic stroke patients with atrial fibrillation, based on clinical trials done in selected populations. However, little is known about whether the clinical benefit of warfarin is preserved outside the clinical trial setting, especially in older patients with ischemic stroke. Methods: PROSPER, a PCORI-funded research program designed by stroke survivors and stakeholders, used American Heart Association Get With The Guidelines (GWTG)-Stroke data linked to Medicare claims to evaluate the association between warfarin treatment at discharge and long-term outcomes among ischemic stroke survivors with atrial fibrillation (AF) and no contraindication to or prior anticoagulation therapy. The primary outcome prioritized by patients was home-time (defined as days spent alive and not in inpatient post-acute care facility) within 2-year follow-up after discharge. Results: Of 12,552 ischemic stroke patients with AF admitted from 2009-2011, 11,039 (88%) received warfarin treatment at discharge. Compared with those not receiving any anticoagulation, warfarin-treated patients were slightly younger (mean 80 vs. 83, p<0.001), less likely to have a history of prior stroke or coronary artery disease, but had similar stroke severity as measured by NIHSS (median 5 [IQR 2-12] vs. 6 [2-13], p=0.09). After adjustment for all observed baseline characteristics using propensity score inverse probability weighting method, patients discharged on warfarin therapy had 45 more days of home-time during 2-year follow-up than those not receiving any oral anticoagulant (513 vs. 468 days, p<0.001). Warfarin use was also associated with a lower risk of all-cause mortality, cardiovascular readmission or death, and ischemic stroke (Table). Conclusions: Among ischemic stroke patients with atrial fibrillation, warfarin therapy was associated with improved long-term outcomes.

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