Stroke and Transient Ischemic Attack in the Long-Term Care Setting: Patient Characteristics, Medication Treatment, and Length of Stay

2011 ◽  
Vol 26 (3) ◽  
pp. 170-181 ◽  
Author(s):  
Juliana L. Meyers ◽  
Keith L. Davis ◽  
Yanni F. Yu
Keyword(s):  
Length Of Stay ◽  
Transient Ischemic Attack ◽  
Care Setting ◽  
Long Term Care ◽  
Patient Characteristics ◽  
Term Care ◽  
Medication Treatment ◽  
Ischemic Attack

scholarly journals Depression and Diabetes Mellitus Multimorbidity Is Associated With Loss of Independence and Dementia Poststroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3531-3540
Author(s):  
Michael Ouk ◽  
Che-Yuan Wu ◽  
Jessica Colby-Milley ◽  
Jiming Fang ◽  
Limei Zhou ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Long Term Care ◽  
Stroke Recovery ◽  
Term Care ◽  
Incident Dementia ◽  
All Cause Mortality ◽  
Ischemic Attack

Background and Purpose: Many patients with ischemic stroke present with multiple comorbidities that threaten survival and recovery. This study sought to determine the risks of adverse long-term stroke outcomes associated with multimorbid diabetes mellitus and depression. Methods: Retrospective analysis of prospectively collected data on consecutive patients without premorbid dementia admitted from the community for a first-ever acute ischemic stroke to comprehensive stroke centers across Ontario, Canada (2003–2013). Premorbid histories of diabetes mellitus and depression were ascertained within 5 years before stroke admission. Adjusted hazard ratios (aHR [95% CI]) of admission to long-term care, incident dementia, readmission for stroke or transient ischemic attack and all-cause mortality, over time among those discharged back into the community poststroke. Results: Among 23 579 stroke admissions, n=20 201 were discharged back into the community. Diabetes mellitus and depression were associated with synergistic hazards of admission to long-term care (X 2 =5.4; P =0.02) over a median follow-up of 5.6 years. This interaction was observed among women specifically; depression multimorbidity showed particularly high hazards of admission to long-term care (aHR Depression =1.57 [1.24–1.98]) and incident dementia (aHR Depression =1.85 [1.40–2.44]) among women with diabetes mellitus. In the whole cohort, diabetes mellitus and depression were associated individually with long-term care admission (aHR Diabetes =1.20 [1.12–1.29]; aHR Depression =1.19 [1.04–1.37]), incident dementia (aHR Diabetes =1.14 [1.06–1.23]; aHR Depression =1.27 [1.08–1.49]), stroke/transient ischemic attack readmission (aHR Diabetes =1.18 [1.10–1.26]; aHR Depression =1.24 [1.07–1.42]), and all-cause mortality (aHR Diabetes =1.29 [1.23–1.36]; aHR Depression =1.16 [1.05–1.29]). Conclusions: The risks of dementia and needing long-term care in the years after surviving a stroke were particularly elevated among women when premorbid diabetes mellitus and depression occurred together. Long-term stroke recovery strategies might target high-risk patients with mood and metabolic multimorbidity.

Commentary: The Broader Context of Long-Term Care Ethics

2016 ◽  
Vol 25 (3) ◽  
pp. 554-556
Author(s):  
Jason Lesandrini ◽  
Carol O’Connell
Keyword(s):  
Care Setting ◽  
Long Term Care ◽  
Ethical Issues ◽  
Term Care ◽  
Ethical Concerns ◽  
Healthcare Settings ◽  
Care Facilities ◽  
Ethics Program ◽  
Made In

Ethical issues in long-term care settings, although having received attention in the literature, have not in our opinion received the appropriate level they require. Thus, we applaud the Cambridge Quarterly for publishing this case. We can attest to the significance of ethical issues arising in long-term care facilities, as Mr. Hope’s case is all too familiar to those practicing in these settings. What is unique about this case is that an actual ethics consult was made in a long-term care setting. We have seen very little in the published literature on the use of ethics structures in long-term care populations. Our experience is that these healthcare settings are ripe for ethical concerns and that providers, patients, families, and staff need/desire ethics resources to actively and preventively address ethical concerns. The popular press has begun to recognize the ethical issues involved in long-term care settings and the need for ethics structures. Recently, in California a nurse refused to initiate CPR for an elderly patient in a senior residence. In that case, the nurse was quoted as saying that the facility had a policy that nurses were not to start CPR for elderly patients.1 Although this case is not exactly the same as that of Mr. Hope, it highlights the need for developing robust ethics program infrastructures in long-term care settings that work toward addressing ethical issues through policy, education, and active consultation.

“They don't just disappear”: Acknowledging death in the long-term care setting— ADDENDUM

2012 ◽  
Vol 10 (4) ◽  
pp. 313-313
Author(s):  
Janine Maitland ◽  
Kevin Brazil ◽  
Bill James-Abra
Keyword(s):  
Care Setting ◽  
Long Term Care ◽  
Term Care

scholarly journals Determinants of Hospital Length of Stay among Patients with Pneumonia Admitted to a Large Canadian Hospital from 1991 to 2001

2005 ◽  
Vol 12 (7) ◽  
pp. 365-370 ◽  
Author(s):  
Margaret J McGregor ◽  
J Mark FitzGerald ◽  
Robert J Reid ◽  
Adrian R Levy ◽  
Michael Schulzer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Long Term Care ◽  
Care Facility ◽  
Community Acquired Pneumonia ◽  
Hospital Length Of Stay ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Care Facilities

BACKGROUND: Pneumonia is a common reason for hospital admission, and the cost of treatment is primarily determined by length of stay (LOS).OBJECTIVES: To explore the changes to and determinants of hospital LOS for patients admitted for the treatment of community-acquired pneumonia over a decade of acute hospital downsizing.METHODS: Data were extracted from the database of Vancouver General Hospital, Vancouver, British Columbia, on patients admitted with community-acquired pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification codes 481.xx, 482.xx, 483.xx, 485.xx and 486.xx) from January 1, 1991 to March 31, 2001. The effects of sociodemographic factors, the specialty of the admitting physician (family practice versus specialist), admission from and/or discharge to a long-term care facility (nursing home) and year of admission, adjusted for comorbidity, illness severity measures and other potential confounders were examined. Longitudinal changes in these factors over the 10-year period were also investigated.RESULTS: The study population (n=2495) had a median age of 73 years, 53% were male and the median LOS was six days. Adjusted LOS was longer for women (10% increase, 95% CI 3 to 16), increasing age group (7% increase, 95% CI 4 to 10), admission under a family physician versus specialist (42% increase, 95% CI 32 to 52) and admission from home with subsequent discharge to a long-term care facility (75% increase, 95% CI 47 to 108). Adjusted hospital LOS decreased by an estimated 2% (95% CI 1 to 3) per annum. The mean age at admission and the proportion admitted from long-term care facilities both increased significantly over the decade (P<0.05).CONCLUSIONS: Results suggest that the management of hospitalized patients with pneumonia changed substantially between 1991 and 2001. The interface of long-term care facilities with acute care would be an important future area to explore potential efficiencies in caring for patients with pneumonia.

Measuring Interdisciplinary Team Performance in a Long-Term Care Setting

Medical Care ◽  
2004 ◽  
pp. 472-481 ◽  
Author(s):  
Helena Temkin-Greener ◽  
Diane Gross ◽  
Stephen J. Kunitz ◽  
Dana Mukamel
Keyword(s):  
Team Performance ◽  
Care Setting ◽  
Long Term Care ◽  
Interdisciplinary Team ◽  
Term Care
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