Long-term Care Transitions in Dementia: Predictors and Caregiver Outcomes

ANALYSIS OF LONG-TERM CARE TRANSITIONS: EXAMPLES IN THE DEMENTIA CARE CONTEXT Joseph E. Gaugler, Ph.D. Associate Professor School of Nursing University of Minnesota

ACKNOWLEDGEMENTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

SPECIFIC AIMS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Longitudinal implications of informal long-term care Effectiveness of psychosocial interventions Social integration in residential long-term care OTHERS Dementia Demonstration Project (VA); Nursing Home Training to Impact CMS Indicators (NIA R42);The Memory Club (Alzheimer’s Association collaboration); Nursing Home Diversion Project (MN-BoA) NIA R01 AG022066 Comprehensive Support for AD CGs (2005-2010) NIA R21 AG026525 CG Outcomes Post NH Placement (2007-2009) NIA K02 ADS Use and Outcomes: MM (2008-2013) NINR R41 NR010642 Communication in the NH (2008; Co-PI) NIA R21 AG026525 CG Outcomes Post NH Placement (2007-2009)

WHAT IS A TRANSITION? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Wethington. E. (2000). An overview of the life course perspective: Implications for health and nutrition. Journal of Nutrition Education and Behavior, 37, 115-120. (p. 116)

MELEIS TRANSITION MODEL (Meleis et al., 2000; p. 16) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

NATURE OF TRANSITIONS TYPES Developmental Situational Health/Illness Organizational PATTERNS Single Multiple Sequential Simultaneous Related Unrelated PROPERTIES Awareness Engagement Change & difference Transition time span Critical points & events TRANSITION CONDITIONS: FACILITATORS AND INHIBITORS PERSONAL Meanings Cultural beliefs & attitudes Socioeconomic status Preparation & knowledge COMMUNITY SOCIETY PATTERNS OF RESPONSE PROCESS INDICATORS Feeling connected Interacting Location & being situated Developing confidence & coping OUTCOMES Mastery Fluid integrative identities NURSING THERAPEUTICS/INTERVENTION From Meleis, A.I., Sawyer, L.M., Im, E-O., Hilfinger Messias, D.K., & Schumacher, K. (2000). Experiencing transitions: An emerging middle-range theory. Advances in Nursing Science, 23, 12-28. (Figure 1)

TRANSITIONS IN INFORMAL DEMENTIA CARE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

NURSING HOME ADMISSION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

QUESTION 1: WHAT PREDICTS NHA IN DEMENTIA? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

METHODS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RESULTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

DISCUSSION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

IMPLICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

QUESTION 2: WHAT HAPPENS TO DEMENTIA CAREGIVERS AFTER NHA? ,[object Object],[object Object],[object Object]

RESEARCH QUESTIONS ,[object Object],[object Object],[object Object],[object Object]

METHODS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

PREDICTIVE DOMAINS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Figure 2. ROC curve for Zarit Burden Inventory at baseline (N = 5,831): “High” depression on GDS. NOTE: Area = .814 (SE = .006) Sensitivity = 77% (screen positive); Specificity = 71% (screen negative)

ANALYSIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

RESULTS: QUESTION 1 ,[object Object],[object Object],[object Object]

IMPLICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

QUESTION 3: DOES PSYCHOSOCIAL SUPPORT HELP CAREGIVERS DURING AND AFTER NHA? ,[object Object],[object Object],[object Object]

METHODS ,[object Object],[object Object],[object Object]

NYUCI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ANALYSIS ,[object Object],[object Object],[object Object],[object Object],[object Object]

DISCUSSION ,[object Object],[object Object],[object Object],[object Object]

IMPLICATIONS ,[object Object],[object Object],[object Object],[object Object]

WHERE DO WE GO FROM HERE? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

INTERESTED IN COLLABORATING? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Long-term Care Transitions in Dementia: Predictors and Caregiver Outcomes

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Long-term Care Transitions in Dementia: Predictors and Caregiver Outcomes