Dementia and transitional care: Gaps in research and practice

July 16, 2019

Patients with dementia are hospitalized at higher rates and involved in transitional care more frequently than those who are cognitively unimpaired. Yet, current practices for managing transitional care--and the research informing them--have overlooked the needs of patients with dementia and their caregivers.

"Patients with dementia have only been considered in a small portion of decades of transitional care studies," said Beth Prusaczyk, Ph.D., a recent postdoctoral fellow in The Center for Clinical Quality and Implementation Research at Vanderbilt University Medical Center. Prusaczyk is among the experts beginning to develop evidence-based practices to support patients with dementia in transitional care.

"The research has excluded patients with dementia for several reasons: because of IRB hurdles, and out of the concern that they can't fully appreciate participation," Prusaczyk said. "There is also an erroneous assumption you can't get good data."

Needs Going Unmet

In a new study published in the Journal of Gerontological Nursing, Prusaczyk and colleagues showed that older patients with dementia at one major teaching hospital were less often provided with transitional care steps including patient education, discharge planning, and documentation of medication history, as compared to patients without dementia.

The study used a chart review of 210 patients aged 70 and older who were discharged from an inpatient stay other than the ED. The 126 patients with dementia--60 percent of those included--experienced significant differences in their transitional care. The researchers assumed charts reflected steps taken with patients or caregivers.

Care teams collected medical histories from the patient, family member or other provider for only 60 percent of patients with dementia, compared to 86 percent of patients without. Patients with dementia also received discharge education far less frequently. This included education about:Prusaczyk says the researchers confirmed these trends during qualitative interviews with providers at the hospital. "They didn't necessarily set a high priority for these types of transitional care activities for patients with dementia or their caregivers," she said.

Aligning Care

In a separate study of the same patient cohort, published in Journal of Interprofessional Care, Prusaczyk's group applied social mapping and network analyses to identify 14 unique types of actors engaged in discharge communications. Both clinicians and non-clinicians (e.g. social workers, case managers) contributed to discharge planning. Perhaps concerningly, primary care physicians did not participate, unless responding to queries initiated by case managers.

"I'd like more research to understand why transition care teams are still struggling to communicate internally, but especially with primary care providers. This is obviously significant with an older patient with dementia," Prusaczyk said.

Prusaczyk, who is a former hospital social worker, acknowledges the "pressures and challenges" of managing care transitions across complex teams. Still, there are clear opportunities to better understand and serve the needs of patients with dementia.

"My focus is identifying changes we can enact now. System-level changes are needed, but there are communication tools available today that improve retention--making sure patients have their glasses, using teach-back and more visual aids," Prusaczyk said. "The change can happen if it is prioritized."
-end-
Beth Prusaczyk, Ph.D., MSW, is faculty at Washington University in St. Louis at the School of Medicine. She recently completed a postdoctoral fellowship in The Center for Clinical Quality and Implementation Research at Vanderbilt University Medical Center. Her research uses implementation science and social network analysis to explore evidence-based practices and policies that will improve the health of older adults, especially those discharging from the hospital.

Vanderbilt University Medical Center

Related Dementia Articles from Brightsurf:

Why people with dementia go missing
People with dementia are more likely to go missing in areas where road networks are dense, complicated and disordered - according to new research from the University of East Anglia.

PTSD may double risk of dementia
People who have experienced post-traumatic stress disorder (PTSD) are up to twice as likely to develop dementia later in life, according to a new study by UCL researchers, published in the British Journal of Psychiatry.

Dementia education
School-based dementia education could deliver much needed empathy and understanding for older generations as new research from the University of South Australia shows it can significantly improve dementia knowledge and awareness among younger generations.

Building dementia friendly churches
A project to help church communities become more 'dementia friendly' has had a significant impact across the country.

A "feeling" for dementia?
A research team led by the DZNE concludes that personal perception can be an important indicator for the early detection of Alzheimer's disease.

New biomarker for dementia diagnosis
Medical researchers in the UK and Australia have identified a new marker which could support the search for novel preventative and therapeutic treatments for dementia.

Digital solutions for dementia care
Telehealth delivery of dementia care in the home can be as effective as face-to-face home visit services if carers and recipients take advantage of the technologies available, Australian researchers say.

Despite a marked reduction in the prevalence of dementia, the number of people with dementia is set to double by 2050 according to new Alzheimer Europe report
Today, at a European Parliament lunch debate, Alzheimer Europe launched a new report presenting the findings of its collaborative analysis of recent prevalence studies and setting out updated prevalence rates for dementia in Europe.

How likely do you think you are to develop dementia?
A poll suggests almost half of adults ages 50 to 64 believe they're likely to develop dementia.

Latest issue of Alzheimer's & Dementia
Predicting heart disease might also be a warning sign for Alzheimer's; A new way to think about the environment and Alzheimer's research; Most dementia patients don't receive care from physicians who specialize in brain health.

Read More: Dementia News and Dementia Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.