Browsing by Subject "ADRD"

Now showing 1 - 3 of 3
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    Impact of interhospital transfer on patients with Alzheimer's disease and other related dementias
    (Wiley, 2023-09-07) Glober, Nancy; LaShell, Alexandra; Montelauro, Nicholas; Troyer, Lindsay; Supples, Michael; Unroe, Kathleen; Tainter, Christopher; Faris, Greg; Fuchita, Mikita; Boustani, Malaz; Emergency Medicine, School of Medicine
    Older adults are often transferred from one emergency department (ED) to another hospital for speciality care, but little is known about whether those transfers positively impact patients, particularly those with Alzheimer's disease and other related dementias (ADRD). In this study we aimed to describe the impact of interhospital transfer on older adults with and without ADRD. In a retrospective review of electronic medical records, we collected data on demographics, insurance type, initial code status, intensive care, length of stay, specialist consult, procedure within 48 hours, and discharge disposition for older adults (≥65years). We included older adults with at least one ED visit, who were transferred to a tertiary care hospital. With logistic regression, we estimated odds of death, intensive care stay, or procedure within 48 hours by ADRD diagnosis. Patients with ADRD more often received a geriatrics (p < 0.001) or palliative care consult (p = 0.038). They were less likely to be full code at admission (p < 0.001) or to be discharged home (p < 0.001). Patients living with ADRD less often received intensive care or a procedure within 48 hours of transfer (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.22–2.88). Patients with ADRD were less likely to receive intensive care unit admission or specialist procedures after transfer. Further study is indicated to comprehensively understand patient‐centered outcomes.
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    Primary care preparedness to care for patients with ADRD: A national survey study
    (Wiley, 2025) Januszewicz, Joseph; Fowler, Nicole R.; Mackwood, Matthew B.; Fisher, Elliott; Andrews, Alice O.; Schmidt, Rachel O.; Akré, Ellesse-Roselee L.; Schifferdecker, Karen E.; Medicine, School of Medicine
    Introduction: It is unknown how prepared primary care practices are to deliver recommended dementia care. Methods: A nationally representative survey of US primary care practices focused on care delivery processes, including those for patients with Alzheimer's disease and related dementias (ADRD). Results: A total of 1245 of 3498 practices (36%) responded. Most practices reported systems to detect patients with ADRD (67%) and refer patients for diagnostic testing (75%). Fewer required ADRD-related training (45%-46%) or maintained an ADRD registry (29%). Practices that scored higher on ADRD care preparedness were more likely to be smaller, receive a higher proportion of revenue from Medicare, and have other important practice capabilities. Discussion: Primary care practices have mixed preparedness to care for patients with ADRD. Efforts to boost ADRD preparedness, including providing adequate infrastructure and resources directly to primary care, should be a priority to address disparities in diagnosis and to optimize the patient and caregiver journey. Highlights: Mixed ADRD preparedness identified in primary care practices across the United States. Practices often lack ADRD-specific registries and staff training initiatives. Medicare-reliant and larger physician-owned groups show higher ADRD preparedness. FQHCs reported lower ADRD preparedness, highlighting potential gaps in care. Cultural awareness and other support services correlate with better ADRD readiness.
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    User Personas to Guide Technology Intervention Design to Support Caregiver-Assisted Medication Management
    (Oxford, 2022-11) Linden, Anna; Loganathar, Priya; Holden, Richard; Boustani, Malaz; Campbell, Noll; Ganci, Aaron; Werner, Nicole; Herron School of Art
    Informal caregivers often help manage medications for people with ADRD. Caregiver-assisted medication management has the potential to optimize outcomes for caregivers and people with ADRD, but is often associated with suboptimal outcomes. We used the user-centered design persona method to represent the needs of ADRD caregivers who manage medications for people with ADRD to guide future design decisions for technology interventions. Data were collected through virtual contextual inquiry in which caregivers (Nf24) sent daily multimedia text messages depicting medication management activities for seven days each, followed by an interview that used the messages as prompts to understand medication management needs. We applied the persona development method to the data to identify distinct caregiver personas, i.e., evidence-derived groups of prospective users of a future intervention. We used team-based affinity diagramming to organize information about participants based on intragroup (dis)similarities, to create meaningful clusters representing intervention-relevant attributes. We then used group consensus discussion to create personas based on attribute clusters. The six identified attributes differentiating personas were: 1. medication acquisition, 2. medication organization, 3. medication administration, 4. monitoring symptoms, 5. care network, 6. technology preferences. Three personas were identified based on differences on those attributes: Regimented Ruth (independent, proactive, tech savvy, controls all medications), Intuitive Ian (collaborative, uses own judgment, some technology, provides some medication autonomy), Passive Pamela (reactive, easy going, technology novice, provides full medication autonomy). These personas can be used to guide technology intervention design by evaluating how well intervention designs support each of them.