- Email: [email protected]
ACCESS TO REHABILITATION AND OUTCOMES FOLLOWING HIP FRACTURE FOR OLDER ADULTS WITH DEMENTIA
P736
Poster Presentations: P3
possibly increasing their risk for functional decline. Their lower risk of rehospitalization (concurrent with their increased risk for long-term care placement) following hospital discharge supports the notion that admission to a nursing home may lead to a reduction in hospital use.
P3-286
ACCESS TO REHABILITATION AND OUTCOMES FOLLOWING HIP FRACTURE FOR OLDER ADULTS WITH DEMENTIA
Dallas Seitz1, Sudeep Gill1, Peter Austin2, Chaim Bell3, Andrea Gruneir4, Geoffrey Anderson5, Paula Rochon6, 1Queen’s University, Kingston, Ontario, Canada; 2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; 3Mt. Sinai Hospital, Toronto, Ontario, Canada; 4 Women’s College Hospital, Research Institute, Toronto, Ontario, Canada; 5 Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada; 6Women’s College Research Institute, Toronto, Ontario, Canada. Contact e-mail: [email protected] Project Description: Older adults with dementia frequently experience hip fractures and access to rehabilitation following hip fractures is important in order to reduce disability and prevent subsequent functional decline. However, older adults with dementia may have restricted access to rehabilitation services following hip fracture as these services are limited and dementia is believed to impede rehabilitation. We evaluated the effects of access to rehabilitation and subsequent outcomes for older adults with dementia who experienced hip fractures. We identified all older adults who dementia who were previously community dwelling that underwent surgery for hip fractures in the province of Ontario, Canada between 2003 and 2011. We categorized individuals into one of 4 possible post-fracture rehabilitation groups: inpatient rehabilitation (IPR); home-care based rehabilitation (HCR); complex continuing care (CCC); or, no rehabilitation. The risks of admission to long-term care (LTC), post-fracture mortality and post-fracture adverse events were then compared across rehabilitation groups after adjusting for potential confounders using multivariate regression. A total of 11,200 individuals with dementia experienced hip fractures during the study period. Of the total group, IPR was provided to 3,075 (27.4%), CCC to 2,474 (22.1%), HCR to 1,157 (10.3%) and 4,494 (40.1%) received no rehabilitation. When compared to no rehabilitation, any form of rehabilitation was associated with a reduced risk of mortality with the greatest effect observed with IPR (hazard ratio (HR: 0.46, 95% confidence interval (CI): 0.42 - 0.49). Similarly, a reduced risk of LTC admission was also observed for both IPR (HR: 0.62, 95% CI: 0.57 - 0.66) and HCR (HR: 0.63; 95% CI: 0.57 - 0.70) when compared to no rehabilitation. Access to post-fracture rehabilitation for older adults with dementia is associated with a reduced risk of mortality and LTC placement although many individuals with dementia do not receive these services following hip fracture. Improving access to rehabilitation services for this vulnerable population may improve post-fracture outcomes and improve quality of life for this population.
P3-287
FAMILY SUPPORT, OVERLOAD CARE, AND RESILIENCE FROM THE PERSPECTIVE OF FAMILY MEMBER CAREGIVERS OF SENIORS WITH ALZHEIMER’S DISEASE
Deusivania Vieira da Silva Falc~ao1, Camila Rodrigues Garcia2, Mayara Cartoni Braz2, Maria Helena Silveira2, Maria Madalena Borges de Ara ujo3, Glenda Dias dos Santos2, Paula Villela Nunes4, Orestes Vicente Forlenza5, 1USP, University of S~ao Paulo, Brazil, S~ao Paulo, SP, Brazil, Brazil; 2USP, S~ao Paulo, SP, Brazil, Brazil; 3USP-HC, S~ao Paulo, SP, Brazil, Brazil; 4University of Sao Paulo, S~ao Paulo, Brazil; 5 Laboratory of Neuroscience-University of S~ao Paulo, S~ao Paulo, Brazil. Contact e-mail: [email protected]
Project Description: This research aimed to identify the relation between resilience, overcharge of roles and family support of family member caregivers of seniors with mild and moderate Alzheimer’s Disease (AD), members of gerontology, psychosocial and educational intervention group. The study was conducted at the Rehabilitation Center and Day Hospital, Institute of Psychiatry, Hospital das Clınicas, Faculty of Medicine, University of S~ao Paulo, Brazil. 25 family caregivers were evaluated (19 women and 6 men, mostly composed of spouses, daughters and sons), before and after 15 sessions (1h and 30 min) of group interventions. The instruments used were a survey containing questions about sociodemographic data, emotional and instrumental activities and the roles played by caregivers; an Inventory of Perception of Family Support, a Zarit Burden Interview (ZBI) and a Resilience Scale.Regarding to the family support, by comparing before and after 15 sessions, it was detected that after the intervention there was more dialogue and communication between the caregiver with the other family members, with greater demonstration of affection through words (p¼0,020). After the interventions, performing instrumental activities at the task of caring for the elderly has increased significantly (p¼0,002). Moreover, the caregivers felt more stressed (p¼0,040) and more ashamed (p¼0,018) with the behavior of the elderly with Alzheimer’s. Regarding the resilience, there was stability in the mean frequency of responses when analyzed statistically before and after the interventions. However, demonstrated to be more concerned after the interventions (p¼0,018). In conclusion, evidences were provided that the present interventions for family caregivers helped to learning strategies for managing behavioral and psychological symptoms. Although they have provided information about the disease, encouraged a better family communication and triggered positive feelings for caregivers, also corroborated to increase the burden of care, the stress and worries with several situations. This may have occurred due to the clarification of the disease and being experiencing the consequences resulting from the evolution of the disease. Family support in the task of caring was an important damper factor in the difficulties found by the caregiver.
P3-288
DIAGNOSIS AND TREATMENT OF ALZHEIMER’S DISEASE IN SPECIALIST UNITS COMPARED TO PRIMARY CARE
Dorota Religa1, Ingrid Nilsson Modeer2, SeyedMohammad Fereshtehnejad2, Farshad Falahati2, Sara Garcia-Ptacek2, Maria Eriksdotter2, 1Karolinska Institutet, Stockholm, Sweden; 2Karolinska Institutet, Stockholm, Sweden. Contact e-mail: [email protected] Project Description: Alzheimer’s disease is a degenerative, incurable and mortal disease. National guidelines are available for diagnosing and treating Alzheimer’s disease, but earlier studies indicate differences in diagnostic work-up and pharmacological treatment between the specialist care and primary care in Sweden. Though only a few studies with small study populations have been made. Aims: To study if clinically relevant differences exist in demographics, diagnostic work-up and pharmacological treatment in specialist versus primary care. Included were all patients diagnosed with Alzheimer’s disease in 2011 or 2012 and registered in the Swedish dementia registry (SveDem), totally 4027 patients. Descriptive statistical analyses were used to compare demographics, diagnostic work-up and pharmacological treatment. Multivariate logistic regression analyses were used to adjust for age, gender, co-morbidity and MMSE-score. Patients diagnosed within primary care were older and had a lower MMSE-score when diagnosed. The number of basic examinations performed during diagnostic work-up were lower in primary care (p-value <0.001 mean 3.48 in primary care respectively 3.83 in specialist care), especially clock tests and computer tomography examinations were less conducted. The time from initial diagnostic work-up to diagnosis was longer than recommended in both groups. Treatment with cholinesterase inhibitors was performed to the same extent but NMDA-antagonists were prescribed more often within specialist care. Both basic diagnostic work-up and demographics of Alzheimer’s disease patients differ between primary care and specialist care in Sweden. An
Poster Presentations: P3
possibly increasing their risk for functional decline. Their lower risk of rehospitalization (concurrent with their increased risk for long-term care placement) following hospital discharge supports the notion that admission to a nursing home may lead to a reduction in hospital use.
P3-286
ACCESS TO REHABILITATION AND OUTCOMES FOLLOWING HIP FRACTURE FOR OLDER ADULTS WITH DEMENTIA
Dallas Seitz1, Sudeep Gill1, Peter Austin2, Chaim Bell3, Andrea Gruneir4, Geoffrey Anderson5, Paula Rochon6, 1Queen’s University, Kingston, Ontario, Canada; 2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; 3Mt. Sinai Hospital, Toronto, Ontario, Canada; 4 Women’s College Hospital, Research Institute, Toronto, Ontario, Canada; 5 Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada; 6Women’s College Research Institute, Toronto, Ontario, Canada. Contact e-mail: [email protected] Project Description: Older adults with dementia frequently experience hip fractures and access to rehabilitation following hip fractures is important in order to reduce disability and prevent subsequent functional decline. However, older adults with dementia may have restricted access to rehabilitation services following hip fracture as these services are limited and dementia is believed to impede rehabilitation. We evaluated the effects of access to rehabilitation and subsequent outcomes for older adults with dementia who experienced hip fractures. We identified all older adults who dementia who were previously community dwelling that underwent surgery for hip fractures in the province of Ontario, Canada between 2003 and 2011. We categorized individuals into one of 4 possible post-fracture rehabilitation groups: inpatient rehabilitation (IPR); home-care based rehabilitation (HCR); complex continuing care (CCC); or, no rehabilitation. The risks of admission to long-term care (LTC), post-fracture mortality and post-fracture adverse events were then compared across rehabilitation groups after adjusting for potential confounders using multivariate regression. A total of 11,200 individuals with dementia experienced hip fractures during the study period. Of the total group, IPR was provided to 3,075 (27.4%), CCC to 2,474 (22.1%), HCR to 1,157 (10.3%) and 4,494 (40.1%) received no rehabilitation. When compared to no rehabilitation, any form of rehabilitation was associated with a reduced risk of mortality with the greatest effect observed with IPR (hazard ratio (HR: 0.46, 95% confidence interval (CI): 0.42 - 0.49). Similarly, a reduced risk of LTC admission was also observed for both IPR (HR: 0.62, 95% CI: 0.57 - 0.66) and HCR (HR: 0.63; 95% CI: 0.57 - 0.70) when compared to no rehabilitation. Access to post-fracture rehabilitation for older adults with dementia is associated with a reduced risk of mortality and LTC placement although many individuals with dementia do not receive these services following hip fracture. Improving access to rehabilitation services for this vulnerable population may improve post-fracture outcomes and improve quality of life for this population.
P3-287
FAMILY SUPPORT, OVERLOAD CARE, AND RESILIENCE FROM THE PERSPECTIVE OF FAMILY MEMBER CAREGIVERS OF SENIORS WITH ALZHEIMER’S DISEASE
Deusivania Vieira da Silva Falc~ao1, Camila Rodrigues Garcia2, Mayara Cartoni Braz2, Maria Helena Silveira2, Maria Madalena Borges de Ara ujo3, Glenda Dias dos Santos2, Paula Villela Nunes4, Orestes Vicente Forlenza5, 1USP, University of S~ao Paulo, Brazil, S~ao Paulo, SP, Brazil, Brazil; 2USP, S~ao Paulo, SP, Brazil, Brazil; 3USP-HC, S~ao Paulo, SP, Brazil, Brazil; 4University of Sao Paulo, S~ao Paulo, Brazil; 5 Laboratory of Neuroscience-University of S~ao Paulo, S~ao Paulo, Brazil. Contact e-mail: [email protected]
Project Description: This research aimed to identify the relation between resilience, overcharge of roles and family support of family member caregivers of seniors with mild and moderate Alzheimer’s Disease (AD), members of gerontology, psychosocial and educational intervention group. The study was conducted at the Rehabilitation Center and Day Hospital, Institute of Psychiatry, Hospital das Clınicas, Faculty of Medicine, University of S~ao Paulo, Brazil. 25 family caregivers were evaluated (19 women and 6 men, mostly composed of spouses, daughters and sons), before and after 15 sessions (1h and 30 min) of group interventions. The instruments used were a survey containing questions about sociodemographic data, emotional and instrumental activities and the roles played by caregivers; an Inventory of Perception of Family Support, a Zarit Burden Interview (ZBI) and a Resilience Scale.Regarding to the family support, by comparing before and after 15 sessions, it was detected that after the intervention there was more dialogue and communication between the caregiver with the other family members, with greater demonstration of affection through words (p¼0,020). After the interventions, performing instrumental activities at the task of caring for the elderly has increased significantly (p¼0,002). Moreover, the caregivers felt more stressed (p¼0,040) and more ashamed (p¼0,018) with the behavior of the elderly with Alzheimer’s. Regarding the resilience, there was stability in the mean frequency of responses when analyzed statistically before and after the interventions. However, demonstrated to be more concerned after the interventions (p¼0,018). In conclusion, evidences were provided that the present interventions for family caregivers helped to learning strategies for managing behavioral and psychological symptoms. Although they have provided information about the disease, encouraged a better family communication and triggered positive feelings for caregivers, also corroborated to increase the burden of care, the stress and worries with several situations. This may have occurred due to the clarification of the disease and being experiencing the consequences resulting from the evolution of the disease. Family support in the task of caring was an important damper factor in the difficulties found by the caregiver.
P3-288
DIAGNOSIS AND TREATMENT OF ALZHEIMER’S DISEASE IN SPECIALIST UNITS COMPARED TO PRIMARY CARE
Dorota Religa1, Ingrid Nilsson Modeer2, SeyedMohammad Fereshtehnejad2, Farshad Falahati2, Sara Garcia-Ptacek2, Maria Eriksdotter2, 1Karolinska Institutet, Stockholm, Sweden; 2Karolinska Institutet, Stockholm, Sweden. Contact e-mail: [email protected] Project Description: Alzheimer’s disease is a degenerative, incurable and mortal disease. National guidelines are available for diagnosing and treating Alzheimer’s disease, but earlier studies indicate differences in diagnostic work-up and pharmacological treatment between the specialist care and primary care in Sweden. Though only a few studies with small study populations have been made. Aims: To study if clinically relevant differences exist in demographics, diagnostic work-up and pharmacological treatment in specialist versus primary care. Included were all patients diagnosed with Alzheimer’s disease in 2011 or 2012 and registered in the Swedish dementia registry (SveDem), totally 4027 patients. Descriptive statistical analyses were used to compare demographics, diagnostic work-up and pharmacological treatment. Multivariate logistic regression analyses were used to adjust for age, gender, co-morbidity and MMSE-score. Patients diagnosed within primary care were older and had a lower MMSE-score when diagnosed. The number of basic examinations performed during diagnostic work-up were lower in primary care (p-value <0.001 mean 3.48 in primary care respectively 3.83 in specialist care), especially clock tests and computer tomography examinations were less conducted. The time from initial diagnostic work-up to diagnosis was longer than recommended in both groups. Treatment with cholinesterase inhibitors was performed to the same extent but NMDA-antagonists were prescribed more often within specialist care. Both basic diagnostic work-up and demographics of Alzheimer’s disease patients differ between primary care and specialist care in Sweden. An