Pain treatment and functional improvement in home health care: Relationship with dementia

Author(s):  
Jinjiao Wang ◽  
Kenrick Cato ◽  
Yeates Conwell ◽  
Fang Yu ◽  
Kathi Heffner ◽  
...  
Author(s):  
Jinjiao Wang ◽  
Todd B. Monroe ◽  
Adam Simning ◽  
Yeates Conwell ◽  
Thomas V. Caprio ◽  
...  

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 166-166
Author(s):  
Jinjiao Wang ◽  
Kenrick Cato ◽  
Yeates Conwell ◽  
Kathi Heffner ◽  
Fang Yu ◽  
...  

Abstract Adequate pain management is important to post-acute care functional recovery, yet persons with Alzheimer’s disease and related dementias (ADRD) are often under-treated for pain. The objectives of this study were to examine in Medicare post-acute home health (HH) recipients with daily interfering pain 1) if analgesic use at home is related to functional outcome, and 2) if ADRD is related to the likelihood of analgesic use at home. We analyzed data from the Outcome and Assessment Information Set, Medicare claims, and electronic medical records of 6,039 Medicare beneficiaries ≥ 65 years who received care from a large HH agency in New York in 2019 and reported daily interfering pain. Analgesic use was identified in medication reconciliation of HH visits and categorized into any analgesics or opioid(s). ADRD was identified from ICD-10 codes and significant cognitive impairment. Functional outcome was measured as change in the composite score of Activity of Daily Living (ADL) limitations from HH admission to HH discharge. Use of any analgesics at home was associated with greater ADL improvement from HH admission to HH discharge (β= -0.20 [greater improvement by 0.2 ADLs], 95% Confidence Interval [CI]: -0.37, -0.04; p=0.017). Compared with patients without ADRD, those with ADRD were less likely to use any analgesics (Odds Ratio [OR] = 0.66, 95% CI: 0.49, 0.90, p=0.008) or opioids (OR=0.53, 95% CI: 0.47, 0.62, p<0.001) at home. Adequate pain management is essential to functional improvement in post-acute HH care. Patients with ADRD may be under-treated for pain in post-acute HH care.


2006 ◽  
Author(s):  
Carol Bova ◽  
Kristopher P. Fennie ◽  
Edith Watrous ◽  
Kevin Dieckhaus ◽  
Ann B. Williams

2020 ◽  
Author(s):  
Abdulaziz A Alodhayani ◽  
Marwah Mazen Hassounah ◽  
Fatima R Qadri ◽  
Noura A Abouammoh ◽  
Zakiuddin Ahmed ◽  
...  

BACKGROUND There is growing evidence of the need to consider cultural factors in the design and implementation of digital health interventions. However, there is still inadequate knowledge pertaining to what aspects of the Saudi Arabian culture need to be considered in the design and implementation of digital health programs, especially in the context of home health care services for chronically and terminally ill patients. OBJECTIVE This study aims to explore the specific cultural factors relating to patients and their caregivers from the perspective of physicians, nurses, and trainers that have influenced the pilot implementation of Remotely Accessible Healthcare At Home (RAHAH); a connected health program in the Home Health Care Department at King Saud University Medical City, Riyadh, Saudi Arabia. METHODS A qualitative study design was adopted to conduct a focus group discussion (FGD) in July 2019 using a semi-structured interview guide with 3 female and 4 male participants working as nurses, family physicians, and information technologists. Qualitative data obtained were analyzed using a thematic framework analysis. RESULTS Two categories emerged from the FGD that influenced the experiences of digital health program intervention: (1) culture-related factors including language and communication, cultural views on using cameras during consultation, non-adherence to online consultations, and family role and commitment (2) caregiver characteristics in telemedicine that includes their skills and education and electronic literacy. Participants of this study revealed that indirect contact with the patients and their family members may work as a barrier to proper communication through RAHAH. CONCLUSIONS We recommend exploring the use of interpreters in digital health, creating awareness among the local population regarding privacy in digital health, and actively involving the direct family members with the healthcare providers.


2019 ◽  
Vol 7 (4) ◽  
pp. 561-569
Author(s):  
Jo-Ana D Chase ◽  
David Russell ◽  
Meridith Rice ◽  
Carmen Abbott ◽  
Kathryn H Bowles ◽  
...  

Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.


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