Cited by 129Hospital Admissions and OutcomesDementia and Cognitive Impairment ResearchAdolescent and Pediatric Healthcare

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Evidence-Based Interventions for Transitions in Care for Individuals Living With Dementia

Hirschman, Karen B, Hodgson, Nancy A·2018·The Gerontologist

DOI 10.1093/geront/gnx152

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Abstract

Background and Objectives: Despite numerous, often predictable, transitions in care, little is known about the core elements of successful transitions in care specifically for persons with dementia. The paper examines available evidence-based interventions to improve the care transitions for persons with dementia and their caregivers. Research Design and Methods: A state-of-the-art review was conducted for research published on interventions targeting transitions in care for persons living with dementia and their caregivers through January 2017. Results: Our review revealed seven evidence-based interventions to postpone/prevent or reduce care transitions specific to persons living with dementia. Effective approaches appear to be those that involve the individual and caregiver in establishing goals of care, educate the individual and caregiver about likely transitions in care; provide timely communication of information about the individual, create strong inter professional teams with competencies in dementia care, and implement evidence-based models of practice. Discussion and Implications: Five essential features for consistent and supported care transitions for persons with dementia and their caregivers are recommended. Findings reinforce the need for additional research and adaptation of evidence-based transitions in care interventions.

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A typology of reviews: an analysis of 14 review types and associated methodologies
Grant, M. J., & Booth, A. (2009) · Health Information & Libraries Journal · doi:10.1111/j.1471-1842.2009.00848.x · Cited by 10,817
The Care Transitions Intervention: Results of a Randomized Controlled Trial
Coleman, E. A., Parry, C., Chalmers, S., & Min, S.-J. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.17.1822 · Cited by 1,937
Comprehensive Discharge Planning and Home Follow-up of Hospitalized Elders: A Randomized Clinical Trial
Naylor, M. D., Brooten, D., Campbell, R., Jacobsen, B. S., Mezey, M. D., Pauly, M. V., & Schwartz, J. S. (1999) · JAMA · doi:10.1001/jama.281.7.613 · Cited by 1,831
A Reengineered Hospital Discharge Program to Decrease Rehospitalization
Jack, B. W., Chetty, V. K., Anthony, D., Greenwald, J. L., Sanchez, G. M., Johnson, A. E., Forsythe, S. R., O'Donnell, J. K., Paasche‐Orlow, M. K., Manasseh, C., et al. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-150-3-200902030-00007 · Cited by 1,613
2017 Alzheimer's disease facts and figures
(, T. D. B. T. A.-R. C. C. A. S. O. A. C. B. S., different, ). J. A. I. A., destroyed, S. A. T. A. S. T. M. E. T. M. C. I. S. I. A. G. W. A. T. R. N. I. T. O. B. T. F. N. T. B. D. A. D. A. U. I. B. R. I. I. F. N. M. A. N. I. O. P. O. T. B. A. D. A., difficulties, I. E. O., agitation, I. N. S. S. A., & delusions., S. A. (2017) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2017.02.001 · Cited by 1,366
Transitional Care of Older Adults Hospitalized with Heart Failure: A Randomized, Controlled Trial
Naylor, M. D., Brooten, D. A., Campbell, R. L., Maislin, G., McCauley, K. M., & Schwartz, J. S. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52202.x · Cited by 1,365
Comprehensive Discharge Planning for the Hospitalized Elderly
Naylor, M. D., Brooten, D., Jones, R., Lavizzo-Mourey, R., Mezey, M., & Pauly, M. V. (1994) · Annals of Internal Medicine · doi:10.7326/0003-4819-120-12-199406150-00005 · Cited by 730
Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease
Mittelman, M. S., Haley, W. E., Clay, O. J., & Roth, D. L. (2006) · Neurology · doi:10.1212/01.wnl.0000242727.81172.91 · Cited by 602
Association of Incident Dementia With Hospitalizations
Phelan, E. A., Borson, S., Grothaus, L., Balch, S., & Larson, E. B. (2012) · JAMA · doi:10.1001/jama.2011.1964 · Cited by 547
End-of-Life Transitions among Nursing Home Residents with Cognitive Issues
Gozalo, P., Teno, J. M., Mitchell, S. L., Skinner, J., Bynum, J., Tyler, D., & Mor, V. (2011) · New England Journal of Medicine · doi:10.1056/nejmsa1100347 · Cited by 484

Show all 56 references

Research works printed but not linked: 3

Alzheimer’s Association, 2017, Policy brief: Reducing potentially preventable hospitalizations for people living with Alzheimer’s and other dementias
American Medical Directors Association (AMDA), 2010, Transitions of care in the long-term care continuum clinical practice guidelines, 1
2015, Training to serve people with dementia: Is our health care system ready? Paper 2: A review of dementia training standards across health care settings

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Khemai, C., Janssen, D. J. A., Schols, J. M. G. A., Naus, L., Kemper, S., Jole, I., Bolt, S., & Meijers, J. M. M. (2020) · Nurse Education in Practice · doi:10.1016/j.nepr.2020.102866 · Cited by 10
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Brown, M., Tolson, D., & Ritchie, L. (2020) · Nursing Older People · doi:10.7748/nop.2020.e1204 · Cited by 9
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Bruce, R., Murdoch, W., Kable, A. K., Palazzi, K. L., Hullick, C., Pond, D. C., Oldmeadow, C. J., Searles, A., Fullerton, A., Fraser, S., et al. (2020) · Healthcare · doi:10.3390/healthcare8030248 · Cited by 6
Creating ‘Partnership in iSupport program’ to optimise family carers’ impact on dementia care: a randomised controlled trial protocol
Xiao, L. D., Yu, Y., Ratcliffe, J., Milte, R., Meyer, C., Chapman, M., Chen, L., Ullah, S., Kitson, A. A., Andrade, A. Q. D., et al. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08148-2 · Cited by 6
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Glober, N., LaShell, A., Montelauro, N., Troyer, L., Supples, M., Unroe, K. T., Tainter, C. “., Faris, G., Fuchita, M., & Boustani, M. A. (2023) · Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring · doi:10.1002/dad2.12469 · Cited by 4
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Weiss, J. O., Tumosa, N., Espinoza, R., Bragg, E. J., Morgan, J. C., Flatt, J. D., McConnell, E. S., & Whiting, G. C. (2021) · OBM Geriatrics · doi:10.21926/obm.geriatr.2101162 · Cited by 4
Research protocol of the Laval-ROSA Transilab: a living lab on transitions for people living with dementia
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Cabin, W. D., & Stites, S. D. (2021) · American Public Health Association eBooks · doi:10.2105/9780875533162ch05 · Cited by 1
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Glober, N., Lardaro, T., Supples, M., Liao, M. Y., Vaizer, J., Faris, G., Ostahowski, P. J., O’Donnell, D., & Kao, C. (2024) · International Journal of Paramedicine · doi:10.56068/tgxv9507 · Cited by 1
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Park, S., Ryu, B., & Kang, E.-N. (2024) · Housing and Society · doi:10.1080/08882746.2024.2391634 · Cited by 1
Services and Settings of Care
Gitlin, L. N., & Hodgson, N. A. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-811928-0.00010-7
Self-citation
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Thompson, A. E., Miron, A. M., Rogers, J. M., & Rice, R. (2020) · International Journal of Alzheimer s Disease · doi:10.1155/2020/1910252 · Cited by 2
Respite services for people with dementia and their carers: perspectives of key stakeholders
O’Shea, E. (2020) · Dublin City University Open Access Institutional Repository (Dublin City University)
Using Technology to Enhance the Well-Being of Caregivers of Persons with Dementia: Implications for Social Work Practice and Policy
Yi, E.-H. G. (2020) · IUScholarWorks (Indiana University) · doi:10.7912/c2/1219
Partnering with Hospital Providers to Facilitate Handoff for Persons with Dementia in the Acute Care Setting
Jeune, V. (2021) · doi:10.46409/sr.cphf9051
TILE-12 index: an interpretable instrument for identifying older adults at risk for transitions in living environment within the next 12-months
Roma, M., Sullivan, S. S., & Casucci, S. (2022) · Home Health Care Services Quarterly · doi:10.1080/01621424.2022.2052220
Translation and psychometric validation of the Chinese version of the meaningful and enjoyable activities scale for mild dementia
Chen, H., Wang, Y., Zhang, M., Wang, N., Hao, X., Xue, Z., Fang, K., & Liu, Y. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1148838
There is an I in WE
Khemai, C. (2023) · Research Publications (Maastricht University) · doi:10.26481/dis.20231115ck

Authors: Hirschman, K. B., & Hodgson, N. A.
Affiliations: University of Pennsylvania (US)
Corresponding author: Hirschman, Karen B
ORCID: Hirschman, Karen B
Hodgson, Nancy A
Venue: The Gerontologist
Publisher: Oxford University Press (OUP)
Published: 2018-01-18
Volume: 58
Issue: suppl_1
Pages: S129-S140
ISSN: 0016-9013 (ISSN-L)
1758-5341
DOI: 10.1093/geront/gnx152
OpenAlex: W2790474892
Cited by: 129
References: 56
Citations by year: 2026: 5 · 2025: 12 · 2024: 25 · 2023: 16 · 2022: 21 · 2021: 24 · 2020: 18 · 2019: 3 · 2018: 3
FWCI: 1.83
Type: journal article
Language: en
Open access: closed
Locations: The Gerontologist (publishedVersion)
PubMed (publishedVersion)
Funders: Alzheimer’s Association
Topics: Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Adolescent and Pediatric Healthcare
Keywords: dementia, care transitions, evidence-based interventions, caregivers, goals of care, multidisciplinary team, practice models, person-centred care
MeSH terms: Aged, Continuity of Patient Care, Dementia, Humans, Patient Transfer, Social Support, Quality Improvement

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Evidence-Based Interventions for Transitions in Care for Individuals Living With Dementia

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