Transitions in Care in a Nationally Representative Sample of Older Americans with Dementia
Open accessAbstract
Objectives: To describe transitions in care for older adults with dementia identified from a nationally representative cohort and to describe transition rates in those with more‐severe levels of cognitive and functional impairment. Design: Longitudinal cohort study. Setting: Health and Retirement Study ( HRS ). Participants: HRS respondents aged 65 and older whose survey data were linked with Medicare claims from 1999 to 2008 (N = 16,186). Measurements: Transitions in care between home, home with formal services, hospital, and nursing facility care; cognitive function; activities of daily living; and mortality. Results: The 3,447 (21.3%) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Of subjects transitioning from a hospital stay, 52.2% returned home without home care services, and 33.8% transitioned to a nursing facility. Of subjects transitioning from a nursing facility, 59.2% transitioned to the hospital, and 25.3% returned home without services. There were 2,139 transitions to death, and 58.7% of HRS subjects with dementia died at home. Even in persons with moderate to severe dementia, multiple transitions in care were documented, including transitions from the hospital to home and back to the hospital. Conclusion: In this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in function and cognition.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Evidence shows that people with dementia receive suboptimal care coordination.
“Despite their distinct transitional care needs and heightened vulnerability, emerging evidence documents that people with dementia receive suboptimal care coordination.13, 14”
From Discharge Communication of Dementia-Related Neuropsychiatric Symptoms and Care Management Strategies during Hospital to Skilled Nursing Facility Transitions (2021) · cites this paper as [14]
The Introduction describes potentially preventable care transitions, and the Discussion reports that some people with substantial dementia-related impairments return home without formal services. The Discussion also identifies inefficiencies in the current system and a need to improve transitions. These findings suggest gaps in care, but the paper does not directly assess whether people with dementia receive suboptimal care coordination. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPeople living with dementia experience care transitions more often and more challengingly than the general population.
“As a result, people living with dementia experience care transitions more often and more challenging than the general population (Callahan et al., 2015; Downs & Bowers, 2014; Phelan et al., 2012).”
From Mind the gap: a systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers. (2026) · cites this paper as Callahan et al., 2015
The Results report more care transitions among older adults with dementia than among those without dementia. The Introduction describes transitions as potentially high-risk for medical errors and patient and family burden, but the paper does not establish that transitions are more challenging for people with dementia than for the general population. Its comparison is with older adults without dementia, not the general population. (LLM, conf=0.85)
Experimental — accuracy not yet measuredStudies have shown twofold differences between hospital use in dementia compared with non-dementia cohorts, including those that addressed differences in population characteristics using propensity score matching.
“Studies have shown twofold differences between hospital use in dementia compared with non-dementia cohorts,5 11 31 32 including those who have addressed the differences in population characteristics using propensity score matching.3”
From Trajectories of health system use and survival for community-dwelling persons with dementia: a cohort study (2020) · cites this paper as [11]
The Results (page unavailable in our copy) say that older adults with dementia were more likely to be hospitalized than those without dementia, but the passages do not establish a twofold difference. The propensity-score-matching clause is attached to a different citation in the citing sentence, so it is not assessed against this paper. (LLM, conf=0.82)
Experimental — accuracy not yet measuredOur findings are consistent with previous work that has demonstrated persons with dementia experience poorer survival and shorter time to long-term care transition than those without dementia, although the magnitude of the differences we show is not as large as in some previous work.
“Our findings are consistent with previous work that has demonstrated persons with dementia experience poorer survival2 26 and shorter time to long-term care transition than those without dementia,11 however the magnitude of the differences we show is not as large as in some previous work.”
From Trajectories of health system use and survival for community-dwelling persons with dementia: a cohort study (2020) · cites this paper as [11]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Hearing loss and cognitive decline in older adults
Lin, F. R., Yaffe, K., Xia, J., Xue, Q.-L., Harris, T. B., Purchase-Helzner, E., Satterfield, S., Ayonayon, H. N., Ferrucci, L., Simonsick, E. M., et al. (2013) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2013.1868 · Cited by 4,017 · see citing works
Monetary Costs of Dementia in the United States
Hurd, M. D., Martorell, P., Delavande, A., Mullen, K. J., & Langa, K. M. (2013) · New England Journal of Medicine · doi:10.1056/nejmsa1204629 · Cited by 1,484 · see citing works
Jorm, A. F. (1994) · Psychological Medicine · doi:10.1017/s003329170002691x · Cited by 1,197 · see citing works
Coleman, E. A. (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2003.51185.x · Cited by 1,109 · see citing works
Crimmins, E. M., Kim, J. K., Langa, K. M., & Weir, D. R. (2011) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbr048 · Cited by 1,062 · see citing works
Change in End-of-Life Care for Medicare Beneficiaries
Teno, J. M., Gozalo, P. L., Bynum, J., Leland, N. E., Miller, S. C., Morden, N. E., Scupp, T., Goodman, D. C., & Mor, V. (2013) · JAMA · doi:10.1001/jama.2012.207624 · Cited by 974 · see citing works
Prevalence of Cognitive Impairment without Dementia in the United States
Plassman, B. L., Langa, K. M., Fisher, G. G., Heeringa, S. G., Weir, D. R., Ofstedal, M. B., Burke, J. R., Hurd, M. D., Potter, G. G., Rodgers, W. L., et al. (2008) · Annals of Internal Medicine · doi:10.7326/0003-4819-148-6-200803180-00005 · Cited by 927 · see citing works
The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): a review
Jorm, A. F. (2004) · International Psychogeriatrics · doi:10.1017/s1041610204000390 · Cited by 823 · see citing works
Coleman, E. A., Smith, J. D., Frank, J. C., Min, S., Parry, C., & Kramer, A. M. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52504.x · Cited by 645 · see citing works
Survival after Initial Diagnosis of Alzheimer Disease
Larson, E. B., Shadlen, M., Wang, L., McCormick, W. C., Bowen, J. D., Teri, L. L., & Kukull, W. A. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-140-7-200404060-00008 · Cited by 544 · see citing works
Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs
Ouslander, J. G., Lamb, G. S., Perloe, M., Givens, J. H., Kluge, L., Rutland, T., Atherly, A. J., & Saliba, D. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.02768.x · Cited by 509 · see citing works
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 · see citing works
The Aging, Demographics, and Memory Study: Study Design and Methods
Langa, K. M., Plassman, B. L., Wallace, R. B., Herzog, A. R., Heeringa, S. G., Ofstedal, M. B., Burke, J. R., Fisher, G. G., Fultz, N. H., Hurd, M. D., et al. (2005) · Neuroepidemiology · doi:10.1159/000087448 · Cited by 409 · see citing works
Ouslander, J. G., Lamb, G. S., Tappen, R. M., Herndon, L., Diaz, S., Roos, B. A., Grabowski, D. C., & Bonner, A. (2011) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2011.03333.x · Cited by 355 · see citing works
Nursing home characteristics and potentially preventable hospitalizations of long-stay residents
Intrator, O., Zinn, J., & Mor, V. (2004) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2004.52469.x · Cited by 265 · see citing works
Transitions in Care for Older Adults with and without Dementia
Callahan, C. M., Arling, G., Tu, W., Rosenman, M. B., Counsell, S. R., Stump, T. E., & Hendrie, H. C. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.03905.x · Cited by 253 · see citing works
Self-citationIncidence of dementia and cognitive impairment, not dementia in the united states
Plassman, B. L., Langa, K. M., McCammon, R. J., Fisher, G. G., Potter, G. G., Burke, J. R., Steffens, D. C., Foster, N. L., Giordani, B., Unverzagt, F. W., et al. (2011) · Annals of Neurology · doi:10.1002/ana.22362 · Cited by 250 · see citing works
Walsh, E. G., Wiener, J. M., Haber, S. G., Bragg, A. W., Freiman, M. P., & Ouslander, J. G. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.03920.x · Cited by 242 · see citing works
The Costs And Potential Savings Associated With Nursing Home Hospitalizations
Grabowski, D. C., O’Malley, A. J., & Barhydt, N. R. (2007) · Health Affairs · doi:10.1377/hlthaff.26.6.1753 · Cited by 221 · see citing works
Interventions to Improve Transitional Care Between Nursing Homes and Hospitals: A Systematic Review
LaMantia, M. A., Scheunemann, L. P., Viera, A. J., Busby‐Whitehead, J., & Hanson, L. C. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.02776.x · Cited by 189 · see citing works
Self-citationFisher, G. G., Franks, M. M., Plassman, B. L., Brown, S. L., Potter, G. G., Llewellyn, D., Rogers, M. A. M., & Langa, K. M. (2011) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.03304.x · Cited by 123 · see citing works
Reuben, D. B., Evertson, L. C., Wenger, N. S., Serrano, K., Chodosh, J., Ercoli, L. M., & Tan, Z. S. (2013) · Journal of the American Geriatrics Society · doi:10.1111/jgs.12562 · Cited by 122 · see citing works
Transitions of Care for the Geriatric Patient in the Emergency Department
Kessler, C. S., Williams, M. C., Moustoukas, J. N., & Pappas, C. (2012) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2012.10.005 · Cited by 93 · see citing works
Redesigning Systems Of Care For Older Adults With Alzheimer’s Disease
Callahan, C. M., Sachs, G. A., LaMantia, M. A., Unroe, K. T., Arling, G. W., & Boustani, M. A. (2014) · Health Affairs · doi:10.1377/hlthaff.2013.1260 · Cited by 90 · see citing works
Self-citationTargeting Residents for Transitions from Nursing Home to Community
Arling, G. W., Kane, R. L., Cooke, V., & Lewis, T. (2010) · Health Services Research · doi:10.1111/j.1475-6773.2010.01105.x · Cited by 63 · see citing works
Workgroup on NAPA's scientific agenda for a national initiative on Alzheimer's disease
Khachaturian, Z. S. (2012) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2012.04.003 · Cited by 31 · see citing works
Cooke, V., Arling, G. W., Lewis, T., Abrahamson, K. A., Mueller, C., & Edstrom, L. (2009) · The Gerontologist · doi:10.1093/geront/gnp140 · Cited by 30 · see citing works
Impact of Dementia on Payments for Long-term and Acute Care in an Elderly Cohort
Arling, G. W., Tu, W., Stump, T. E., Rosenman, M. B., Counsell, S. R., & Callahan, C. M. (2013) · Medical Care · doi:10.1097/mlr.0b013e31828d4d4a · Cited by 23 · see citing works
Self-citationClark, D. O., Stump, T. E., Tu, W., Miller, D. K., Langa, K. M., Unverzagt, F. W., & Callahan, C. M. (2012) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0b013e318276994e · Cited by 7 · see citing works
Self-citationKane, R. L., & Ouslander, J. G. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.03918.x · Cited by 6 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Possin, K. L., Merrilees, J. J., Dulaney, S., Bonasera, S. J., Chiong, W., Lee, K., Hooper, S. M., Allen, I. E., Braley, T., Bernstein, A., et al. (2019) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2019.4101 · Cited by 272 · see citing works
Evidence-Based Interventions for Transitions in Care for Individuals Living With Dementia
Hirschman, K. B., & Hodgson, N. A. (2018) · The Gerontologist · doi:10.1093/geront/gnx152 · Cited by 129 · see citing works
Care Settings and Clinical Characteristics of Older Adults with Moderately Severe Dementia
Harrison, K. L., Ritchie, C. S., Patel, K., Hunt, L. J., Covinsky, K. E., Yaffe, K. S., & Smith, A. K. (2019) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16054 · Cited by 85 · see citing works
Lehmann, J., Michalowsky, B., Kaczynski, A., Thyrian, J. R., Schenk, N. S., Esser, A., Zwingmann, I., & Hoffmann, W. U. (2018) · Journal of Alzheimer s Disease · doi:10.3233/jad-171128 · Cited by 60 · see citing works
Gilmore-Bykovskyi, A. L., Roberts, T. J., King, B. J., Kennelty, K. A., & Kind, A. J. H. (2017) · The Gerontologist · doi:10.1093/geront/gnw085 · Cited by 56 · see citing works
Steinbeißer, K., Grill, E., Holle, R., Peters, A., & Seidl, H. (2018) · BMC Geriatrics · doi:10.1186/s12877-018-0860-x · Cited by 53 · see citing works
Hospice Improves Care Quality For Older Adults With Dementia In Their Last Month Of Life
Harrison, K. L., Cenzer, I. S., Ankuda, C. K., Hunt, L. J., & Aldridge, M. D. (2022) · Health Affairs · doi:10.1377/hlthaff.2021.01985 · Cited by 50 · see citing works
LaMantia, M. A., Lane, K. A., Tu, W., Carnahan, J. L., Messina, F. C., & Unroe, K. T. (2016) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2016.02.011 · Cited by 47 · see citing works
Self-citationBronskill, S. E., Maclagan, L. C., Walker, J. D., Guan, J., Wang, X., Ng, R., Rochon, P. A., Yates, E. A., Vermeulen, M. J., & Maxwell, C. J. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-037485 · Cited by 35 · see citing works
“Most of the cost of long-term care is covered by the provincial health system and access to long-term care is centrally managed.”
Gaugler, J. E., Statz, T. L., Birkeland, R. W., Louwagie, K. W., Peterson, C., Zmora, R., Emery, A., McCarron, H. R., Hepburn, K. W., Whitlatch, C. J., et al. (2020) · BMC Geriatrics · doi:10.1186/s12877-020-01542-7 · Cited by 41 · see citing works
Targeting Functional Decline in Alzheimer Disease
Callahan, C. M., Boustani, M. A., Schmid, A. A., LaMantia, M. A., Austrom, M. G., Miller, D. K., Gao, S., Ferguson, D. Y., Lane, K. A., & Hendrie, H. C. (2016) · Annals of Internal Medicine · doi:10.7326/m16-0830 · Cited by 40 · see citing works
Self-citationKnox, S., Downer, B. G., Haas, A. M., Middleton, A., & Ottenbacher, K. J. (2019) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2019.09.012 · Cited by 39 · see citing works
Depression and cognitive impairment among newly admitted nursing home residents in the USA
Ulbricht, C. M., Rothschild, A. J., Hunnicutt, J. N., & Lapane, K. L. (2017) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.4723 · Cited by 35 · see citing works
Burke, R. E., Xu, Y., Ritter, A. Z., & Werner, R. M. (2021) · Health Services Research · doi:10.1111/1475-6773.13855 · Cited by 35 · see citing works
Burke, R. E., Xu, Y., & Ritter, A. Z. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17321 · Cited by 33 · see citing works
Orsulic‐Jeras, S., Whitlatch, C. J., Powers, S. M., & Johnson, J. D. (2020) · Alzheimer s & Dementia Translational Research & Clinical Interventions · doi:10.1002/trc2.12037 · Cited by 30 · see citing works
Barbic, D., Kim, B., Salehmohamed, Q., Kemplin, K. R., Carpenter, C. R., & Barbic, S. P. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019652 · Cited by 30 · see citing works
Alzheimer's Disease: Individuals, Dyads, Communities, and Costs
Callahan, C. M. (2017) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14808 · Cited by 29 · see citing works
Self-citationPrevalence of pressure injuries in Japanese older people: A population-based cross-sectional study
Nakashima, S., Yamanashi, H., Komiya, S., Tanaka, K., & Maeda, T. (2018) · PLoS ONE · doi:10.1371/journal.pone.0198073 · Cited by 28 · see citing works
Trends in US Medicare Decedents’ Diagnosis of Dementia From 2004 to 2017
Davis, M. A., Chang, C.-H., Simonton, S., & Bynum, J. P. W. (2022) · JAMA Health Forum · doi:10.1001/jamahealthforum.2022.0346 · Cited by 28 · see citing works
Post–Acute Care Reform: Implications and Opportunities for Hospitalists
Burke, R. E., Cumbler, E., Coleman, E. A., & Levy, C. R. (2017) · Journal of Hospital Medicine · doi:10.1002/jhm.2673 · Cited by 27 · see citing works
Downer, B. G., Thomas, K. S., Mor, V., Goodwin, J. S., & Ottenbacher, K. J. (2017) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2017.04.021 · Cited by 26 · see citing works
Relationship between Functional Improvement and Cognition in Short‐Stay Nursing Home Residents
Loomer, L., Downer, B. G., & Thomas, K. S. (2018) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15708 · Cited by 26 · see citing works
Disparities in 30‐day readmission rates among Medicare enrollees with dementia
Gilmore‐Bykovskyi, A., Zuelsdorff, M., Block, L., Golden, B., Kaiksow, F., Sheehy, A. M., Bartels, C. M., Kind, A. J. H., & Powell, W. R. (2023) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18311 · Cited by 25 · see citing works
Saragosa, M., Jeffs, L., Okrainec, K., & Kuluski, K. (2022) · Dementia · doi:10.1177/14713012211031779 · Cited by 21 · see citing works
Kraal, A. Z., Massimo, L. M., Fletcher, E. M., Carrión, C. I., Medina, L. D., Mungas, D., Gavett, B. E., & Farias, S. T. (2021) · Neuropsychology · doi:10.1037/neu0000705 · Cited by 21 · see citing works
Palliative Care in Advanced Dementia: Comparison of Strategies in Three Countries
Sternberg, S. A., Shinan‐Altman, S., Volicer, L., Casarett, D., & van der Steen, J. T. (2021) · Geriatrics · doi:10.3390/geriatrics6020044 · Cited by 21 · see citing works
Gaugler, J. E., Birkeland, R. W., Albers, E. A., Peterson, C., Louwagie, K. W., Baker, Z. G., Mittelman, M. S., Hepburn, K. W., & Roth, D. L. (2024) · Psychology and Aging · doi:10.1037/pag0000820 · Cited by 18 · see citing works
Kamdar, N. S., Syrjamaki, J. D., Aikens, J. E., & Mahmoudi, E. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.2109 · Cited by 17 · see citing works
Wild, K. V., Sharma, N., Mattek, N., Karlawish, J. H., Riley, T., & Kaye, J. A. (2020) · Journal of Medical Internet Research · doi:10.2196/18806 · Cited by 17 · see citing works
Knox, S., Downer, B. G., Haas, A. M., & Ottenbacher, K. J. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2020.12.014 · Cited by 15 · see citing works
Smith, L., & Phillipson, L. (2022) · Dementia · doi:10.1177/14713012221097237 · Cited by 17 · see citing works
Schumacher‐Schönert, F., Wucherer, D., Nikelski, A., Kreisel, S. H., Vollmar, H. C., Hoffmann, W. U., & Thyrian, J. R. (2020) · Zeitschrift für Gerontologie und Geriatrie · doi:10.1007/s00391-020-01732-3 · Cited by 16 · see citing works
Cloutier, D., Penning, M. J., Nuernberger, K., Taylor, D., & MacDonald, S. W. S. (2017) · Journal of Aging and Health · doi:10.1177/0898264317725618 · Cited by 16 · see citing works
The Black and White of Invasive Mechanical Ventilation in Advanced Dementia
Sharma, R. K., Kim, H., Gozalo, P. L., Sullivan, D. R., Bunker, J., & Teno, J. M. (2020) · Journal of the American Geriatrics Society · doi:10.1111/jgs.16635 · Cited by 16 · see citing works
Kracht, F., Boekholt, M., Schumacher‐Schönert, F., Nikelski, A., Chikhradze, N., Lücker, P., Vollmar, H. C., Hoffmann, W., Kreisel, S. H., & Thyrian, J. R. (2021) · BMC Geriatrics · doi:10.1186/s12877-021-02298-4 · Cited by 15 · see citing works
Skilled Nursing Facility-to-Home Trajectories for Older Adults With Mental Illness or Dementia
Simning, A., Orth, J., Temkin‐Greener, H., Li, Y., Simons, K. V., & Conwell, Y. (2021) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2021.06.013 · Cited by 14 · see citing works
Life expectancy for community‐dwelling persons with dementia and severe disability
Harrison, K. L., Ritchie, C. S., Hunt, L. J., Patel, K., Boscardin, W. J., Yaffe, K. S., & Smith, A. K. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17767 · Cited by 14 · see citing works
Temkin‐Greener, H., Yan, D., & Cai, S. (2022) · Health Services Research · doi:10.1111/1475-6773.14059 · Cited by 15 · see citing works
What Predicts Health Care Transitions for Older Adults Following Introduction of LTSS?
Hirschman, K. B., Toles, M., Hanlon, A. L., Huang, L., & Naylor, M. D. (2019) · Journal of Applied Gerontology · doi:10.1177/0733464819833565 · Cited by 14 · see citing works
Gilmore-Bykovskyi, A. L., Hovanes, M., Mirr, J., & Block, L. (2021) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/0891988720944245 · Cited by 14 · see citing works
“Despite their distinct transitional care needs and heightened vulnerability, emerging evidence documents that people with dementia receive suboptimal care coordination.(13,14) The consequences of suboptimal care are reflected by substantial disparities in the use of acute and post-acute care.”
BackgroundMaxwell, C. J., Mondor, L., Hogan, D. B., Campitelli, M. A., Bronskill, S. E., Seitz, D. P., & Wodchis, W. P. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-029523 · Cited by 17 · see citing works
Albers, E. A., Birkeland, R. W., Louwagie, K. W., Yam, H., Baker, Z. G., Mittelman, M. S., & Gaugler, J. E. (2023) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580231217981 · Cited by 13 · see citing works
Caregiver Response to an Online Dementia and Caregiver Wellness Education Platform
Rodriguez, K., Fugard, M. I., Amini, S., Smith, G. E., Marasco, D., Shatzer, J., Guerrero, M., GARVAN, C. W., Davis, J., & Price, C. C. (2021) · Journal of Alzheimer s Disease Reports · doi:10.3233/adr-200292 · Cited by 13 · see citing works
Skilled home healthcare utilization and outcomes for older adults with dementia: A scoping review
Smith, J. M., Burgdorf, J. G., Riser, T. J., & Ryvicker, M. B. (2024) · Journal of the American Geriatrics Society · doi:10.1111/jgs.19203 · Cited by 12 · see citing works
Gilmore-Bykovskyi, A. L., Block, L., Hovanes, M., Mirr, J., & Kolanowski, A. (2019) · Research in Gerontological Nursing · doi:10.3928/19404921-20190122-01 · Cited by 11 · see citing works
Hirschman, K. B., McHugh, M., & Morgan, B. (2023) · Alzheimer's & Dementia: Translational Research & Clinical Interventions · doi:10.1002/trc2.12391 · Cited by 11 · see citing works
Evidence for Building an Integrated Dementia Healthcare System: A Systematic Review
Lin, G., Lin, T., Alluhidan, M., Saber, R., Hamza, M. M., Rakic, S., Alfaisal, A., Alamri, A., Çetinkaya, V., & Alazmi, N. M. (2025) · Clinical Gerontologist · doi:10.1080/07317115.2025.2505577 · Cited by 10 · see citing works
Use of Post-Acute Care by Medicare Beneficiaries With a Diagnosis of Dementia
Burke, R. E., Xu, Y., & Ritter, A. Z. (2021) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2021.09.016 · Cited by 11 · see citing works
Pneumonia Readmissions in Older Adults With Dementia
Knox, S. (2019) · Medical Care · doi:10.1097/mlr.0000000000001195 · Cited by 11 · see citing works
Post-hospitalization experiences of older adults diagnosed with diabetes: “It was daunting!”
LaManna, J. B., Bushy, A., & Gammonley, D. (2017) · Geriatric Nursing · doi:10.1016/j.gerinurse.2017.07.005 · Cited by 11 · see citing works
Radcliffe, K. G., Halim, M., Ritchie, C. S., Maus, M., & Harrison, K. L. (2023) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/10499091231155601 · Cited by 10 · see citing works
A Scoping Review of Care Trajectories across Multiple Settings for Persons with Dementia
Kosteniuk, J. G., Morgan, D. G., Elliot, V., Chow, A. F., Bayly, M., Watson, E., Osman, M., Osman, B. A., O’Connell, M. E., Kirk, A., et al. (2021) · Canadian Journal on Aging / La Revue canadienne du vieillissement · doi:10.1017/s0714980821000167 · Cited by 10 · see citing works
Nurses’ needs when collaborating with other healthcare professionals in palliative dementia care
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 · see citing works
Oud, L. (2016) · Journal of Clinical Medicine Research · doi:10.14740/jocmr2783w · Cited by 10 · see citing works
Smith, L., Phillipson, L., & Knight, P. (2023) · Ageing and Society · doi:10.1017/s0144686x2100043x · Cited by 9 · see citing works
Greene, L., Brain, J., Watkins, P., Kafadar, A. H., Sabatini, S., Blundell, B., Bothe, E., Harper, K., Hersh, D., Morrisby, C., et al. (2026) · The Gerontologist · doi:10.1093/geront/gnaf275 · Cited by 9 · see citing works
Oh, S.-T., Han, K., Choi, W., & Park, J. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.08.010 · Cited by 7 · see citing works
Mueller, K. E., & Puymbroeck, M. V. (2021) · Therapeutic Recreation Journal · doi:10.18666/trj-2021-v55-i2-10782 · Cited by 8 · see citing works
Yang, M., Temkin‐Greener, H., Veazie, P. J., & Cai, S. (2024) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18884 · Cited by 8 · see citing works
Oud, L. (2016) · Medical Science Monitor · doi:10.12659/msm.897760 · Cited by 8 · see citing works
Fear of Incompetence in Family Caregivers and Dementia Care Transitions
Miron, A. M., Groves, C. L., Thompson, A. E., McFadden, S. H., Bowers, H. R., & DeBraal, J. M. (2022) · The International Journal of Aging and Human Development · doi:10.1177/00914150221106075 · Cited by 8 · see citing works
Yang, M., Temkin‐Greener, H., Veazie, P. J., & Cai, S. (2024) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2024.105057 · Cited by 7 · see citing works
A Scoping Review of Care Trajectories across Multiple Settings for Persons with Dementia
Kosteniuk, J. G., Morgan, D., Elliot, V., Chow, A. F., Bayly, M. K., Watson, E., Osman, M., Osman, B. A., O'Connell, M. E., Kirk, A., et al. (2022) · Project Muse (Johns Hopkins University) · Cited by 7 · see citing works
Caregivers’ experience with Tele-Savvy Caregiver Program post-hospitalization
Kovaleva, M. A., Kleinpell, R., Dietrich, M. S., Jones, A. C., Boon, J. T., Duggan, M. C., Dennis, B. M., Lauderdale, J., & Maxwell, C. A. (2023) · Geriatric Nursing · doi:10.1016/j.gerinurse.2023.03.002 · Cited by 6 · see citing works
Block, L., Hovanes, M., & Gilmore‐Bykovskyi, A. L. (2022) · Geriatric Nursing · doi:10.1016/j.gerinurse.2022.04.010 · Cited by 6 · see citing works
Association of Dementia Severity and Caregiver Support With Early Discharge From Home Health
Knox, S., Haas, A. M., Downer, B. G., & Ottenbacher, K. J. (2022) · American Journal of Alzheimer s Disease & Other Dementias® · doi:10.1177/15333175221129384 · Cited by 6 · see citing works
Lehrer, H., Lin, J., Kwon, C., Agarwal, P., Mazumdar, M., & Jetté, N. (2021) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2021.108126 · Cited by 6 · see citing works
Eldercaring Conflict Checklist (ECC): Development, Pilot, and Initial Validation of Scale
Saini, M., Alschech, J., Fieldstone, L., & Bronson, S. (2024) · Ageing International · doi:10.1007/s12126-023-09550-9 · Cited by 5 · see citing works
Post-Acute Care Rehabilitation for Persons Living With Dementia: A Systematic Review
Semelka, C., Freeman, V., Williamson, J., & Frechman, E. (2024) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2024.105189 · Cited by 5 · see citing works
Gustavson, A. M., Hudson, E. M., Wisdom, J. P., Woodward-Abel, A. B., Hoffman, R. M., Miller, M. J., Fink, H. A., Gaugler, J. E., & Hagedorn, H. (2025) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2025.105534 · Cited by 5 · see citing works
Yi, E.-H. G., & Adamek, M. E. (2020) · Journal of Applied Gerontology · doi:10.1177/0733464820964088 · Cited by 5 · see citing works
Gilmore‐Bykovskyi, A. L., Markart, M., Imig, K., Hunt, K., Murray, D., Block, L., & Dhein, J. (2021) · Journal of Gerontological Nursing · doi:10.3928/00989134-20210803-02 · Cited by 6 · see citing works
Holtz, L. R., Kroenke, K., Gao, S., Hickman, S. E., Torke, A. M., Johnson, N. M., Pemberton, A., Vrobel, A., Pan, M., & Sachs, G. A. (2023) · Contemporary Clinical Trials · doi:10.1016/j.cct.2023.107217 · Cited by 5 · see citing works
Fazio‐Eynullayeva, E., Cunnington, M. C., Mystkowski, P., Lv, L., Aly, A., Yee, C. W., Desai, R. A., Liu, C., Duh, M. S., & Mattke, S. (2024) · Journal of Medical Economics · doi:10.1080/13696998.2024.2442240 · Cited by 5 · see citing works
Penning, M. J., Cloutier, D., Nuernberger, K., & Taylor, D. (2017) · Innovation in Aging · doi:10.1093/geroni/igx011 · Cited by 5 · see citing works
The impact of dementia on aged care service transitions in the last five years of life
Welberry, H., Jorm, L. R., Barbieri, S., Hsu, B., & Brodaty, H. (2020) · Age and Ageing · doi:10.1093/ageing/afaa254 · Cited by 4 · see citing works
Continuity of Care and Successful Hospital Discharge of Older Veterans With Dementia
Lei, L., Cai, S., Conwell, Y., Fortinsky, R. H., & Intrator, O. K. (2021) · Journal of Applied Gerontology · doi:10.1177/07334648211051867 · Cited by 3 · see citing works
Place of care in the last three years of life for Medicare beneficiaries
Lin, H., Grafova, I. B., Zafar, A., Setoguchi, S., Roy, J., Kobylarz, F. A., Halm, E. A., & Jarrin, O. F. (2024) · BMC Geriatrics · doi:10.1186/s12877-023-04610-w · Cited by 3 · see citing works
Boekholt, M., Nikelski, A., Schumacher‐Schönert, F., Kracht, F., Vollmar, H. C., Hoffmann, W. U., Kreisel, S. H., & Thyrian, J. R. (2025) · Age and Ageing · doi:10.1093/ageing/afaf011 · Cited by 2 · see citing works
Profiles of healthcare use of persons living with dementia: A population‐based cohort study
Dufour, I., Margo-Dermer, E., Hudon, C., Sirois, C., Godard‐Sebillotte, C., Sourial, N., Rochette, L., Quesnel‐Vallée, A., & Vedel, I. (2024) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.14930 · Cited by 1 · see citing works
Jung, D., Jarrin, O. F., Choi, J. H., Knox, S., Emerson, K. G., & Chen, Z. (2024) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2024.105170 · Cited by 2 · see citing works
Zhang, A. D., Zepel, L., Woolson, S., Miller, K. E. M., Schleiden, L. J., Shepherd‐Banigan, M. E., Thorpe, J. M., & Hastings, S. N. (2024) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2024.09.010 · Cited by 2 · see citing works
Sanogo, V., Chen, Z., Almutairi, R., Xiao, H., & Diaby, V. (2023) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1080/14737167.2023.2195628 · Cited by 1 · see citing works
Bayer, T. A., Varma, H., Hollmann, P. A., & Gozalo, P. L. (2025) · Journal of the American Geriatrics Society · doi:10.1111/jgs.19563 · Cited by 1 · see citing works
Yang, M., Temkin‐Greener, H., Veazie, P. J., & Cai, S. (2025) · Journal of Applied Gerontology · doi:10.1177/07334648251358532 · Cited by 1 · see citing works
Xu, D., Garcia, E., & Arling, G. W. (2025) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2025.105885 · Cited by 1 · see citing works
Process evaluation of the residential care transition module
Urbanski, D. P., Birkeland, R. W., Albers, E., Roth, D. L., Baker, Z. G., Gustavson, A. M., Yam, H., & Gaugler, J. E. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-13547-2 · Cited by 1 · see citing works
Associations Between Subacute Rehabilitation Experiences and Transitions into Long-Term Care
Mueller, K. E., Piatt, J. A., Huber, L. L., & McCormick, B. P. (2023) · Activities Adaptation & Aging · doi:10.1080/01924788.2023.2210421 · Cited by 1 · see citing works
Cabin, W. D. (2023) · Home Health Care Management & Practice · doi:10.1177/10848223231208704 · Cited by 1 · see citing works
Gitlin, L. N., & Hodgson, N. A. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-811928-0.00010-7
The aching backbone: perceptions and experiences of care aides in long term residential care
Booi, L. (2018) · Summit (Simon Fraser University)
Yi, E.-H. G. (2020) · IUScholarWorks (Indiana University) · doi:10.7912/c2/1219
Wallem, A., Martinez, A. I., Vickers, L., Singleton, M. D., & Moga, D. C. (2021) · Exploratory Research in Clinical and Social Pharmacy · doi:10.1016/j.rcsop.2021.100058
Holmes, S., Kuzucan, A., Brandt, N., Briesacher, B. A., Desai, A. K., Feng, Z., Fleming, S., Johnson, A. M., Olopoenia, A., Qato, D. M., et al. (2022) · Aging & Mental Health · doi:10.1080/13607863.2022.2103098
Khemai, C. (2023) · doi:10.26481/dis.20231115ck
Fragmented Readmissions From a Nursing Facility in Medicare Beneficiaries
Turbow, S. D., Perkins, M. M., Vaughan, C. P., Klemensen, T., Culler, S. D., Rask, K. J., Clevenger, C. K., & Ali, M. K. (2024) · Journal of Applied Gerontology · doi:10.1177/07334648241254282
CEDART study: protocol for a non-randomized feasibility study
Kwak, J., Jafari, A., Salter, A., Perry, A., Shepherd, A. D. M., Jayasundera, M., Stayer, S., Brode, M., Patel, S. G., & Kvale, E. A. (2026) · Pilot and Feasibility Studies · doi:10.1186/s40814-026-01909-4
Kim, S., Jung, H., Lake, D. T., Brown, R. T., Werner, R. M., Karlawish, J. H., & Ryskina, K. L. (2025) · Health Services Research · doi:10.1111/1475-6773.70035
Opioid Exposure Measurement in Postacute Care Under Medicare Consolidated Payments
Corcoran, K. L., Hayes, K. N., Joshi, R., Berry, S. D., & Zullo, A. R. (2025) · JAMA Health Forum · doi:10.1001/jamahealthforum.2025.3724
- Authors
- Callahan, C. M., Tu, W., Unroe, K. T., LaMantia, M. A., Stump, T. E., & Clark, D. O.
- Affiliations
- Regenstrief Institute (US)
- Indiana University Indianapolis (US)
- Corresponding author
- Callahan, Christopher M.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2015-07-22
- Volume
- 63
- Issue
- 8
- Pages
- 1495-1502
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- PMC
- PMC4834213
- OpenAlex
- W1511970718
- Cited by
- 107
- References
- 30
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 15 · 2023: 11 · 2022: 10 · 2021: 17 · 2020: 11 · 2019: 8 · 2018: 7 · 2017: 8 · 2016: 5
- FWCI
- 12.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- PMC
- Funders
- National Institute on Aging (R01 AG031222, K24 AG024078)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- dementia, care transitions, older adults, nursing facilities, hospital readmission, home care, cognitive impairment, activities of daily living, mortality, end-of-life care, Medicare claims data
- MeSH terms
- Aged, Dementia, Female, Follow-Up Studies, Health Services for the Aged, Homes for the Aged, Humans, Male, Middle Aged, Nursing Homes, Retrospective Studies, United States
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
