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Marian
S. Ware Alzheimers Program
Care Coordination Initiative
Hospital to Home: Cognitively Impaired
Elders and their Caregivers
Mary
D. Naylor, PhD, FAAN, RN
and her colleagues
Over
the last two decades, Dr. Mary Naylor and her colleagues have
been building models of transitional
care,
designed to improve outcomes and reduce costs of care for
vulnerable community-based elders. The
Marian S. Ware Alzheimers
Program Care Coordination Initiative, "Hospital
to Home: Cognitively Impaired Elders and their Caregivers," builds
upon the team’s extensive
body of research and testing of care management interventions
with high-risk cognitively intact
elders.
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Cognitive
impairment (CI) among older adults hospitalized for
a common medical or surgical condition is associated
with increased mortality and morbidity. These patients
typically experience prolonged hospital stays, higher
rates of complications, delayed rehabilitation, increased
hospital readmissions and higher health care costs.
Prevalence rates for dementia and delirium, the most
common causes of CI, are expected to increase substantially
as the population ages.
A
large body of research has demonstrated how CI adds
to the complexity of care among elders suffering from
an acute illness and multiple comorbid conditions,
increases their risk for poor outcomes and adds to
the burden of their caregivers. Multiple |
Dr. Mary Nayor |
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studies
also have revealed that
both delirium and dementia among hospitalized elders are
poorly recognized and managed often
with devastating and costly consequences for patients, families
and hospital staffs already coping
with a severe shortage of nurses. Thus, it is not surprising
that the Institute of Medicine (IOM)
identified improving the care management of this challenging
patient group as a priority for
national action.
Studies
have informed the design of clinical practices to detect
and prevent delirium among hospitalized
elders. However, little evidence exists to guide optimal
care of hospitalized elders with
delirium and/or dementia and their caregivers. Collectively,
available evidence suggests that hospitalized
cognitively impaired elders may benefit from interventions
aimed at improving care management
of both CI and comorbid conditions. However,
the exact nature and intensity of an intervention
needed to effectively and efficiently improve health and
cost outcomes for this patient
group and their caregivers is not known.
This new
study addresses these important gaps in knowledge, building
upon the team’s extensive
body of research testing care management interventions with
high-risk cognitively intact
elders. Findings from their work have consistently demonstrated
improved health outcomes, reductions
in hospitalizations and decreased health care costs compared
to standard care.
Initially,
the team proposes to compare across three hospital sites
the effects of three interventions of
varying intensities and nurse staffing and skill set requirements.
Each intervention is designed to
promote positive adaptation to an acute illness by cognitively
impaired hospitalized elders and their
caregivers, thereby enhancing their care management and improving
patient, caregiver and cost
outcomes.
Specifically,
guided by Roy’s Adaptation
Model, a body of research in care management of cognitively
intact high risk elders, pilot findings and other empirical
evidence, a prospective on randomized three-
group cross-sectional design followed by a longitudinal,
confirmatory design
will be used to accomplish the study aims.
>>> more
PROJECT
TEAM
Principal
Investigator:
Mary D.
Naylor, PhD, RN, FAAN, University
of Pennsylvania
Co-Investigators:
Kathryn
H. Bowles, PhD, University
of Pennsylvania
Christopher
M. Clark, MD, University
of Pennsylvania
Lenore
Kurlowicz, PhD, University
of Pennsylvania
Kathleen
M. McCauley, PhD, University
of Pennsylvania
Greg
Maislin, MS, MA, Biomedical
Statistical Consulting
J.
Sanford Schwartz, MD, University
of Pennsylvania
Consultant:
Marquis
Foreman, PhD, University
of Illinois
Project
Manager:
Lucinda Bertsinger
This is
initiative is funded by the Marian S. Ware Alzheimer Program.
Other
currently funded grants by Dr. Mary D. Naylor
For more
information on the Marian
S. Ware Alzheimers Program Care Coordination Initiative,
please contact Dr.
Mary Naylor or Lucinda
Bertsinger, project manager.
| The
above listed initiative is just one of many
ongoing studies or projects by our Penn Nursing
scholars. For
more information on other Penn Nursing experts,
or to
request a CONSULTATION, please contact |
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