Successful Discharge to Community From Home Health Less Likely for People in Late Stages of Dementia.
Sara Knox, Brian Downer, Allen Haas and 1 others
PMID 38133896WHAT IT FOUND
Successful discharge to community rates varied by dementia stage.
Patients in the most advanced stage had the lowest success rate at 52.0%. Those in middle stages had the highest rates, between 78.8% and 79.3%. Declining independence and higher caregiver needs were linked to lower success.
Key findings
01Patients in the most advanced dementia severity category (7) had the lowest successful discharge rate (52.0%), while those in middle categories (3 and 4) had the highest rates (78.8% and 79.3%).
02Individuals in the highest dementia severity category had a relative risk of successful discharge of 0.737 compared to the lowest category, and those in the second-highest had a relative risk of 0.900.
03Successful discharge rates were lower for patients with higher needs for caregiver assistance and greater dependence on medication management.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The definition of ADRD relied solely on ICD-10 codes, which has poor sensitivity for detecting early or mild dementia. Dementia severity was estimated using a crosswalk between OASIS items and the FAST scale, rather than a gold standard clinical assessment. The study could not account for variations in how home health agencies collected or recorded OASIS data. The analysis did not determine how caregiver availability specifically interacts with dementia severity to influence outcomes.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institutes of Health and the National Institute on Aging, but the funding agencies were not involved in the study design, data collection, analysis, or writing.
The easy way to misread this
Do not assume that patients with no prescribed oral medications are at lower risk for discharge failure. This group had the lowest likelihood of successful discharge, 20% below the cohort average, suggesting that the absence of medications may indicate other unmet needs or health complexities.