PPA 419 – Aging PPA 419 – Aging Services AdministrationServices Administration

Lecture 8c – Caregiver Lecture 8c – Caregiver Attitudes and Hospitalization Attitudes and Hospitalization

RiskRisk

SourceSource

Shugarman, L. R., Buttar, A., Fries, Shugarman, L. R., Buttar, A., Fries, B.E., Moore, T., & Blaum, C. S. B.E., Moore, T., & Blaum, C. S. (2002). Caregiver attitudes and (2002). Caregiver attitudes and hospitalization risk in Michigan hospitalization risk in Michigan residents receiving home- and residents receiving home- and community-based care. community-based care. Journal of the Journal of the American Geriatric Society, 50American Geriatric Society, 50, 1079-, 1079-1085.1085.

ObjectivesObjectives

To study a cohort of participants in To study a cohort of participants in home- and community-based home- and community-based services (HCBS) in Michigan to services (HCBS) in Michigan to evaluate the relationship between:evaluate the relationship between: Caregiver attitudes and participant Caregiver attitudes and participant

characteristicscharacteristics And the risk of hospitalization.And the risk of hospitalization.

DesignDesign

A population-based study.A population-based study.

SettingSetting

HCBS programs funded by Medicaid HCBS programs funded by Medicaid or state/local funds in Michigan.or state/local funds in Michigan.

ParticipantsParticipants

Five hundred twenty-seven Five hundred twenty-seven individuals eligible for HCBS in individuals eligible for HCBS in Michigan were studied. These HCBS Michigan were studied. These HCBS participants were randomly selected participants were randomly selected clients of all agencies providing clients of all agencies providing publicly funded HCBS in Michigan publicly funded HCBS in Michigan from November 1996 to October from November 1996 to October 1997.1997.

MeasurementsMeasurements

Data for this study were collected Data for this study were collected using the Minimum Data Set for Home using the Minimum Data Set for Home Care.Care.

Assessments were collected Assessments were collected longitudinally, and the baseline (initial longitudinally, and the baseline (initial admission adjustment) and 90-day admission adjustment) and 90-day follow-up assessments were used.follow-up assessments were used.

Uses Andersen model of predisposing, Uses Andersen model of predisposing, enabling, and need characteristics.enabling, and need characteristics.

MeasurementsMeasurements

Key measures were caregiver Key measures were caregiver attitudes (distress, dissatisfaction, attitudes (distress, dissatisfaction, and decreased caregiving ability) and and decreased caregiving ability) and HCBS participant characteristics HCBS participant characteristics (cognition, functioning, diseases, (cognition, functioning, diseases, symptoms, nutritional status, symptoms, nutritional status, medications, and disease stability).medications, and disease stability).

MeasurementsMeasurements

Multinomial logistic regression was Multinomial logistic regression was used to evaluate how these used to evaluate how these characteristics were associated with characteristics were associated with the competing risks of hospitalization the competing risks of hospitalization and death within 90 days of and death within 90 days of admission to HCBS.admission to HCBS.

ResultsResults

We found a strong association We found a strong association between caregiver dissatisfaction between caregiver dissatisfaction (caregiver dissatisfied with the level (caregiver dissatisfied with the level of care the home care participant of care the home care participant was currently receiving) and an was currently receiving) and an increased likelihood of increased likelihood of hospitalization.hospitalization.

ResultsResults

HCBS participant cancer, chronic HCBS participant cancer, chronic obstructive pulmonary disease, pain, obstructive pulmonary disease, pain, and flare-up of a chronic condition and flare-up of a chronic condition were also associated with increased were also associated with increased hospitalization.hospitalization.

Poor food intake and prior Poor food intake and prior hospitalization were associated with hospitalization were associated with hospitalization and death.hospitalization and death.

ConclusionsConclusions

We conclude that, within a cohort of We conclude that, within a cohort of people receiving HCBS who are people receiving HCBS who are chronically ill, highly disabled, and at chronically ill, highly disabled, and at high risk for hospitalization and high risk for hospitalization and death, interventions addressing death, interventions addressing caregiver dissatisfaction, pain caregiver dissatisfaction, pain control, and medical monitoring control, and medical monitoring should be evaluated for their should be evaluated for their potential to decrease hospitalization.potential to decrease hospitalization.