Transitions of People with Dementia in the Continuing Care System
Creators: name: Cepoiu-Martin, Monica
Publisher: name: Graduate Studies
Year: 2016
Subjects: subject: Epidemiology
subject: Health Care Management
subject: Mental Health
subject: Public Health
subject: continuing care
subject: Dementia
subject: supportive living
subject: System Dynamics
subject: Health Policy

description: Aging of the population raises a number of challenges to health care and continuing care systems around the world. One of them is ensuring that seniors with disabilities receive the best care at home and in the continuing care system, in order to avoid unnecessary transitions. Dementia is one of the major sources of disability in seniors and the literature exploring the transitions of people with dementia in the continuing care system is growing. Nevertheless, there are still important gaps in the literature pertaining to specific factors that govern these transitions, especially those related to informal caregivers. Moreover, the complexity of the continuing care system makes it difficult to meaningfully incorporate research data on transitions into policies meant to improve the outcomes of people with dementia. The work reported in this dissertation focuses on addressing these gaps and applying system thinking to policy making in continuing care. The systematic review and meta-analysis provided pooled estimates of known and less well-known risk factors for long-term care (LTC) placement in people with dementia. Also, our review highlighted the scarcity of data on resident and caregiver related factors that may delay the LTC placement in people with dementia living in supporting living (SL) settings. This gap in the literature was addressed in the second study, which found that low strength of social relationships, among other factors, significantly increases the risk of LTC placement (HR=1.57, 95% CI: 1.02 – 2.43). Also, the number of activities performed by the informal caregivers modified the effect of residents’ level of ADL impairment on the risk of LTC placement. Specifically, among residents with severe ADL impairment, those with caregivers that performed 5 to 7 activities had a significantly lower risk of LTC placement, compared to those with caregivers that performed 4 or fewer activities (p=0.017). These research findings, along with data extracted from various reports and information obtained from continuing care stakeholders, were used to build a system dynamics (SD) model that describes the Alberta Continuing Care System (ACCS). This computer simulation model was used to explore policy options in the ACCS, illustrating the applicability of system thinking to developing and testing policies in continuing care. In the particular case of modifying benchmarks for staff/resident ratios in the continuing care system, increasing the availability of trained staff in SL might help decrease costs in the system by reducing the rapid transitions of people with dementia from SL to LTC, and consequently, reducing the pressure for adding LTC beds in the system. A better understanding of the transitions of people with dementia in the continuing care system, provided by this research, may help researchers to develop and test interventions aimed at improving the outcomes of people with dementia in the continuing care system and allowing them to age in place. Moreover, it lays the foundation for future work in planning, developing and evaluating various components of continuing care using system thinking.