title: Transitions in care for older adults with and without dementia.
abstract: OBJECTIVE
  To describe transitions in care of persons with dementia with attention to nursing facility transitions.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Public health system.
  
  
  METHODS
  Four thousand one hundred ninety-seven community-dwelling older adults.
  
  
  METHODS
  Participants' electronic medical records were merged with Medicare claims, Medicaid claims, the Minimum Data Set (MDS), and the Outcome and Assessment Information Set (OASIS) from 2001 to 2008 with a mean follow-up of 5.2 years from the time of enrollment.
  
  
  RESULTS
  Older adults with prevalent (n = 524) or incident (n = 999) dementia had greater Medicare (44.7% vs 44.8% vs 11.4%, P < .001) and Medicaid (21.0% vs 16.8% vs 1.4%, P < .001) nursing facility use, greater hospital (76.2% vs 86.0% vs 51.2%, P < .001) and home health (55.7% vs 65.2% vs 27.3%, P < .001) use, more transitions in care per person-year of follow-up (2.6 vs 2.7 vs 1.4, P < .001), and more mean total transitions (11.2 vs 9.2 vs 3.8, P < .001) than those who were never diagnosed (n = 2,674). For the 1,523 participants with dementia, 74.5% of transitions to nursing facilities were transfers from hospitals. For transitions from nursing facilities, the conditional probability was 41.0% for a return home without home health care, 10.7% for home health care, and 39.8% for a hospital transfer. Of participants with dementia with a rehospitalization within 30 days, 45% had been discharged to nursing facilities from the index hospitalization. At time of death, 46% of participants with dementia were at home, 35% were in the hospital, and 19% were in a nursing facility.
  
  
  CONCLUSIONS
  Individuals with dementia live and frequently die in community settings. Nursing facilities are part of a dynamic network of care characterized by frequent transitions.
authors.affiliation: Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA. ccallaha@iupui.edu
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
authors.forename: Greg
authors.initials: G
authors.lastname: Arling
authors.forename: Wanzhu
authors.initials: W
authors.lastname: Tu
authors.forename: Marc B
authors.initials: MB
authors.lastname: Rosenman
authors.forename: Steven R
authors.initials: SR
authors.lastname: Counsell
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Stump
authors.forename: Hugh C
authors.initials: HC
authors.lastname: Hendrie
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000628:therapy; D003704:Dementia / Q000628:therapy*; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011446:Prospective Studies