title: Redesigning acute care for cognitively impaired older adults: Optimizing health care services.
abstract: OBJECTIVE
  Cognitive impairment (CI) is one of several factors known to influence hospitalization, hospital length of stay, and rehospitalization among older adults. Redesigning care delivery systems sensitive to the influence of CI may reduce acute care utilization while improving care quality. To develop a foundation of fundamental needs for health care redesign, we conducted focus groups with inpatient and outpatient providers to identify barriers, facilitators, and suggestions for improvements in care delivery for patients with CI.
  
  
  METHODS
  Focus group sessions were conducted with providers to identify their approach to caring for cognitively impaired hospitalized adults; obstacles and facilitators to providing this care; and suggestions for improving the care process. Using a thematic analysis, two reviewers analyzed these transcripts to develop codes and themes.
  
  
  RESULTS
  Seven themes emerged from the focus group transcripts. These were: (1) reflections on serving the cognitively impaired population; (2) descriptions of perceived barriers to care; (3) strategies that improve or facilitate caring for hospitalized older adults; (4) the importance of fostering a hospital friendly to the needs of older adults; (5) the need for educating staff, patients, and caregivers; (6) the central role of good communication; and (7) steps needed to provide more effective care.
  
  
  CONCLUSIONS
  Providing effective acute care services to older adults with CI is an important challenge in health care reform. An understanding derived from the perspective of multiple professional disciplines is an important first step. Future research will build on this preliminary study in developing new acute care models for patients with CI.
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA malamant@iu.edu.
authors.forename: Michael A
authors.initials: MA
authors.lastname: LaMantia
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Malaz A
authors.initials: MA
authors.lastname: Boustani
authors.affiliation: Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
authors.forename: Shola
authors.initials: S
authors.lastname: Jhanji
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA.
authors.forename: Mungai
authors.initials: M
authors.lastname: Maina
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Arif
authors.initials: A
authors.lastname: Nazir
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Frank C
authors.initials: FC
authors.lastname: Messina
authors.affiliation: Indiana University Center for Aging Research, Indianapolis, IN, USA; Regenstrief Institute, Inc., Indianapolis, IN, USA.
authors.forename: Amie
authors.initials: A
authors.lastname: Frame
authors.affiliation: Eskenazi Health, Indianapolis, IN, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Alder
authors.affiliation: Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Chodosh
mesh_terms: D001291:Attitude of Health Personnel; D060825:Cognitive Dysfunction / Q000628:therapy*; D006297:Health Services Accessibility / Q000458:organization & administration; D006760:Hospitalization; D006801:Humans; D020380:Needs Assessment / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*
keywords: dementia; focus groups; hospital/ambulatory care