title: Transitions in Care in a Nationally Representative Sample of Older Americans with Dementia.
abstract: OBJECTIVE
  To describe transitions in care for older adults with dementia identified from a nationally representative cohort and to describe transition rates in those with more-severe levels of cognitive and functional impairment.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Health and Retirement Study (HRS).
  
  
  METHODS
  HRS respondents aged 65 and older whose survey data were linked with Medicare claims from 1999 to 2008 (N = 16,186).
  
  
  METHODS
  Transitions in care between home, home with formal services, hospital, and nursing facility care; cognitive function; activities of daily living; and mortality.
  
  
  RESULTS
  The 3,447 (21.3%) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Of subjects transitioning from a hospital stay, 52.2% returned home without home care services, and 33.8% transitioned to a nursing facility. Of subjects transitioning from a nursing facility, 59.2% transitioned to the hospital, and 25.3% returned home without services. There were 2,139 transitions to death, and 58.7% of HRS subjects with dementia died at home. Even in persons with moderate to severe dementia, multiple transitions in care were documented, including transitions from the hospital to home and back to the hospital.
  
  
  CONCLUSIONS
  In this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in function and cognition.
authors.affiliation: Center for Aging Research, Indiana University, Indianapolis, Indiana.|Department of Medicine, Indiana University, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indianapolis, Indiana.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
authors.affiliation: Center for Aging Research, Indiana University, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indianapolis, Indiana.|Department of Biostatistics, School of Medicine, Indiana University, Indianapolis, Indiana.
authors.forename: Wanzhu
authors.initials: W
authors.lastname: Tu
authors.affiliation: Center for Aging Research, Indiana University, Indianapolis, Indiana.|Department of Medicine, Indiana University, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indianapolis, Indiana.
authors.forename: Kathleen T
authors.initials: KT
authors.lastname: Unroe
authors.affiliation: Center for Aging Research, Indiana University, Indianapolis, Indiana.|Department of Medicine, Indiana University, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indianapolis, Indiana.
authors.forename: Michael A
authors.initials: MA
authors.lastname: LaMantia
authors.affiliation: Department of Biostatistics, School of Medicine, Indiana University, Indianapolis, Indiana.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Stump
authors.affiliation: Center for Aging Research, Indiana University, Indianapolis, Indiana.|Department of Medicine, Indiana University, Indianapolis, Indiana.|Regenstrief Institute, Inc., Indianapolis, Indiana.
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Clark
mesh_terms: D000368:Aged; D003704:Dementia / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
keywords: dementia; elder care; transitions