title: Discharge Destination of Dementia Patients Who Undergo Intermediate Care at a Facility.
abstract: OBJECTIVE
  Intermediate care for patients with dementia has important implications for aging in place as long as possible. In Japan, geriatric intermediate care facilities provide institutional rehabilitation services to patients under the public Long-Term Care Insurance program and aim to discharge the patients to home from the hospital. The aim of this study was to determine the association between dementia and discharge destination of patients in geriatric intermediate care facilities in Japan.
  
  
  METHODS
  This study was conducted using a retrospective study design for data from 2007, 2010, and 2013.
  
  
  METHODS
  We used data from the Survey of Institutions and Establishments for Long-Term Care, which is a nationally representative cross-sectional survey that assessed discharges from geriatric intermediate care facilities in September.
  
  
  METHODS
  There were 9992 discharged patients included in the analysis.
  
  
  METHODS
  Discharge destination was categorized as home, facility, hospital, or death. Primary disease was based on ICD-10 codes. Diagnosis of dementia included F00 (Alzheimer), F01 (vascular), F02 (other), and F03 (unspecified). Multilevel multinomial logistic analysis was used for discharge destination, with discharge to home as the reference group.
  
  
  RESULTS
  Of the 9992 discharged patients, 2483 (24.8%) had dementia as the primary disease. Of the 2483 patients with dementia, 1090 (43.9%) were hospitalized, 624 (25.1%) were admitted to another facility, 605 (24.4%) were discharged to home, and 164 (6.6%) were discharged by death. Patients with dementia were more likely to be admitted to hospital (adjusted odds ratio [OR] 1.47; 95% confidence interval [CI] 1.25-1.73; P < .001), transferred to another facility (adjusted OR 1.94; 95% CI 1.64-2.29; P < .001), or discharged by death (adjusted OR, 1.46; 95% CI 1.13-1.89; P = .004) than discharged to home.
  
  
  CONCLUSIONS
  Intermediate care in residential settings might have limited effectiveness in discharging patients with dementia to home. The national dementia plan should explore intermediate care for dementia at other care settings rather than facilities.
authors.affiliation: Department of Pychiatry and behavioral Sciences, Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan. Electronic address: mnakanishi-tky@umin.ac.jp.
authors.forename: Miharu
authors.initials: M
authors.lastname: Nakanishi
authors.affiliation: Division of Research, Tokyo Dementia Care Research and Training Center, Suginami-ku, Tokyo, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Shindo
authors.affiliation: Department of Pychiatry and behavioral Sciences, Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Niimura
mesh_terms: D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007380:Intermediate Care Facilities; D007564:Japan / Q000453:epidemiology; D008297:Male; D010351:Patient Discharge; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: Dementia; frail elderly; geriatrics; intermediate care; rehabilitation