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Article ; Online: Toward Gerineuropalliative Care for Patients with Dementia.

Harrison, Krista L / Boyd, Nicole / Ritchie, Christine S

2023 Volume 389, Issue 9, Page(s) 775–778

MeSH term(s)	Humans ; Dementia/therapy ; Palliative Care ; Aged
Language	English
Publishing date	2023-08-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMp2301347
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Article ; Online: Live discharge from hospice for people living with dementia isn't "graduating"-It's getting expelled.

Hunt, Lauren J / Harrison, Krista L

Journal of the American Geriatrics Society

2021 Volume 69, Issue 6, Page(s) 1457–1460

MeSH term(s)	Dementia ; Hospice Care ; Hospices ; Humans ; Patient Discharge
Language	English
Publishing date	2021-04-14
Publishing country	United States
Document type	Editorial ; Research Support, N.I.H., Extramural ; Comment
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.17107
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Article ; Online: Care Setting Transitions for People With Dementia: Qualitative Perspectives of Current and Former Care Partners.

Radcliffe, Kate G / Halim, Madina / Ritchie, Christine S / Maus, Marlon / Harrison, Krista L

The American journal of hospice & palliative care

2023 Volume 40, Issue 12, Page(s) 1310–1316

Abstract: Care partners (CP) of people with dementia (PWD) report that decisions about care setting are aided by the support of healthcare providers. However, providers are often underprepared to offer adequate counseling. This qualitative study aimed to identify ... ...

Abstract	Care partners (CP) of people with dementia (PWD) report that decisions about care setting are aided by the support of healthcare providers. However, providers are often underprepared to offer adequate counseling. This qualitative study aimed to identify what support from providers will assist CPs in making decisions related to care setting throughout the dementia journey. We conducted semi-structured interviews with current CPs of PWD and former CPs of decedents. We utilized the constant comparative method to identify themes regarding preferences around care setting as the PWD progressed from diagnosis to end-of-life. Participants were 31 CPs, including 16 current and 15 former CPs. CPs had a mean age of 67 and were primarily white (n = 23/31), female (n = 21/31), and spouses (n = 24/31). Theme 1: Current CPs discussed overwhelming uncertainty pertaining to care setting, expressing "I don't know when I need to plan on more care," and a desire to understand "what stage we are at." Theme 2: Later in the disease, former CPs wanted guidance from healthcare providers on institutional placement ("I sure would've loved some help finding better places") or support to stay in the home ("a doctor had to come to the house"). CPs want early, specific guidance from healthcare providers related to transitions between home and long-term care. Early in the disease course, counseling geared toward prognosis and expected disease course helps CPs make plans. Later, caregivers want help identifying locations or institutionalization or finding home care resources.
MeSH term(s)	Humans ; Female ; Aged ; Caregivers/psychology ; Decision Making ; Health Personnel ; Home Care Services ; Qualitative Research ; Dementia
Language	English
Publishing date	2023-02-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1074344-3
ISSN	1938-2715 ; 1049-9091
ISSN (online)	1938-2715
ISSN	1049-9091
DOI	10.1177/10499091231155601
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Article ; Online: In sickness and in health: Loneliness, depression, and the role of marital quality among spouses of persons with dementia.

Hsu, Kristie Y / Cenzer, Irena / Harrison, Krista L / Ritchie, Christine S / Waite, Linda / Kotwal, Ashwin

Journal of the American Geriatrics Society

2023 Volume 71, Issue 11, Page(s) 3538–3545

Abstract: Background: Older adults married to persons living with dementia (PLwD) may be at risk for loneliness and depression. We assessed the prevalence of loneliness and depressive symptoms among spouses of PLwD or cognitive impairment not dementia (CIND), and ...

Abstract	Background: Older adults married to persons living with dementia (PLwD) may be at risk for loneliness and depression. We assessed the prevalence of loneliness and depressive symptoms among spouses of PLwD or cognitive impairment not dementia (CIND), and the role of marital quality in mediating these outcomes. Methods: We used a US population-based sample of 4071 couples enrolled in the Health and Retirement Study (2014 and 2016). We included older adults married to PLwD (N = 227), married to persons with CIND (N = 885), or married to persons with no cognitive impairment (NCI) (N = 2959). We determined the prevalence of loneliness (UCLA 3-item scale), depressive symptoms (CESD-8 scale), and both, using multivariable logistic regression adjusting for sociodemographic and health-related characteristics. We then tested for interaction terms between marital quality (4-item scale) and degree of spousal cognitive impairment for each outcome of loneliness and depressive symptoms. Results: The sample was 55% women and on average 67-years-old (range: 50-97). After adjustment, spouses of persons with cognitive impairment were more likely to be lonely (NCI: 20%, CIND: 23%, PLwD: 29%; p = 0.04), depressed (NCI: 8%, CIND: 15%, PLwD: 14%; p < 0.01), and both (NCI: 4%, CIND: 9%, PLwD: 7%; p < 0.01). The association between cognition and loneliness, but not depression, differed by marital quality (interaction p-value = 0.03). Among couples with high marital quality, spousal cognitive impairment was associated with higher likelihood of loneliness (p < 0.05). In contrast, no association existed between spousal cognition and loneliness among couples with lower marital quality (p = 0.37). Conclusions: One in six spouses of persons with CIND or more advanced disease (PLwD) experienced depressive symptoms, and loneliness among spouses of PLwD was experienced at a twofold rate. By identifying and managing both, and facilitating interventions that promote high-quality social connection, clinical teams might improve the lives of older couples facing dementia.
MeSH term(s)	Humans ; Female ; Aged ; Male ; Loneliness/psychology ; Spouses/psychology ; Depression/epidemiology ; Cognitive Dysfunction/epidemiology ; Dementia/epidemiology
Language	English
Publishing date	2023-08-04
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.18520
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Article ; Online: Out-of-Pocket Expenses for Long-Term Care by Dementia Status and Residential Setting among US Older Adults.

Li, Jing / Bancroft, Hannah / Harrison, Krista L / Fox, Julia / Tyler, Ana M / Arias, Jalayne J

Journal of the American Medical Directors Association

2023 Volume 25, Issue 1, Page(s) 47–52

Abstract: Objective: To examine long-term care out-of-pocket payments by dementia status and residential setting.: Design: Compare monthly out-of-pocket long-term care expenses paid to facilities and helpers, total monthly out-of-pocket long-term expenses and ... ...

Abstract	Objective: To examine long-term care out-of-pocket payments by dementia status and residential setting. Design: Compare monthly out-of-pocket long-term care expenses paid to facilities and helpers, total monthly out-of-pocket long-term expenses and as a percentage of monthly income by dementia status and residential status (community, residential facility, and nursing home). Setting and participants: US Nationwide, 2019 National Health and Aging Trends Study (NHATS) respondents aged ≥70 years. Methods: We analyzed respondent-level data from the nationally representative 2019 NHATS. Weighted descriptive statistics were calculated for long-term care payments by source and summarized by dementia status and the respondent's residential status. Results: Among 4505 respondents aged ≥70 years, 1750 (38.8%) had possible or probable dementia and 2755 (61.2%) had no dementia. The median monthly out-of-pocket long-term care expenses for persons with dementia was $1465 for those living in nursing homes, and $2925 for those living in other residential facilities, much higher than those with dementia living in the community ($260). Although these are similar to the median out-of-pocket payments for persons without dementia by setting, those with dementia were at greater risk of facing catastrophic out-of-pocket expenses for long-term care than those without dementia, with the 75th percentile value of out-of-pocket payment at $4566 among dementia adults living in non-nursing home residential care facilities, and $7500 for those in nursing homes, compared to $3694 and $3100 among those without dementia. At median, these expenses accounted for 100% of monthly income of respondents with dementia living in facilities. Conclusions and implications: Persons with dementia living in facilities often face substantial financial burdens from high out-of-pocket long-term care expenses. Policies that provide sufficient financial assistance are needed to address long-term care-related financial burdens experienced by older adults and their families, especially for those with dementia.
MeSH term(s)	Humans ; Aged ; Health Expenditures ; Long-Term Care ; Nursing Homes ; Income ; Dementia
Language	English
Publishing date	2023-10-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2023.09.010
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Article ; Online: "Relationships, Very Quickly, Turn to Nothing": Loneliness, Social Isolation, and Adaptation to Changing Social Lives Among Persons Living With Dementia and Care Partners.

Kotwal, Ashwin A / Allison, Theresa A / Halim, Madina / Garrett, Sarah B / Perissinotto, Carla M / Ritchie, Christine S / Smith, Alexander K / Harrison, Krista L

The Gerontologist

2024 Volume 64, Issue 4

Abstract: Background and objectives: Persons with dementia and their care partners have known risks for loneliness and social isolation throughout the disease trajectory, yet little is described about social lives in a population heterogeneous for disease stage, ... ...

Abstract	Background and objectives: Persons with dementia and their care partners have known risks for loneliness and social isolation throughout the disease trajectory, yet little is described about social lives in a population heterogeneous for disease stage, syndrome type, and setting. Research design and methods: We conducted a secondary analysis of qualitative interviews from multiple studies to triangulate responses from a cohort of persons with dementia (n = 24), and active (n = 33) or bereaved (n = 15) care partners diverse in setting, dementia type and stage, and life experience. Interviews explored challenges related to social lives and were analyzed thematically. Results: Persons with dementia were on average 80 years old (range: 67-94), 38% female, and 78% diagnosed with Alzheimer's dementia; care partners were on average 67 years old (range: 40-87) and 69% female. We identified 3 primary themes. First, dyads lost external social networks due to complex factors, including discomfort of surrounding social networks, caregiving responsibilities, and progressive cognitive deficits. Second, care partners described disruptions of meaningful dyadic relationships due to progressive cognitive and functional deficits, leading to loneliness and anticipatory grief. Third, adaptive strategies centered on care partners facilitating shared social activities and programs addressing caregiver burden. An overarching theme of disease-course accumulation of barriers to social interactions and constant adaptations was present in all themes. Discussion and implications: Isolation and loneliness are a shared experience and source of distress for persons with dementia and care partners. Results can inform interventions tailored to individual needs and disease stages of dyads that enhance social connectedness.
MeSH term(s)	Humans ; Female ; Aged, 80 and over ; Aged ; Male ; Loneliness ; Dementia/psychology ; Caregivers/psychology ; Social Isolation ; Alzheimer Disease
Language	English
Publishing date	2024-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	216760-8
ISSN	1758-5341 ; 0016-9013
ISSN (online)	1758-5341
ISSN	0016-9013
DOI	10.1093/geront/gnae014
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Article ; Online: Instead of wasting money on aducanumab, pay for programs proven to help people living with dementia.

Hunt, Lauren J / Harrison, Krista L / Covinsky, Kenneth E

Journal of the American Geriatrics Society

2021 Volume 69, Issue 12, Page(s) 3690–3692

MeSH term(s)	Alzheimer Disease/economics ; Antibodies, Monoclonal, Humanized/economics ; Community Health Services/economics ; Dementia/economics ; Financial Support ; Humans ; Palliative Care/economics ; Value-Based Purchasing/economics
Chemical Substances	Antibodies, Monoclonal, Humanized ; aducanumab (105J35OE21)
Language	English
Publishing date	2021-09-16
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/jgs.17462
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Article ; Online: Extreme Vulnerability of Home Care Workers During the COVID-19 Pandemic-A Call to Action.

Allison, Theresa A / Oh, Anna / Harrison, Krista L

JAMA internal medicine

2020 Volume 180, Issue 11, Page(s) 1459–1460

MeSH term(s)	COVID-19 ; Health Personnel ; Home Care Services ; Humans ; New York City ; Pandemics ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-06-09
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2020.3937
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Article ; Online: Palliative Care for Patients With Noncancer Illnesses.

Harrison, Krista L / Kotwal, Ashwin A / Smith, Alexander K

JAMA

2020 Volume 324, Issue 14, Page(s) 1404–1405

MeSH term(s)	Adult ; Chronic Disease ; Humans ; Palliative Care ; Quality of Life ; Terminal Care
Language	English
Publishing date	2020-10-13
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2020.15075
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Article ; Online: Hospice Improves Care Quality For Older Adults With Dementia In Their Last Month Of Life.

Harrison, Krista L / Cenzer, Irena / Ankuda, Claire K / Hunt, Lauren J / Aldridge, Melissa D

Health affairs (Project Hope)

2022 Volume 41, Issue 6, Page(s) 821–830

Abstract: The Medicare hospice benefit was originally designed around a cancer disease paradigm but increasingly serves people living with dementia. At this time, almost half of all older adults receiving hospice care have dementia. Yet there is minimal evidence ... ...

Abstract	The Medicare hospice benefit was originally designed around a cancer disease paradigm but increasingly serves people living with dementia. At this time, almost half of all older adults receiving hospice care have dementia. Yet there is minimal evidence as to whether hospice benefits people living with dementia outside of nursing facilities. We asked whether and how the perceived quality of last-month-of-life care differed between people with and without dementia and whether hospice use among people living with dementia was associated with perceived quality of care compared with the quality of care for those who did not use hospice. We used nationally representative data from the National Health and Aging Trends Study and Medicare claims from the period 2011-17 to examine the impact of hospice enrollment on proxy perceptions of last-month-of-life care quality. Proxies of people living with dementia enrolled in hospice compared with proxies of those not enrolled more often reported care to be excellent (predicted probability: 52 percent versus 41 percent), more often reported having anxiety or sadness managed (67 percent versus 46 percent), and less often reported changes in care settings in the last three days of life (10 percent versus 25 percent). There were no differences in the impact of hospice on proxy ratings of care for people with and without dementia. Policy makers should consider these benefits when weighing changes to hospice policy and regulations that may affect people living with dementia.
MeSH term(s)	Aged ; Dementia/therapy ; Hospice Care ; Hospices ; Humans ; Medicare ; Quality of Health Care ; United States
Language	English
Publishing date	2022-06-06
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	632712-6
ISSN	1544-5208 ; 0278-2715
ISSN (online)	1544-5208
ISSN	0278-2715
DOI	10.1377/hlthaff.2021.01985
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