Impact of Advance Care Planning on the Hospitalization-Associated Utilization and Cost of Patients with Alzheimer's Disease-Related Disorders Receiving Primary Care via Telehealth in a Provider Shortage Area: A Quantitative Pre-Study.

Telehealth has been adopted as an alternative to in-person primary care visits. With multiple participants able to join remotely, telehealth can facilitate the discussion and documentation of advance care planning (ACP) for those with Alzheimer's disease-related disorders (ADRDs). We measured hospitalization-associated utilization outcomes, instances of hospitalization and 90-day re-hospitalizations from payors' administrative databases and verified the data via electronic health records. We estimated the hospitalization-associated costs using the Nevada State Inpatient Dataset and compared the estimated costs between ADRD patients with and without ACP documentation in the year 2021. Compared to the ADRD patients without ACP documentation, those with ACP documentation were less likely to be hospitalized (mean: 0.74; standard deviation: 0.31; p < 0.01) and were less likely to be readmitted within 90 days of discharge (mean: 0.16; standard deviation: 0.06; p < 0.01). The hospitalization-associated cost estimate for ADRD patients with ACP documentation (mean: USD 149,722; standard deviation: USD 80,850) was less than that of the patients without ACP documentation (mean: USD 200,148; standard deviation: USD 82,061; p < 0.01). Further geriatrics workforce training is called for to enhance ACP competencies for ADRD patients, especially in areas with provider shortages where telehealth plays a comparatively more important role.

Exploring the Impact of The NEST Collaborative's Remote Social Intervention on Feelings of Depression and Isolation.

Early evidence of remote, volunteer-led social support interventions to reduce social isolation in older adults has been encouraging; however, evaluation data on outcomes related to social isolation associated from these interventions is scarce. Here, we share programmatic details of a novel, statewide initiative, called the NEST Collaborative, rolled out to meet immediate emotional, informational, and instrumental needs of older adults in Nevada during the COVID-19 pandemic. The evaluation included 31 older adults participating in weekly one-to-one empathy-based phone calls with multi-generational volunteers seeking to enhance participants' social networks through meaningful friendships. The calls were associated with programmatically meaningful, though not statistically significant, improvements in modified Hawthorne Friendship Scale and PHQ-2 Depression Scale scores over two waves of survey responses. These results suggest that social isolation and depression among older adults decreased among our sample over a period of increased isolation and mental health burden across the general population. With the potential for sustained impact in reducing social isolation over time, remote social support programs, such as the NEST Collaborative, may have persistent value long-term, beyond time-limited crisis response contexts.