Unmet Caregiving Needs Among Sepsis Survivors Receiving Home Health Care: The Need for Caregiver Training.

Unmet needs for family caregiver assistance threaten patient outcomes during Medicare home health care (HHC). Sepsis survivors represent a growing proportion of the HHC patient population, but little is known regarding their risk for unmet caregiving needs. We describe prevalence and underlying cause of unmet caregiving needs for sepsis survivors receiving HHC, using HHC patient assessment data for 85,851 older sepsis survivors receiving post-acute HHC in 2013-2014. Unmet caregiving needs were most common for assistance with Activities of Daily Living (ADLs) (28%) and medication administration (27%). Caregivers' need for training accounted for more than three-fourths of all unmet caregiving needs. Those who experienced decline/no improvement in cognitive function were more likely to experience unmet caregiving needs. Findings highlight the potential value of expanding family caregiver training to improve HHC outcomes for sepsis survivors and indicate that caregivers of sepsis survivors with poor cognitive function may benefit most.

Sepsis Survivors Transitioned to Home Health Care: Characteristics and Early Readmission Risk Factors.

OBJECTIVE: To profile the characteristics of growing numbers of sepsis survivors receiving home healthcare (HHC) by type of sepsis before, during, and after a sepsis hospitalization and identify characteristics significantly associated with 7-day readmission. DESIGN: Cross-sectional descriptive study. Data sources included the Outcome and Assessment Information Set (OASIS) and Medicare administrative and claims data. SETTING AND PARTICIPANTS: National sample of Medicare beneficiaries hospitalized for sepsis who were discharged to HHC between July 1, 2013 and June 30, 2014 (N = 165,228). METHODS: We used an indicator distinguishing among 3 types of sepsis: explicitly coded sepsis diagnosis without organ dysfunction; severe sepsis with organ dysfunction; and septic shock. We compared these subgroups' demographic, clinical and functional characteristics, comorbidities, risk factors for rehospitalization, characteristics of the index hospital stay, and predicted 7-day hospital readmission. RESULTS: The majority (80.7%) had severe sepsis, 5.7% had septic shock, and 13.6% had sepsis without acute organ system dysfunction. The medical diagnoses recorded at HHC admission identified sepsis or blood infection only 7% of the time, potentially creating difficulty identifying the sepsis survivor in HHC. Among sepsis types, septic shock survivors had the greatest illness burden profile. This study describes 12 key variables, each of which individually raises the relative 7-day readmission risk by as much as 60%. Increased risk of 7-day rehospitalization was found among those with septic shock, 3 or more previous inpatient stays, index hospital length of stay of >8 days, dyspnea, >6 functional dependencies, and other risk factors. CONCLUSIONS AND IMPLICATIONS: Implications for practice include using our findings to identify sepsis survivors who are at risk for early readmission. Assessment for these factors may profile the at-risk patient, thereby triggering the call for additional acute care intervention such as delayed discharge, or post-acute intervention such as early home visit and outpatient follow-up.

Relationships Between Race/Ethnicity and Health Care Utilization Among Older Post-Acute Home Health Care Patients.

Few studies have explored racial/ethnic differences in health care outcomes among patients receiving home health care (HHC), despite known differences in other care settings. We conducted a retrospective cohort study examining racial/ethnic disparities in rehospitalization and emergency room (ER) use among post-acute patients served by a large northeastern HHC agency between 2013 and 2014 (N = 22,722). We used multivariable binomial logistic regression to describe the relationship between race/ethnicity and health care utilization outcomes, adjusting for individual-level factors that are conceptually related to health service use. Overall rates of rehospitalization and ER visits were 10% and 13%, respectively. African American and Hispanic patients experienced higher odds of ER visits or rehospitalization during their HHC episode. Racial/ethnic differences in utilization were mediated by enabling factors, such as caregiver availability, and illness-level factors, such as illness severity, functional status, and symptoms. Intervention targets may include early risk assessment, proactive management of clinical conditions, rehabilitative therapy, and caregiver training.

Caregivers' Perceptions Managing Functional Needs Among Older Adults Receiving Post-Acute Home Health Care.

Caregivers play important roles in managing the physical functioning (PF) needs of older adults transitioning home after a hospitalization. Training and support of caregivers in the post-acute home health care (HHC) setting should incorporate caregivers' perspectives. To explore caregivers' experiences managing PF needs in the post-acute HHC setting, semi-structured telephone interviews of 20 caregivers were conducted. Conventional content analysis revealed patient-, caregiving task-, caregiver-, and home environment-related themes consistent with the Theory of Dependent Care. Caregivers highlighted the dynamics and contributors of PF needs for older patients in the post-acute HHC setting and depicted the enormity of caregiving tasks needed to manage older patients' PF needs. Caregivers also described their perceived roles and challenges in managing PF deficits, including a sense of isolation when they were the sole caregiver. Findings from this research can guide nursing efforts to target caregiver training and support during this critical care transition. [Res Gerontol Nurs. 2019; 12(4):174-183.].

The Social Context of Sedentary Behaviors and Their Relationships With Health in Later Life.

This study examined sedentary behaviors among older adults and explored associations with social context and health measures using cross-sectional data from the National Health and Aging Trends Study (N = 1,687). Multivariate models were estimated to explore associations of time in six sedentary behaviors (i.e., television watching, sitting and talking, hobbies, computer use, driving, and resting) with sociodemographic characteristics and level of social engagement and with health status. Results indicated substantial variability in sedentary behaviors, with television watching being the most frequent and resting the least frequent activities. Sedentary behaviors varied by sociodemographic characteristics, including age, race/ethnicity, and education, as well as by level of social engagement. Television watching and resting, but not other behaviors, were associated with poorer health. These findings help to unpack the role of social context in sedentary behaviors and could inform public health interventions aimed at reducing time spent in behaviors that are adversely associated with health.

Racial/ethnic disparities in disability outcomes among post-acute home care patients.

OBJECTIVE: To examine activities of daily living (ADL) disability outcomes among racially/ethnically diverse elders receiving home care (HC) after hospitalization. METHOD: We conducted a retrospective cohort analysis of single-agency, 2013-2014 Outcome and Assessment Information Set data from older adults who received post-hospitalization HC ( n = 20,674). We measured overall change in ADL disability by summing the difference of standardized admission and discharge scores from nine individual ADL. Associations between race/ethnicity and overall ADL change scores were modeled using general linear regression, adjusting for covariates consistent with the Disablement Model. RESULTS: Overall, patients experienced improvement in ADL disability from HC admission to discharge. However, Asian, African American, and Hispanic patients experienced significantly less improvement compared with non-Hispanic Whites (all p < .001), even after controlling for covariates. DISCUSSION: Racial/ethnic disparities exist in ADL disability improvement among HC patients. Research is needed to clarify mechanisms underlying these disparities. Disablement Model factors may be targets for clinical intervention.

Physical activity interventions with healthy minority adults: meta-analysis of behavior and health outcomes.

This meta-analysis is a systematic compilation of research focusing on various exercise interventions and their impact on the health and behavior outcomes of healthy African American, Hispanic, Native American, and Native Hawaiian adults. Comprehensive searching located published and unpublished studies. Random-effects analyses synthesized data to calculate effect sizes (ES) as a standardized mean difference (d) and variability measures. Data were synthesized across 21,151 subjects in 100 eligible samples. Supervised exercise significantly improved fitness (ES=.571-.584). Interventions designed to motivate minority adults to increase physical activity changed subsequent physical activity behavior (ES=.172-.312) and anthropometric outcomes (ES=.070-.124). Some ES should be interpreted in the context of limited statistical power and heterogeneity. Attempts to match intervention content and delivery with minority populations were inconsistently reported. Healthy minority adults experienced health improvements following supervised exercise. Interventions designed to motivate subjects to increase physical activity have limited magnitude heterogeneous effects.